Diabetic Neuropathy: Symptoms, Treatment & More

Diabetic Neuropathy Overview
Diabetic neuropathy, a common complication of diabetes, is damage to the nerves that allow you to feel sensations such as pain. There are a number of ways that diabetes damages the nerves, but they all seem related to blood sugar being too high for a long period of time. Diabetes-related nerve damage can be painful, but it isn't severe pain in most cases. There are four types of diabetic neuropathy: peripheral, autonomic, proximal, and focal.

Diabetic Peripheral Neuropathy
The areas of the body most commonly affected by diabetic peripheral neuropathy are the feet and legs. Nerve damage in the feet can result in a loss of foot sensation, increasing your risk of foot problems. Injuries and sores on the feet may go unrecognized due to lack of sensation. Therefore, you should practice proper skin and foot care. Rarely, other areas of the body such as the arms, abdomen, and back may be affected. Symptoms of diabetic peripheral neuropathy may include:
• • • •

Tingling Numbness (severe or long-term numbness can become permanent) Burning (especially in the evening) Pain

In most cases, early symptoms of diabetic peripheral neuropathy will become less when blood sugar is under control. Medications can be taken to help control the discomfort if needed. To prevent peripheral neuropathy:

Work with your doctor to keep your blood glucose under tight control

To help prevent the complications of peripheral neuropathy:
• • •

Examine your feet and legs daily. Apply lotion if your feet are dry. Care for your nails regularly. (Go to a podiatrist, if necessary).

Wear properly fitting footwear and wear them all the time to prevent foot injury.

Diabetic Autonomic Neuropathy
Diabetic autonomic neuropathy most often affects the digestive system, especially the stomach, blood vessels, urinary system, and sex organs. To prevent autonomic neuropathy, continuously keep your blood sugar levels well controlled. Symptoms of neuropathy of the digestive system may include:
• • • • • • •

Bloating Diarrhea Constipation Heartburn Nausea Vomiting Feeling full after small meals

Treatments of autonomic neuropathy of the digestive system may include:
• •

Eat smaller meals Medication

Symptoms of autonomic neuropathy of the blood vessels may include:
• • • •

Blacking out when you stand up quickly Increased heart rate Dizziness Low blood pressure

• • •

Nausea Vomiting Early fullness

Treatments of autonomic neuropathy of the blood vessels may include: • • • Avoid standing up too quickly Medications Wearing special stockings Symptoms of autonomic neuropathy of the male sex organs may include: • • Unable to have or maintain an erection (erectile dysfunction)* "Dry" or reduced ejaculations *Note: Impotence needs to be evaluated by your doctor. It may be caused by your medicines or factors other than diabetes. suppositories and rings Lubricants Symptoms of autonomic neuropathy of the urinary system may include: • • Unable to completely empty bladder Bloating . Treatments of autonomic neuropathy of the male sex organs include: • • • • • Counseling Penile implant Vacuum erection device Penile injections Medication Symptoms of autonomic neuropathy of the female sex organs may include: • • Decrease in vaginal lubrication Decrease in number of orgasms or lack of orgasm Treatments of autonomic neuropathy of the female sex organs include: • • • Counseling Vaginal estrogen creams.

• • Incontinence (leaking urine) Increased urination at night Treatments of autonomic neuropathy of the urinary system include: • • • Medication Self-catheterization (inserting a catheter into the bladder to release urine) Surgery Diabetic Proximal Neuropathy Diabetic proximal neuropathy causes pain (usually on one side) in the thighs. however. Diabetic Focal Neuropathy Diabetic focal neuropathy can also appear suddenly and affect specific nerves. Other Nerve Conditions Seen With Diabetes People with diabetes can also develop other nerve-related conditions. causing muscle weakness or pain. such as the lower back or leg(s) chest or abdominal pain that is sometimes mistaken for another condition such as heart attack or appendicitis Diabetic focal neuropathy is painful and unpredictable. Treatment for weakness or pain is usually needed and may include medication and physical therapy. Carpal tunnel syndrome is a very common type of entrapment syndrome and causes numbness and tingling of the hand and sometimes muscle weakness or pain. depending on the type of nerve damage. . most often in the head. The recovery varies. Prevention consists of keeping blood sugar under tight control. It can also lead to weakness in the legs. or leg. Symptoms of diabetic focal neuropathy may include: • • • • • double vision eye pain paralysis on one side of the face (Bell's palsy) severe pain in a certain area. such as nerve compressions (entrapment syndromes). torso. hips. it tends to improve by itself over weeks or months and does not tend to cause long-term damage. or buttocks.

About half of people with diabetes will develop nerve damage.Prevention of Diabetic Neuropathy Keeping tight control of your blood sugar levels will help prevent many of these diabetes-related nerve conditions. MD on March 08. stomach. and intestines (called autonomic neuropathy) . Causes Nerve injuries are caused by decreased blood flow and high blood sugar levels. They are more likely to develop if blood sugar levels are not well controlled. Seibel. All rights reserved. LLC. bladder. WebMD Medical Reference Reviewed by John A. Most of the time symptoms do not begin until 10 to 20 years after diabetes has been diagnosed." ADA: "Additional Specific Types of Diabetic Neuropathy. Talk to your doctor about optimizing your individual diabetes treatment plan. Nerve injuries may affect: • • • Nerves in the skull (cranial nerves) Nerves from the spinal column and their branches Nerves that help your body manage vital organs. 2009 © 2009 WebMD." National Diabetes Education Program: "Prevention and Early Intervention for Diabetes Foot Problems. such as the heart. REFERENCES: American Diabetes Association (ADA): "Diabetic Neuropathy (Nerve Damage) and Diabetes." Last Editorial Review: 11/4/2009 Diabetic neuropathy Diabetic neuropathy is damage to nerves in the body that occurs due to high blood sugar levels from diabetes.

These feelings often start in your toes and feet. constipation. the chest pain that warns of heart disease and heart attack Other symptoms of nerve damage are: • • • • Sexual problems. often in the feet and legs. Sweating too much -. Nerve damage may cause you to lose feeling in your arms and legs. when you are at rest. or at other unusual times Exams and Tests A physical exam may show: • • A lack of reflexes in the ankle A loss of feeling in the feet (your health care provider will check this with a brush-like instrument called a monofilament) . They can vary depending on the nerves that are affected. You may leak urine and may not be able to tell when your bladder is full.Symptoms Symptoms often develop slowly over several years. Because of this you may: • • • Not notice when you step on something sharp Not know that you have a blister or small cut Not notice when you touch something that is too hot or cold Damage to nervves in your heart and blood vessels may cause you to: • • • Feel light-headed when you stand up (orthostatic hypotension) Have a fast heart rate Not notice angina. Women may have trouble with vaginal dryness or orgasm. Not being able to tell when your blood sugar gets too low Bladder problems.when the temperature is cool. These problems can make your diabetes harder to control. You may have deep pain. Some people are not able to empty their bladder. Men may have problems with erections. or diarrhea Swallowing problems Throwing up food you have eaten a few hours after a meal Tingling or burning in the arms and legs may be an early sign of nerve damage. Symptoms of this problem are: • • • • • Feeling full after eating only a small amount of food Heartburn and bloating Nausea. People with diabetes may have trouble digesting food.

such as amitriptyline (Elavil). and staying as healthy as possible. You should learn the basic steps for managing your diabetes. or more often. See also: • • Bowel retraining Neurogenic bladder . and valproate (Depakote) Pain medicines Treatments for nausea and vomiting may include: • • • Taking medicines that help food move more quickly through your stomach and intestines Sleeping with your head raised Eating smaller. bladder problems.a recording of the speed at which signals travel along nerves Treatment It is very important to keep your blood sugar in a healthy range.a recording of electrical activity in muscles Nerve conduction velocity tests (NCV) -. exercise. These steps will include diet. and sometimes medicines. Your doctor will help you by taking blood tests and other tests.• • Changes in the skin Drop in blood pressure when you stand up after sitting or lying down Tests that may be done include: • • Electromyogram (EMG) -. and arms: • • • Certain drugs that are also used to treat depression. such as gabapentin (Neurontin). doxepin (Sinequan). pregabalin (Lyrica). You may need to check your blood sugar daily. carbamazepine (Tegretol). or duloxetine (Cymbalta) Certain drugs that are also used to treat seizures. constipation. See also: • • Type 1 diabetes Type 2 diabetes The following medications may be used to reduce symptoms in the feet. and other symptoms are treated as needed. legs. more frequent meals Diarrhea. avoiding its complications.

To keep your feet healthy. See also: Diabetes foot care Outlook (Prognosis) Treatment relieves pain and can control some symptoms.Drugs such as sildenafil (Viagra). This is why no appointment for diabetes care is complete without a thorough foot examination.diabetic . Alternative Names Nerve damage . and learn whether you have nerve damage. the warning chest pain for heart disease and heart attack. and may reduce the severity of symptoms. Make sure you wear the right kind of shoes. regular foot care can prevent a small infection from getting worse. but the disease generally continues to get worse. Possible Complications • • • • • Bladder and kidney infections Injury to the feet due to loss of feeling Muscle damage Poor blood sugar control due to nausea and vomiting Skin and soft tissue damage and risk of amputation Neuropathy may also hide angina. Prevention Tight control of blood sugar levels may prevent neuropathy in many people with type 1 diabetes. When to Contact a Medical Professional Call your health care provider if you develop symptoms of diabetic neuropathy. vardenafil (Levitra). and tadalafil (Cialis) may be used for treating impotence. In addition. Discuss these medicines with your doctor before taking them. you should: • • • Check and care for your feet EVERY DAY Get a foot exam by your doctor at least once every 6 to 12 months.

Williams Textbook of Endocrinology. MD. cardiac arrhythmias.A. In: Kronenberg HM. MD. Polonsky KS. Diabetic Neuropathy • Author: Helen C Lin. Melmed S. Polonsky KS. these patients already have neuropathy at the time of diagnosis. 2008:chap 31.. falls. Standards of medical care in diabetes--2011. Wong MC. Larsen PR. Type 1 diabetes mellitus. Buse JB. NJ. Physical examination of patients with suspected distal sensory . Diabetes and Metabolism. MD Background Neuropathies are characterized by a progressive loss of nerve fiber function. while the primary symptoms of neuropathy can be highly unpleasant. 11th ed.) Neuropathies severely decrease patients' quality of life (QOL). 2011 Jan.References Eisenbarth GS. Conversely. Chief. distal polyneuropathy typically becomes symptomatic after many years of chronic prolonged hyperglycemia. MD. Chief Editor: Nicholas Lorenzo. affecting up to 50% of patients with type 1 and type 2 DM. Pa: Saunders Elsevier. Trinitas Regional Medical Center. amputations. and autonomic symptoms. foot ulcers. and ileus) are even more serious and can lead to fractures. Philadelphia. Since diabetic neuropathy can manifest with a wide variety of sensory. Also reviewed by David Zieve. and even death in patients with DM. Wong TK. In type 1 diabetes mellitus. Review provided by VeriMed Healthcare Network. a structured list of symptoms can be used to help screen all diabetic patients for possible neuropathy (see History). Furthermore."[1] Neuropathies are the most common complication of diabetes mellitus (DM). Chung JW. A.D.M. Diabetes Care. American Diabetes Association. patients with type 2 diabetes mellitus may present with distal polyneuropathy after only a few years of known poor glycemic control. Elizabeth. sometimes. motor. Update Date: 6/28/2011 Updated by: Ari S. the secondary complications (eg. Division of Endocrinology. Eckman. MHA. Inc. (See Clinical Presentation. BMJ.34 Suppl 1:S11-61.335:87. Medical Director. A widely accepted definition of diabetic peripheral neuropathy is "the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes. 2007. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review.

Multiple consensus panels recommend the inclusion of electrophysiologic testing in the evaluation of diabetic neuropathy. (See Workup. Autonomic neurons consist of sympathetic and parasympathetic types. which may comprise physical. with particular attention to foot inspection to reinforce the need for regular self-care. In the periphery. preganglionic fibers leave the CNS and synapse on postganglionic neurons in the sympathetic chain or in sympathetic ganglia. they exit the spinal cord (via ventral roots) and combine with other fibers in the brachial or lumbar plexuses and innervate their target organs through peripheral nerves. Sensory neurons originate at the dorsal root ganglia (which lie outside the spinal cord) and follow a similar course with motor neurons. Motor neurons originate in the central nervous system (CNS) and extend to the anterior horn of the spinal cord.) Anatomy A review of the anatomy of the peripheral nervous system can facilitate understanding of the classification of diabetic peripheral neuropathy. the primary care physician is responsible for educating patients about the acute and chronic complications of diabetes (see Patient Education). or autonomic. although most of them are not specifically approved by the United States Food and Drug Administration for this use. tight and stable glycemic control is probably the most important for slowing the progression of neuropathy. entrapment or noncompressive) neuropathies should include assessments for both peripheral and autonomic neuropathy (see Physical Examination). Peripheral neurons can be categorized broadly as motor. Sensory neurons are subdivided into categories according to the sensory modality they convey (see the Table below).) Management of diabetic neuropathy includes 2 approaches: therapies for symptomatic relief and those that may slow the progression of neuropathy. occupational. (See Medication. and recreational therapy. including disability and amputation. sensory. Many medications are available for the treatment of diabetic neuropathic pain. (See Treatment Strategies and Management. An appropriate array of electrodiagnostic tests includes both nerve conduction testing and needle EMG of the most distal muscles usually affected. Patients with diabetic peripheral neuropathy require more frequent follow-up.motor or focal (ie. In addition. speech.) Management of diabetic neuropathy should begin at the initial diagnosis of diabetes. . From the anterior horn. Nonpharmacologic treatment includes rehabilitation. The primary care physician needs to be alert for the development of neuropathy—or even its presence at the time of initial diabetes diagnosis—because failure to diagnose diabetic polyneuropathy can lead to serious consequences. Of all treatments.

7. Polyol pathway Hyperglycemia causes increased levels of intracellular glucose in nerves. 11] It is generally accepted to be a multifactorial process. 5.[12] Important contributing biochemical mechanisms in the development of the more common symmetrical forms of diabetic polyneuropathy likely include the polyol pathway. advanced glycation end products. and oxidative stress. as shown in the table below. With continued exposure to hyperglycemia. 8. 9. Genetic factors may also play a role. the larger fibers become affected. and high exposure to other potentially neurotoxic agents such as ethanol. leading to saturation of the normal glycolytic pathway. decreased membrane Na+/K+ -ATPase activity. impaired axonal transport. causing abnormal action potential propagation. and structural breakdown of nerves. vibration. mechanical burning pain Pathophysiology The factors leading to the development of diabetic neuropathy are not understood completely. 10.2-1.5 micrometers Thermal pain. such as total hyperglycemic exposure and other risk factors such as elevated lipids. 4. blood pressure. Table. 6. smoking. Development of symptoms depends on many factors. 3. increased height. This is the rationale for the use of aldose reductase inhibitors to improve nerve conduction.[13] Accumulation of sorbitol and fructose lead to reduced nerve myoinositol.[14] Advanced glycation end products .The smaller fibers are affected first in DM. Fibers of different size mediate different types of sensation. pressure Myelinati on Yes Yes Yes No 1-5 micrometers Mechanical sharp pain 0. and multiple hypotheses have been advanced. Extra glucose is shunted into the polyol pathway and converted to sorbitol and fructose by the enzymes aldose reductase and sorbitol dehydrogenase. see Type 2 Diabetes and TCF7L2. Subdivisions of Sensory Neurons (Open Table in a new window) Fiber Type A-alpha (I) A-beta (II) A-delta (III) C (IV) Size 13-20 micrometers 6-12 micrometers Modality Limb proprioception Limb proprioception.[2. For more information.

suggesting a common etiologic mechanism .The nonenzymatic reaction of excess glucose with proteins. These include direct damage to blood vessels leading to nerve ischemia and facilitation of AGE reactions. 18] Related contributing factors Problems that are a consequence of or co-contributors to these disturbed biochemical processes include altered gene expression with altered cellular phenotypes. reduction in neurotrophins. 17. human recombinant nerve growth factor. and nerve ischemia. use of the antioxidant alpha-lipoic acid may hold promise for improving neuropathic symptoms. blood pressure. and high exposure to other potentially neurotoxic agents such as ethanol. however. In the case of focal or asymmetrical diabetic neuropathy syndromes.[20] Etiology Risk factors that are associated with more severe symptoms include the following[21] : • • • • • • • • • Poor glycemic control Advanced age Hypertension Long duration of DM Dyslipidemia Smoking Heavy alcohol intake HLA-DR3/4 phenotype Tall height Development of symptoms depends on many factors.[15] Oxidative stress The increased production of free radicals in diabetes may be detrimental via several mechanisms that are not fully understood. smoking. vascular injury or autoimmunity may play more important roles.[16. such as total hyperglycemic exposure and other risk factors such as elevated lipids. changes in cell physiology relating to endoskeletal structure or cellular transport. nucleotides. With future refinements. Despite the incomplete understanding of these processes. were disappointing. and lipids results in advanced glycation end products (ACE) that may have a role in disrupting neuronal integrity and repair mechanisms through interference with nerve cell metabolism and axonal transport. increased height.[12] Peripheral neuropathies have been described in patients with primary DM (types 1 and 2) and in those with secondary diabetes of diverse causes. pharmacologic intervention targeting one or more of these mechanisms may prove successful. Genetic factors may also play a role.[19] Clinical trials of the best-studied neurotrophin.

Hispanics.[31. In the United Kingdom. Solid prevalence data for the latter 2 less-common syndromes is lacking. 25.[27] Neuropathy is estimated to be present in 7. members of minority groups (eg. 30] radiculopathies/plexopathies. the number with neuropathy rose to 45%.5% of patients at the time of diabetes diagnosis. male patients with type 2 diabetes may develop diabetic polyneuropathy earlier than female patients.[23.[34] Diabetic neuropathy in racial minorities No definite racial predilection has been demonstrated for diabetic neuropathy. although this relationship remains an area of some controversy for type 2 diabetes and prediabetes. than whites. The use of additional diagnostic techniques. The contribution of hyperglycemia has received strong support from the Diabetes Control and Complications Trial (DCCT).[33] After 25 years. African Americans) have more secondary complications from diabetic neuropathy. such as autonomic or quantitative sensory testing.[28. 24. might result in a higher recorded prevalence. Pirart et al found that 7. The wide variability in symmetric diabetic polyneuropathy prevalence data is due to lack of consistent criteria for diagnosis.[35] and neuropathic pain causes more morbidity in females than in males. because many patients with diabetic polyneuropathy are initially asymptomatic.[21] They also have more hospitalizations for neuropathic complications.[22] An association between impaired glucose tolerance and peripheral neuropathy has been construed as further evidence of a dose-dependent effect of hyperglycemia on nerves. the prevalence of diabetic neuropathy among the hospital clinic population was noted to be around 29%.5% of patients already had neuropathy when diagnosed with diabetes. In addition. and cranial neuropathies account for the rest. variable methods of selecting patients for study. However. 29. 32] International statistics In a cohort of 4400 Belgian patients. More than half of cases are distal symmetric polyneuropathy. detection is extremely dependent on careful neurologic examination by the primary care clinician. such as lower-extremity amputations. and differing assessment techniques. 26] Epidemiology United States statistics A large American study estimated that 47% of patients with diabetes have some peripheral neuropathy. Sex differences in diabetic neuropathy DM affects men and women with equal frequency. .based on chronic hyperglycemia. However. Focal syndromes such as carpal tunnel syndrome (14-30%).

and impotence are common symptoms that decrease the QOL of a patient with DM. Patients with diabetic neuropathy should work with nutritionists or their primary care physicians to develop a realistic diet for lowering blood glucose and minimizing large fluctuations in blood glucose. the prognosis is good. diarrhea. Most of the medicines mentioned in the Medication section do not lead to complete symptom relief. go to Diabetic Foot. Patients with diabetic neuropathy should be encouraged to remain as active as possible. Repetitive trauma to affected areas may cause skin breakdown. Clinical trials are under way to help find new ways to treat symptoms and delay disease progression. Mortality is higher in people with cardiovascular autonomic neuropathy (CAN). However. progressive ulceration. patients with extremity numbness may not be aware of frostbite injuries during prolonged cold exposure. Morbidity results from foot ulceration and lower-extremity amputation.Diabetic neuropathy and advancing age Diabetic neuropathy can occur at any age but is more common with increasing age and severity and duration of diabetes. Prevention of diabetic . go to Diabetic Foot Infections. These 2 complications are the most common causes of hospitalization among people with DM in Western countries. Patients with diabetic neuropathy need to be educated on all aspects of their condition. or those with abnormal sweating may become easily overheated in hot conditions. The overall mortality rate over periods up to 10 years was 27% in patients with DM and CAN detected. dizziness. compared with a 5% mortality rate in those without evidence of CAN. Treating diabetic neuropathy is a difficult task for the physician and patient. For example. Amputations and death may result. those with significant sensory loss or autonomic dysfunction should be cautioned about exercising in extreme weather conditions. consultation with the patient's regular physician is reasonable before the initiation of a regular exercise program. Patient Education Controlling diet and nutrition are paramount to improving the secondary complications of diabetes. but the patient's QOL is reduced. In most cases. which may result in injury. including neuropathy. In patients with diabetic peripheral neuropathy. Prognosis Patients with untreated or inadequately treated diabetes have higher morbidity and complication rates related to neuropathy than patients with tightly controlled diabetes. For more information. for more information. Severe pain. and they need to know that it is very much affected by poor glycemic control. and infection.

Patient education should begin in the primary care office. However. The bottom line for patients is that medications are imperfect. then the hands) Pain Muscle weakness Low blood pressure and dizziness when rising quickly from sitting or lying down Rapid or irregular heartbeats Trouble having an erection Nausea or vomiting Difficulty swallowing . The following outline reviews some common questions and answers that can serve as a springboard for discussion. Diabetic neuropathy can affect nerves that supply feeling and movement in the arms and legs. pain may be exacerbated (possibly due to an insulin effect). In the United States. but this pain disappears in a few days. Any fungal or bacterial infection mandates prompt medical attention. What is diabetic neuropathy? Diabetic neuropathy is nerve damage caused by diabetes. Patients should be instructed to trim their toenails with great care and to be fastidious about foot hygiene. It can also affect the nerves that regulate unconscious vital functions such as heart rate and digestion. they have observed that good control of blood sugar levels helps prevent diabetic neuropathy and slows its progression. Even in patients with symptoms of diabetic neuropathy. diabetes is one of the most common causes of nerve damage. also known as peripheral neuropathy. When a person has poor control and becomes euglycemic quickly. Patients with neuropathy should be counseled to seek appropriate eye care and discuss renal care and follow-up with their primary care physicians or endocrinologists. Diabetic polyneuropathy is often associated with diabetic retinopathy and nephropathy. What are the symptoms? Symptoms of diabetic neuropathy may include the following: • • • • • • • • Numbness or loss of feeling (usually in the feet and legs first. How does diabetic neuropathy occur? Doctors have been studying this problem for many years.neuropathy is potentially best achieved by having near-euglycemic control from the onset of DM. The importance of protection and care of insensitive feet cannot be overemphasized. The need for well-fitting shoes should be stressed. especially in patients with type 1 diabetes. controlling blood glucose to euglycemic levels reduces pain significantly. Many result in no pain relief for certain patients. glucose control is something that the patient can achieve that may reduce pain. However. but they do not yet understand exactly how diabetes damages nerves.

Pain may be sharp or lightning-like. cuts. try to keep blood sugar at a normal level Maintain normal blood pressure Exercise regularly. because patients with neuropathy have more complications from simple injuries and may not heal as quickly as healthy individuals. Extreme sensitivity to the slightest touch can also occur (allodynia). and diarrhea. deep and aching. or prosthetic devices can be put in the penis. according to the healthcare provider's recommendation Stop smoking Limit the amount of alcohol intake because excessive alcohol also can cause neuropathy or make it worse Eat a healthy diet and avoid elevated levels of triglycerides in the blood Maintain a healthy weight Keep follow-up appointments with the healthcare provider How is diabetic neuropathy treated? No treatment is currently available to reverse neuropathy. or broken bones is especially important. The best approach is to control the diabetes and other risk factors. How can I help prevent diabetic neuropathy? The following steps may help to prevent or slow the worsening of diabetic neuropathy[36] : • • • • • • • • Control diabetes. or burning. Men who have trouble having erections because of neuropathy should talk to their healthcare providers. Preventing injuries such as burns. Medications can help a man achieve and maintain an erection. vomiting. Pain medications may help make pain more tolerable. such as braces. Physical therapy and regular exercise may help patients maintain the muscle strength they have.• Constipation or diarrhea Pain from diabetic neuropathy may range from minor discomfort or tingling in toes to severe pain. How can I take care of myself? Diabetes patients can take the following self-care measures: • • Work with primary care physicians and endocrinologists to control glucose levels Examine the skin of feet and lower legs regularly to look for injuries . Medications can be used to treat nausea. Muscle weakness is treated with support.

2011 Helen C Lin. Yet you can often prevent diabetic neuropathy or slow its progress with tight blood sugar control and a healthy lifestyle. see eMedicine's patient education articles. Updated: Nov 1. sores on the skin. these symptoms are mild. For excellent patient education resources. symptoms of neuropathy develop before diabetes is ever diagnosed. Medical College of Wisconsin. Depending on the affected nerves. MD Assistant Professor of Neurology. . Symptoms By Mayo Clinic staff There are four main types of diabetic neuropathy. visit eMedicine's Diabetes Center and Erectile Dysfunction Center. Wear good-fitting. diabetic neuropathy can be painful. Milwaukee Helen C Lin. but diabetic neuropathy most often damages nerves in your legs and feet. Keeping blood sugar under good control may stop neuropathy from worsening. Most develop gradually. urinary tract. Also. fulfilling lives. For some people with type 2 diabetes. or other potential problems so they can be treated properly. You may have just one type or symptoms of several types. symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system. High blood sugar can injure nerve fibers throughout your body. the symptoms will persist indefinitely. Diabetic neuropathy is a common serious complication of diabetes. comfortable shoes that protect the feet How long will the problem last? Once a person has neuropathy. but most people with diabetic neuropathy are able to lead active. For some people. disabling and even fatal. for others. blood vessels and heart. MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine Definition By Mayo Clinic staff Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. Diabetes and Diabetic Foot Care.• • See a healthcare provider promptly for calluses. and you may not notice problems until considerable damage has occurred.

such as ulcers. Diabetes can affect the nerves in any of these areas. leading to sharp drops in blood pressure when you rise from sitting or lying down (orthostatic hypotension) that may cause you to feel lightheaded or even faint Problems regulating your body temperature Changes in the way your eyes adjust from light to dark Difficulty exercising Increased heart rate when you're at rest Autonomic neuropathy is most likely to occur in people who have had poorly controlled diabetes for many years. and bone and joint pain Autonomic neuropathy The autonomic nervous system controls your heart. followed by your hands and arms. leading to nausea. stomach. especially in your feet and toes A tingling or burning feeling Sharp. radiculoplexus neuropathy . It affects the very ends of nerves first. uncontrolled diarrhea or a combination of the two Slow stomach emptying (gastroparesis). possibly causing: • • • • • • • • • • • • A lack of awareness that blood sugar levels are low (hypoglycemia unawareness) Bladder problems.The signs and symptoms of diabetic neuropathy vary. bladder. Peripheral neuropathy Peripheral neuropathy is the most common form of diabetic neuropathy. even the weight of a sheet can be agonizing Muscle weakness and difficulty walking Serious foot problems. That means your feet and legs are often affected first. depending on the type of neuropathy and which nerves are affected. deformities. intestines. starting with the longest nerves. lungs. including frequent urinary tract infections or urinary incontinence Constipation. Possible signs and symptoms of peripheral neuropathy include: • • • • • • • Numbness or reduced ability to feel pain or changes in temperature. infections. sex organs and eyes. vomiting and loss of appetite Erectile dysfunction in men Vaginal dryness and other sexual difficulties in women Increased or decreased sweating Inability of your body to adjust blood pressure and heart rate. jabbing pain that may be worse at night Pain when walking Extreme sensitivity to the lightest touch — for some people. like peripheral neuropathy. Radiculoplexus neuropathy (diabetic amyotrophy) Instead of affecting the ends of nerves.

The nerve may be in the arm. Signs and symptoms of carpal tunnel syndrome include: • • • Numbness or tingling in your fingers or hand. weakness or pain in your hands or feet that interferes with your daily routine or your sleep Dizziness Changes in your digestion. especially in your thumb. Mononeuropathy. if the abdomen is affected Mononeuropathy The term mononeuropathy means damage to just one nerve. This condition is often marked by: • • • • • Sudden. it usually doesn't cause any long-term problems. this condition is more common in people with type 2 diabetes and older adults. or proximal neuropathy. severe pain in your hip and thigh or buttock Eventual weak and atrophied thigh muscles Difficulty rising from a sitting position Unintentional weight loss Abdominal swelling. Signs and symptoms depend on which nerve is involved and may include: • • • • • Difficulty focusing your eyes. Symptoms are usually on one side of the body. femoral neuropathy. It's most common in older adults. Symptoms usually diminish and disappear on their own over a few weeks or months. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes. Although mononeuropathy can cause severe pain. Though the legs are affected more often. Most people improve at least partially over time. is infected or is getting worse Unusual burning.affects nerves closer to your hips or shoulders. often comes on suddenly. though symptoms may worsen before they get better. Also called diabetic amyotrophy. though in some cases symptoms may spread to the other side too. index finger. urination or sexual function . double vision or aching behind one eye Paralysis on one side of your face (Bell's palsy) Pain in your shin or foot Pain in the front of your thigh Chest or abdominal pain Sometimes mononeuropathy occurs when a nerve is compressed. tingling. which may also be called focal neuropathy. middle finger and ring finger A sense of weakness in your hand and a tendency to drop things Worsening of symptoms upon awakening or while gripping something When to see a doctor Seek medical care if you notice: • • • • A cut or sore on your foot that doesn't seem to be healing. leg or face. this type of neuropathy may affect nerves in the arms or even the abdomen.

causing diabetic neuropathy. This occurs when your immune system mistakenly attacks part of your body as if it were a foreign organism. Peripheral neuropathy is most common in people who have had diabetes for at least 25 years. This is the greatest risk factor for every complication of diabetes. Early treatment can help prevent this from happening. In either case. Causes By Mayo Clinic staff Damage to nerves and blood vessels Prolonged exposure to high blood sugar (glucose) can damage delicate nerve fibers. untreated foot ulcers may become gangrenous — a condition in which the tissue dies — and require surgery or even amputation of your foot. Exactly why this happens isn't completely clear.These symptoms don't always indicate nerve damage. early diagnosis and treatment offer the best chance for controlling symptoms and preventing more-severe problems. Other factors Other factors that may contribute to diabetic neuropathy include: • • • Inflammation in the nerves caused by an autoimmune response. Risk factors By Mayo Clinic staff Anyone who has diabetes can develop neuropathy. Smoking and alcohol abuse. Your risk of diabetic neuropathy increases the longer you have diabetes. including the complex interaction between nerves and blood vessels. It also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients. which damage both nerves and blood vessels and significantly increase the risk of infections. In the most severe cases. High blood glucose interferes with the ability of the nerves to transmit signals. including nerve damage. Length of time you have diabetes. but they may signal other problems that require medical care. Genetic factors unrelated to diabetes that make some people more susceptible to nerve damage. Keeping blood sugar consistently within your target range is the best way to protect the health of your nerves and blood vessels. . but a combination of factors likely plays a role. Even minor sores on the feet that don't heal can turn into ulcers. but these factors make you more susceptible to nerve damage: • • Poor blood sugar control. especially if your blood sugar isn't well controlled.

foot or even the lower leg.9 millimoles per liter (mmol/L) — you develop symptoms such as shakiness. . The risk of infection is high because diabetes reduces blood flow to your feet. usually in the foot. including • Loss of a limb. Complications By Mayo Clinic staff Diabetic neuropathy can cause a number of serious complications. cuts and sores may go unnoticed and eventually become severely infected or ulcerated — a condition in which the skin and soft tissues break down. Infections that spread to the bone and cause tissue death (gangrene) may be impossible to treat and require amputation of a toe. Smoking. This can cause a sharp drop in pressure when you stand after sitting (orthostatic hypotension). Hypoglycemia unawareness. which may lead to dizziness and fainting. cause nausea and vomiting. Damage to the nerves that control circulation can affect your body's ability to adjust blood pressure. Nerve damage can also affect your ability to feel when you need to urinate or to control the muscles that release urine. One particularly serious digestive problem is gastroparesis. Diabetes can cause damage to the kidneys. when your blood sugar drops too low — below 70 milligrams per deciliter (mg/dL). instability and sometimes deformity in the joint itself. Urinary tract infections and urinary incontinence. Damage to the nerves in the digestive system can cause a range of problems. More than half the nontraumatic lower limb amputations performed every year in the United States are due to diabetes. reducing blood flow to your legs and feet. This makes it more difficult for wounds to heal and damages the integrity of the peripheral nerves. These symptoms alert you to the problem so that you can take steps to raise your blood sugar quickly. This occurs when a joint. bloating and loss of appetite. Charcot joint is marked by pain. sweating and a fast heartbeat. Autonomic neuropathy can interfere with your ability to notice these symptoms. This is extremely serious — untreated hypoglycemia can be fatal. Because nerve damage can cause a lack of feeling in your feet. Smoking narrows and hardens your arteries. This can interfere with digestion. This allows bacteria to multiply in your bladder and kidneys. Low blood pressure. as well as swelling. • • • • • Charcot joint. or below 3. Damage to the nerves that control your bladder can prevent it from emptying completely. vomiting. Normally. and severely affect blood sugar levels and nutrition.• • Kidney disease. a condition in which the stomach empties too slowly or not at all. including severe constipation or diarrhea — or alternating bouts of constipation and diarrhea — as well as nausea. which may increase the toxins in the blood and contribute to nerve damage. leading to urinary tract infections. deteriorates because of nerve damage. Digestive problems.

and bone and joint abnormalities at every office visit. electromyography measures the electrical discharges produced in your muscles. disability and embarrassment caused by nerve damage can rob people — particularly older adults — of their independence. Autonomic neuropathy also causes excessive sweating. This noninvasive test is used to assess how your nerves respond to vibration and changes in temperature. leaving them increasingly isolated and depressed. Other tests that may be conducted include: • • • • • Filament test. blisters. your medical history and a physical exam. and sensitivity to touch. particularly at night. Increased or decreased sweating. leading to erectile dysfunction in men and problems with lubrication and arousal in women. you'll likely be referred to a podiatrist or other specialist for monitoring and treatment. If you already have diabetic neuropathy. If you're unable to feel the filament on your feet. This test measures how quickly the nerves in your arms and legs conduct electrical signals. Autonomic testing. It's often used to diagnose carpal tunnel syndrome. If you have symptoms of autonomic neuropathy. Sensitivity to touch may be tested using a soft nylon fiber called a monofilament. During the exam. Often performed along with nerve conduction studies. The American Diabetes Association recommends that all people with diabetes have a comprehensive foot exam — either by a doctor or by a foot specialist (podiatrist) — at least once a year. A reduced or complete lack of perspiration (anhidrosis) can be life-threatening. calluses. your doctor may request special tests to look at your blood pressure in different positions and assess your ability to sweat. tendon reflexes. The pain. Social isolation. temperature and vibration. your feet should be checked for sores. it's a sign that you've lost sensation in those nerves. Tests and diagnosis By Mayo Clinic staff Diabetic neuropathy is usually diagnosed based on your symptoms. Quantitative sensory testing. Autonomic neuropathy often damages the nerves that affect the sex organs. In addition. your body isn't able to regulate its temperature properly.• • • Sexual dysfunction. Nerve conduction studies. Electromyography (EMG). your doctor is likely to check your muscle strength and tone. Prevention By Mayo Clinic staff . cracked skin. When the sweat glands don't function normally.

your doctor or a podiatrist to help you. but do look for socks made of cotton or moisture-wicking fibers that don't have tight bands or thick seams. . For the best control. If your feet can't sense temperature. Consistency is important because shifts in blood sugar levels can accelerate nerve damage. as this can encourage fungal growth. Foot care Foot problems. But keeping your blood sugar as close to normal as possible is the best way to help prevent neuropathy and other complications of diabetes. bruises. Make sure that your shoes fit properly.You can help prevent or delay diabetic neuropathy and its complications by keeping your blood sugar consistently well controlled. If you can't see some parts of your feet.9 to 7. The American Diabetes Association recommends that people with diabetes have an A1C test at least twice a year if blood sugar levels are consistently in a healthy range. frequent doses of medication. Dry your feet gently by blotting or patting. Blood sugar control Keeping your blood sugar tightly controlled every day is a big commitment. It's best to try on shoes later in the day when your feet are more swollen to ensure that the shoes aren't too tight. test the water by touching a dampened washcloth to a sensitive part of your body. Then moisturize your skin thoroughly to prevent cracking. ask a family member. such as your neck or wrist. Trim your toenails carefully. however. It requires constant monitoring and. use a mirror or ask a family member or friend to examine those areas. dry socks. To protect the health of your feet: • • • • Check your feet every day.2 mmol/L) before meals and an A1C reading that is less than 7 percent. Dry carefully between your toes. cuts. But many of these problems can be prevented by having a comprehensive foot exam at least once a year. If your blood sugar isn't well controlled or you change medications. An A1C test measures your average blood sugar level over a period of two to three months. you should be tested more often. You don't need to buy special socks for people with diabetes. • Wear cushioned shoes that fit well. A podiatrist can teach you how to buy properly fitted shoes and to prevent problems such as corns and calluses. if you take insulin. Try to avoid getting lotion between your toes. Wear clean. cracked and peeling skin. If you're not able to reach your feet. Keep your feet clean and dry. taking good care of your feet and following a healthy lifestyle. having your doctor check your feet at each office visit and taking good care of your feet at home. Rubbing may damage your skin. and redness and swelling. Cut your toenails straight across. and file the edges carefully so there are no sharp edges. Look for blisters. are a common complication of diabetic neuropathy. including sores that don't heal. ulcers and even amputation. aim for a blood glucose level from 70 to 130 mg/dL (3. Wash your feet every day with lukewarm water. Always wear shoes to protect your feet from injury.

Shoes that fit well can be costly.649. 11529 Daffodil Lane. For more information. a podiatrist can help treat them to prevent more-serious conditions from developing.7809 Email: info@medifocus. 2011 169 Pages Medifocus.If problems do occur. your plan may cover the cost of at least one pair of shoes a year.com What is Peripheral Neuropathy? The nervous system controls the smooth functioning of all systems in the body as well as all interactions between the human being and the environment. Even small sores can quickly turn into severe infections if left untreated. The nervous system is comprised of millions of neurons that are interconnected and form a communications network within the body that governs many vital functions including: • • The five senses (sight. Inc. holding an object) . smell.649.g. 2010 Medifocus Guidebook on Peripheral Neuropathy Updated: June 22.9300 FAX: 301. If you qualify for Medicare. Suite 200. and taste) Voluntary functions (e. touch.965. MD 20902 Phone: 800. walking. talk to your doctor or diabetes educator. March 17.3002/301. hearing. Silver Spring.

includes the nerves that lead from the brain and spinal cord to all parts of the body. infection. feet) o sensory nerves which carry information from organs to the central nervous system where it is processed into sensation (e. burning. breathing. An extensive system of specialized nerves makes up the peripheral nervous system which is responsible for a variety of important functions.includes the brain and spinal cord Peripheral nervous system .g. and bladder function Peripheral neuropathy is a term used to describe damage to nerves of the peripheral nervous system which leads to symptoms such as pain. digestion.• • Involuntary functions (e. touch. These specialized nerves include: o motor nerves which carry messages from the brain to the body and are responsible for the ability to move any part of the body (e.. temperature changes. numbness. blood pressure.. breathing. hands. The incidence of peripheral neuropathy is not known with any degree of certainty. and cancer chemotherapy. tingling. It has been estimated that approximately 2 to 3 million Americans have some form of peripheral neuropathy. and vibrations) o nerves that control autonomic (involuntary) functions including heart rate. blood pressure) Cognitive reasoning The human nervous system has two major components: • • Central nervous system .g.g. The prevalence of peripheral neuropathy worldwide has been estimated to range from 2% to 8% of the population. Peripheral neuropathy can be caused by a variety of precipitating factors including trauma. diabetes. and weakness most commonly affecting the hands and feet. Peripheral neuropathy affects both genders at all ages but symptoms are unique to each individual in terms of . alcohol abuse.

Peripheral neuropathy can significantly impact an individual's quality of life and daily activities by causing major disruptions including: • • • Sleep disturbances Mood changes Impairment of social. and recreational functioning Knowledge is Critical when Dealing with a Life-Altering Condition such as Peripheral Neuropathy If you or a loved one has been diagnosed with peripheral neuropathy. occupational. Idiopathic peripheral neuropathy typically affects adults over the age of 50. quality. it's critical to learn everything you possibly can about this condition so that you can make .frequency. and severity of pain.

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