Diabetic Neuropathies

An Overview

Diabetic neuropathies are nerve disorders that may affect people with diabetes. They occur more often in people with persistently high blood sugar levels.

Types Diabetic neuropathies

There are several different diabetic neuropathies. They include:

Peripheral neuropathy. This is the most common type. It affects the longest nerves in the body. These nerves are part of the peripheral nervous system. This is the network of nerves that carry signals from your brain and spinal cord to the rest of your body and back. The most common symptoms of peripheral neuropathy are numbness or pain in the feet and lower legs. Peripheral neuropathy is nerve damage that typically affects the feet and legs and sometimes affects the hands and arms.

Autonomic neuropathy. Autonomic neuropathy is damage to nerves that control your internal organs. Autonomic neuropathy can lead to problems with your heart rate and blood pressure, digestive system, bladder, sex organs, sweat glands, eyes, and ability to sense hypoglycemia.

Focal neuropathies. Focal neuropathies are conditions in which you typically have damage to single nerves, most often in your hand, head, torso and leg.

Proximal neuropathy. Proximal neuropathy is a rare and disabling type of nerve damage in your hip, buttock, or thigh. This type of nerve damage typically affects one side of your body and may rarely spread to the other side. Proximal neuropathy often causes severe pain and may lead to significant weight loss.

Causes of diabetic neuropathy

Over time, high blood glucose levels, also called blood sugar, and high levels of fats, such astriglycerides, in the blood from diabetes can damage your nerves. High blood glucose levels can also damage the small blood vessels that nourish your nerves with oxygen and nutrients. Without enough oxygen and nutrients, your nerves cannot function well.
High blood sugar (glucose). High blood glucose causes chemical changes in nerves and impairs the nerves’ ability to transmit signals. It can also damage blood vessels that carry oxygen and nutrients to the nerves.
Metabolic factors. In addition to glucose levels, high triglyceride and cholesterol levels are also associated with increased risk of neuropathy. Patients who are overweight or obese are also at increased risk of developing neropathy.
Inherited factors. There are some genetic traits that may make some people more susceptible to nerve disease than others.
Feeling numbness. A common symptom of diabetic peripheral neuropathy is numbness. Sometimes you may be unable to feel your feet while walking. Other times, your hands or feet will tingle or burn. Or it may feel like you’re wearing a sock or glove when you’re not.
Loss of balance. Walking with a wobbly motion or even losing your balance can result from diabetic peripheral neuropathy. Wearing orthopedic shoes often helps with this.
Loss of coordination is a common sign of diabetic peripheral neuropathy. Often, muscle weakness affects the ankle, which can affect your gait. Numbness in the feet can also contribute to loss of balance.

How common is diabetic neuropathy

Although different types of diabetic neuropathy can affect people who have diabetes, research suggests that up to one-half of people with diabetes have peripheral neuropathy. 1,2 More than 30 percent of people with diabetes have autonomic neuropathy.
The most common type of focal neuropathy is carpal tunnel syndrome NIH external link, in which a nerve in your wrist is compressed. Although less than 10 percent of people with diabetes feel symptoms of carpal tunnel syndrome, about 25 percent of people with diabetes have some nerve compression at the wrist.

Symptoms of diabetic neuropathy

Your symptoms depend on which type of diabetic neuropathy you have. In peripheral neuropathy, some people may have a loss of sensation in their feet, while others may have burning or shooting pain in their lower legs. Most nerve damage develops over many years, and some people may not notice symptoms of mild nerve damage for a long time. In some people, severe pain begins suddenly.

Early diagnosis of diabetic neuropathy gives patients the best chance of effective treatment. But since not all foot or limb pain means diabetic neuropathy, accurate diagnosis is important to ensure appropriate treatment.
Diagnosis of diabetic neuropathies is based on history, clinical examination and supporting laboratory tests. Your doctor may:

• Check muscle strength and reflexes.
• Check muscle sensitivity to position, vibration, temperature and light touch.
• Request additional tests.
• Ultrasound to determine how parts of the urinary tract are functioning.
• Electromyography to determine how muscles respond to electrical impulses.
• Nerve conduction studies to check flow of electrical current through a nerve.
• Numbness or reduced ability to feel pain or changes in temperature, especially in your feet and toes
• A tingling or burning feeling
• Sharp, jabbing pain that may be worse at night
• Extreme sensitivity to the lightest touch — for some people even the weight of a sheet can be agonizing
• Muscle weakness
• Loss of reflex response
• Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain.
• A lack of awareness that blood sugar levels are low (hypoglycemia unawareness)
• Bladder problems, including frequent urinary tract infections, urinary incontinence or urinary retention
• Constipation, uncontrolled diarrhea or a combination of the two
• Slow stomach emptying (gastroparesis) leading to nausea, vomiting, sensation of fullness and loss of appetite
• Difficulty swallowing
• Erectile dysfunction in men
• Vaginal dryness and other sexual difficulties in women
• Increased or decreased sweating


• Treatment of diabetic neuropathies consists of two stages: using lifestyle changes and sometimes medications to achieve optimal diabetic control, and symptomatic control of pain and other complications.
• Controlling Blood Glucose Levels
• Getting blood glucose levels under control can’t reverse nerve damage but can prevent further damage from occurring. Your doctor will give you specific blood sugar goals. Managing these levels includes eating a healthy diet high in protein and low in carbs. When you eat carbs, try to choose food with a higher fiber content, avoiding chips and soda.

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