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by Drugs.com
Overview
Diabetic
neuropathy most often damages nerves in your legs and feet.
Depending on
the affected nerves, symptoms of diabetic neuropathy can range from pain and
numbness in your legs and feet to problems with your digestive system, urinary
tract, blood vessels and heart.
Some people
have mild symptoms. But for others, diabetic neuropathy can be quite painful
and disabling.
Diabetic
neuropathy is a common and serious complication of diabetes. But you can often
prevent diabetic neuropathy or slow its progress with tight blood sugar control
and a healthy lifestyle.
Symptoms
There are four
main types of diabetic neuropathy. You can have one or more than one type of
neuropathy.
Your symptoms
will depend on the type you have and which nerves are affected. Usually,
symptoms develop gradually.
You may not
notice anything wrong until considerable nerve damage has occurred.
Peripheral neuropathy
Peripheral
neuropathy is the most common type of diabetic neuropathy. It affects the feet
and legs first, followed by the hands and arms.
Signs and
symptoms of peripheral neuropathy are often worse at night, and may include:
· Numbness or reduced ability to feel pain or temperature changes
· Tingling or burning sensation
· Sharp pains or cramps
· Increased sensitivity to touch — for some people, even the
weight of a bedsheet can be painful
· Muscle weakness
· Loss of reflexes, especially in the ankle
· Loss of balance and coordination
· Serious foot problems, such as ulcers, infections, and bone and
joint pain
Autonomic neuropathy
The autonomic
nervous system controls your heart, bladder, stomach, intestines, sex organs
and eyes.
Diabetes can
affect nerves in any of these areas, possibly causing:
· A lack of awareness that blood sugar levels are low
(hypoglycemia unawareness)
· Bladder problems, including urinary tract infections or urinary
retention or incontinence
· Constipation, uncontrolled diarrhea or both
· Slow stomach emptying (gastroparesis), causing nausea, vomiting,
bloating and loss of appetite
· Difficulty swallowing
· Increased or decreased sweating
· Problems controlling body temperature
· Changes in the way your eyes adjust from light to dark
· Increased heart rate at rest
· Sharp drops in blood pressure after sitting or standing that may
cause you to faint or feel lightheaded
· Erectile dysfunction
· Vaginal dryness
· Decreased sexual response
Radiculoplexus neuropathy
(diabetic amyotrophy)
Radiculoplexus neuropathy affects nerves in the thighs, hips,
buttocks or legs. It's more common in people with type 2 diabetes and older
adults. Other names for this type are diabetic amyotrophy, femoral neuropathy
or proximal neuropathy.
Symptoms are usually on one side of the body, but sometimes may
spread to the other side. You may have:
· Severe pain in a hip and thigh or buttock that occurs in a day
or more
· Eventual weak and shrinking thigh muscles
· Difficulty rising from a sitting position
· Abdominal swelling, if the abdomen is affected
· Weight loss
Most people
improve at least partially over time, though symptoms may worsen before they
get better.
Mononeuropathy
Mononeuropathy,
or focal neuropathy, is damage to a specific nerve in the face, middle of the
body (torso) or leg.
It's most
common in older adults. Mononeuropathy often strikes suddenly and can cause
severe pain. However, it usually doesn't cause any long-term problems.
Symptoms
usually go away without treatment over a few weeks or months. Your specific
signs and symptoms depend on which nerve is involved. You may have pain in the:
· Shin or foot
· Lower back or pelvis
· Front of thigh
· Chest or abdomen
Mononeuropathy
may also cause nerve problems in the eyes and face, leading to:
· Difficulty focusing
· Double vision
· Aching behind one eye
· Paralysis on one side of your face (Bell's palsy)
Sometimes
mononeuropathy occurs when something is pressing on a nerve (nerve
compression).
Carpal tunnel
syndrome is a common type of compression neuropathy in people with diabetes.
It can cause
numbness or tingling in your hand or fingers, except your pinkie (little
finger). Your hand may feel weak, and you may drop things.
When to see a doctor
Call your
doctor for an appointment if you have:
· A cut or sore on your foot that is infected or won't heal
· Burning, tingling, weakness or pain in your hands or feet that
interferes with daily activities or sleep
· Changes in digestion, urination or sexual function
· Dizziness
These signs
and symptoms don't always mean you have nerve damage. But they can be a sign of
another condition that requires medical care.
Early
diagnosis and treatment of any health condition gives you the best chance for
controlling your diabetes and preventing future problems.
Causes
Damage to nerves and blood vessels
The exact
cause likely differs for each type of neuropathy.
Researchers
think that over time, uncontrolled high blood sugar damages nerves and
interferes with their ability to send signals, leading to diabetic neuropathy.
High blood
sugar also weakens the walls of the small blood vessels (capillaries) that
supply the nerves with oxygen and nutrients.
However, a
combination of factors may lead to nerve damage, including:
· Inflammation in the nerves caused
by an autoimmune response. The immune system mistakes nerves as foreign and
attacks them.
· Genetic factors unrelated to diabetes may
make some people more likely to develop nerve damage.
· Smoking and alcohol abuse damage
both nerves and blood vessels and significantly increase the risk of infection.
Risk factors
Anyone who has
diabetes can develop neuropathy, but these risk factors make you more likely to
get nerve damage:
· Poor blood sugar control. Uncontrolled
blood sugar puts you at risk of every diabetes complication, including nerve
damage.
· Diabetes history. Your risk of diabetic
neuropathy increases the longer you have diabetes, especially if your blood
sugar isn't well-controlled.
· Kidney disease. Diabetes can damage the
kidneys. Kidney damage sends toxins into the blood, which can lead to nerve
damage.
· Being overweight. Having a body mass index
(BMI) greater than 24 may increase your risk of diabetic neuropathy.
· Smoking. Smoking narrows and
hardens your arteries, reducing blood flow to your legs and feet. This makes it
more difficult for wounds to heal and damages the peripheral nerves.
Complications
Diabetic
neuropathy can cause a number of serious complications, including:
· Loss of a toe, foot or leg. Nerve
damage can make you lose feeling in your feet. Foot sores and cuts may silently
become severely infected or turn into ulcers. Even minor foot sores that don't
heal can turn into ulcers. In severe cases, infection can spread to the bone,
and ulcers can lead to tissue death (gangrene). Removal (amputation) of a toe,
foot or even the lower leg may be necessary.
· Joint damage. Nerve damage can cause a
joint to deteriorate, causing a condition called Charcot joint. This usually
occurs in the small joints in the feet. Symptoms include loss of sensation and
joint swelling, instability and sometimes joint deformity. Prompt treatment can
help you heal and prevent further joint damage.
· Urinary tract infections and urinary incontinence. If the
nerves that control your bladder are damaged, you may be unable to fully empty
your bladder. Bacteria can build up in the bladder and kidneys, causing urinary
tract infections. Nerve damage can also affect your ability to feel when you
need to urinate or to control the muscles that release urine, leading to
leakage (incontinence).
· Hypoglycemia unawareness. Low
blood sugar (below 70 milligrams per deciliter, or mg/dL) normally causes
shakiness, sweating and a fast heartbeat. But if you have autonomic neuropathy,
you may not notice these warning signs.
· Sharp drops in blood pressure. Damage
to the nerves that control blood flow can affect your body's ability to adjust
blood pressure. This can cause a sharp drop in pressure when you stand after
sitting (orthostatic hypotension), which may lead to dizziness and fainting.
· Digestive problems. If nerve damage strikes
your digestive tract, you can have constipation or diarrhea, or bouts of both.
Diabetes-related nerve damage can lead to gastroparesis, a condition in which
the stomach empties too slowly or not at all. This can interfere with digestion
and severely affect blood sugar levels and nutrition. Signs and symptoms
include nausea, vomiting and bloating.
· Sexual dysfunction. Autonomic neuropathy often
damages the nerves that affect the sex organs. Men may experience erectile
dysfunction. Women may have difficulty with lubrication and arousal.
· Increased or decreased sweating. Nerve
damage can disrupt how your sweat glands work and make it difficult for your
body to control its temperature properly. Some people with autonomic neuropathy
have excessive sweating, particularly at night or while eating. Too little or
no sweating at all (anhidrosis) can be life-threatening.
Prevention
You can
prevent or delay diabetic neuropathy and its complications by keeping tight
control of your blood sugar and taking good care of your feet.
Blood sugar control
Use an at-home
blood sugar monitor to check your blood sugar and make sure it consistently
stays within target range.
It's important
to do this on schedule. Shifts in blood sugar levels can accelerate nerve
damage.
The American
Diabetes Association recommends that people with diabetes have the A1C test at
least twice a year.
This blood
test indicates your average blood sugar level for the past two to three months.
If your blood sugar isn't well-controlled or you change medications, you may
need to get tested more often.
Foot care
Follow your
doctor's recommendations for good foot care.
Foot problems,
including sores that don't heal, ulcers and even amputation, are a common complication
of diabetic neuropathy.
But you can
prevent many of these problems by having a comprehensive foot exam at least
once a year, having your doctor check your feet at each office visit and taking
good care of your feet at home.
To protect the
health of your feet:
· Check your feet every day. Look for
blisters, cuts, bruises, cracked and peeling skin, redness, and swelling. Use a
mirror or ask a friend or family member to help examine parts of your feet that
are hard to see.
· Keep your feet clean and dry. Wash
your feet every day with lukewarm water and mild soap. Avoid soaking your feet.
Dry your feet and between your toes carefully by blotting or patting with a
soft towel.
Moisturize your feet
thoroughly to prevent cracking. Avoid getting lotion between your toes,
however, as this can encourage fungal growth.
· Trim your toenails carefully. Cut your
toenails straight across, and file the edges carefully so there are no sharp
edges.
· Wear clean, dry socks. Look for
socks made of cotton or moisture-wicking fibers that don't have tight bands or
thick seams.
· Wear cushioned shoes that fit well. Always
wear shoes or slippers to protect your feet from injury. Make sure that your
shoes fit properly and allow your toes to move. A podiatrist (foot doctor) can
teach you how to buy properly fitted shoes and to prevent problems such as
corns and calluses.
If problems do
occur, your doctor can help treat them to prevent more-serious conditions. Even
small sores can quickly turn into severe infections if left untreated.
If you qualify
for Medicare, your plan may cover the cost of at least one pair of shoes each
year. Talk to your doctor or diabetes educator for more information.
Diagnosis
A doctor can
usually diagnose diabetic neuropathy by performing a physical exam and
carefully reviewing your symptoms and medical history.
Your doctor
will check your:
· Overall muscle strength and tone
· Tendon reflexes
· Sensitivity to touch and vibration
Also, at every
visit, your doctor should check your feet for sores, cracked skin, blisters,
and bone and joint problems.
The American
Diabetes Association recommends that all people with diabetes have a
comprehensive foot exam at least once a year.
Along with the
physical exam, your doctor may perform or order specific tests to help diagnose
diabetic neuropathy, such as:
· Filament test. Your doctor will brush a
soft nylon fiber (monofilament) over areas of your skin to test your
sensitivity to touch.
· Quantitative sensory testing. This
noninvasive test is used to tell how your nerves respond to vibration and
changes in temperature.
· Nerve conduction studies. This
test measures how quickly the nerves in your arms and legs conduct electrical
signals. It's often used to diagnose carpal tunnel syndrome.
· Electromyography (EMG). Often
performed along with nerve conduction studies, EMG measures the electrical
discharges produced in your muscles.
· Autonomic testing. If you have symptoms of
autonomic neuropathy, special tests may be done to determine how your blood
pressure changes while you are in different positions, and whether you sweat
normally.
Treatment
Diabetic
neuropathy has no known cure. The goals of treatment are to:
· Slow progression of the disease
· Relieve pain
· Manage complications and restore function
Slowing progression of the disease
Consistently
keeping your blood sugar within your target range is the key to preventing or
delaying nerve damage. Doing so may even improve some of your current symptoms.
Your doctor
will determine the best target range for you based on several factors, such as
your age, how long you've had diabetes and your overall health.
For many
people who have diabetes, the American Diabetes Association generally
recommends the following target blood sugar levels:
· Between 80 and 130 mg/dL (4.4 and 7.2 mmol/L) before meals
· Less than 180 mg/dL (10.0 mmol/L) two hours after meals
For many
people who have diabetes, Mayo Clinic generally recommends the following target
blood sugar levels before meals:
· Between 80 and 120 mg/dL (4.4 and 6.7 mmol/L) for people age 59
and younger who have no other medical conditions
· Between 100 and 140 mg/dL (5.6 and 7.8 mmol/L) for people age 60
and older, or for those who have other medical conditions, including heart,
lung or kidney disease
Keep in mind,
your doctor may need to adjust these target ranges to meet your individual
health needs.
Other
important ways to help slow or prevent disease progression include keeping your
blood pressure under control and maintaining a healthy weight and lifestyle.
Relieving pain
Many
prescription medications are available for diabetes-related nerve pain, but
they don't work for everyone. Side effects are always possible.
When
considering any medication, talk to your doctor about the benefits and
drawbacks to determine what might work best for you.
Pain-relieving
prescription treatments may include:
· Anti-seizure drugs. Some medications used to
treat seizure disorders (epilepsy) are also used to ease nerve pain. The
American Diabetes Association recommends starting with pregabalin (Lyrica).
Others that have been used to treat neuropathy are gabapentin (Gralise,
Neurontin) and carbamazepine (Carbatrol, Tegretol). Side effects may include
drowsiness, dizziness and swelling.
· Antidepressants. Some antidepressants
disrupt the chemical processes in the brain that make you feel pain. You don't
need to have depression for these medicines to ease nerve pain. Two classes of
antidepressants have been used for neuropathy treatment.
Tricyclics,
including amitriptyline, desipramine (Norpramin) and imipramine (Tofranil), may
provide relief for mild to moderate symptoms. But side effects can be
bothersome and include dry mouth, sweating, weight gain, constipation and
dizziness.
Serotonin and
norepinephrine reuptake inhibitors (SNRIs) may ease pain with fewer side
effects.
The American
Diabetes Association recommends duloxetine (Cymbalta) as a first treatment.
Another that may be used is venlafaxine (Effexor XR).
Possible side
effects of SNRIs include nausea, sleepiness, dizziness, decreased appetite and
constipation.
Sometimes, an
antidepressant may be combined with an anti-seizure drug or pain-relieving
medication.
Managing complications and restoring function
Your diabetes
health care team will likely include different specialists, such as doctor that
treats urinary tract problems (urologist) and a heart doctor (cardiologist), who
can help prevent or treat complications.
Treatment
depends on the neuropathy-related complication you have:
· Urinary tract problems. Some
medications can interfere with bladder function. Your doctor may recommend
stopping or changing medications. A strict urination schedule or urinating
every few hours (timed urination) while applying gentle pressure to the bladder
area (below your bellybutton) is recommended. Other methods, including
self-catheterization, may be needed to remove urine from a nerve-damaged
bladder.
· Digestive problems. To relieve mild signs and
symptoms of gastroparesis — indigestion, belching, nausea or vomiting — doctors
suggest eating smaller, more-frequent meals, reducing fiber and fat in the
diet, and, for many people, eating soups and pureed foods. Diet changes and
medications may help relieve diarrhea, constipation and nausea.
· Low blood pressure on standing (orthostatic
hypotension). Treatment starts with simple lifestyle changes, such as
avoiding alcohol, drinking plenty of water, and sitting or standing slowly.
Sleeping with the head of the bed raised 6 to 10 inches helps prevent swings in
blood pressure. Your doctor may also recommend compression stockings and
similar compression support for your abdomen (abdominal binder). Several
medications, either alone or together, may be used to treat orthostatic
hypotension.
· Sexual dysfunction. Medications taken by mouth
or injection may improve sexual function in some men, but they aren't safe and
effective for everyone. Mechanical vacuum devices may increase blood flow to
the penis. Women may find relief with vaginal lubricants.
Lifestyle and home remedies
These measures
can help you feel better overall and reduce your risk of diabetic neuropathy:
· Keep your blood pressure under control. People
with diabetes are more likely to have high blood pressure than are people who
don't have diabetes. Having both high blood pressure and diabetes greatly
increases your risk of complications because both damage your blood vessels and
reduce blood flow. Try to keep your blood pressure in the range your doctor
recommends, and be sure to have it checked at every office visit.
· Make healthy food choices. Eat a
balanced diet that includes a variety of healthy foods — especially fruits,
vegetables and whole grains — and limit portion sizes to help achieve or
maintain a healthy weight.
· Be active every day. Exercise
is one of the best ways to keep your blood sugar under control. It also
improves blood flow and keeps your heart healthy. The American Diabetes
Association recommends 150 minutes of moderate-intensity exercise a week for
most adults with diabetes. Also, it suggests taking a break from sitting every
30 minutes to get a few quick bursts of activity. But talk with your doctor or
physical therapist first. If you have decreased feeling in your legs, some
types of exercise may be safer than others.
· Stop smoking. If you have diabetes and
use tobacco in any form, you're more likely than are nonsmokers with diabetes
to die of heart attack or stroke. And you're more likely to develop circulation
problems in your feet. If you use tobacco, talk to your doctor about finding
ways to quit.
Alternative medicine
There are also
a number of alternative therapies, such as capsaicin cream (made from chili
peppers), physical therapy or acupuncture, that may help with pain relief.
Doctors frequently use them along with medications, but some may work on their
own.
· Capsaicin. Capsaicin cream, applied
to the skin, can reduce pain sensations in some people. Side effects may
include a burning feeling and skin irritation.
· Alpha-lipoic acid. This powerful antioxidant
is found in some foods and may help relieve nerve pain symptoms in some people.
· Transcutaneous electrical nerve stimulation (TENS). Your
doctor may prescribe this therapy, which can help prevent pain signals from
reaching your brain. TENS delivers tiny electrical impulses to specific nerve
pathways through small electrodes placed on your skin. Although safe and
painless, TENS doesn't work for everyone or for all types of pain.
· Acupuncture. Acupuncture may help
relieve the pain of neuropathy, and generally doesn't have any side effects.
Keep in mind that you may not get immediate relief with acupuncture and will
likely require more than one session.
Coping and support
Living with
diabetic neuropathy can be difficult and frustrating. If you find yourself
feeling depressed, it may help to talk to a counselor or therapist.
Support groups
can also offer encouragement and advice about living with diabetic neuropathy.
Ask your
doctor if there are any in your area, or for a referral to a therapist. The
American Diabetes Association offers online support through its website.
Preparing for an appointment
If you don't
already see an endocrinologist, you'll likely be referred to one if you start
showing signs of diabetes complications.
An
endocrinologist is a doctor who specializes in treating metabolic disorders,
such as diabetes.
You may also
be referred to a neurologist, which is a doctor who specializes in treating
nervous system problems.
To prepare for
your appointment, you may want to:
· Be aware of any pre-appointment restrictions. When you make the
appointment, ask if there's anything you need to do in advance, such as
restrict your diet.
· Write down any symptoms you're having, including any that may
seem unrelated to the reason for the appointment.
· Write down key personal information, including any major
stresses or recent life changes.
· Make a list of all medications, vitamins and supplements you're
taking.
· Write down your recent blood sugar levels, if you check them at
home.
· Ask a family member or friend to come with you. It can be
difficult to remember everything your doctor tells you during an appointment.
Someone who accompanies you may remember something that you missed or forgot.
You may also
want to write down questions to ask your doctor. For diabetic neuropathy, some
basic questions include:
· Is diabetes the most likely cause of my symptoms?
· Do I need tests to confirm the cause of my symptoms? Do these
tests require any special preparation?
· Is this condition temporary or long lasting?
· If I control my blood sugar, will these symptoms improve or go
away?
· Are there treatments available, and which do you recommend?
· What types of side effects can I expect from treatment?
· I have other health conditions. How can I best manage them
together?
· Are there brochures or other printed material I can take with
me? What websites do you recommend?
· Do I need to see other doctors, a certified diabetes educator or
a dietitian?
Prevention
What to expect from your doctor
Examples of
questions your doctor may ask, include:
· How is your blood sugar control?
· When did you start having symptoms?
· Do you always have symptoms or do they come and go?
· How severe are your symptoms?
· Does anything seem to improve your symptoms?
· What, if anything, appears to make your symptoms worse?
· What do you find most challenging about managing your diabetes?
· What might help you manage your diabetes better?
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