Diabetic neuropathy: causes, symptoms and treatment

Medically reviewed: 10, February 2024

Diabetic Neuropathy: full overview

Diabetic neuropathy refers to peripheral nerve damage caused by unmanaged high blood sugar levels associated with diabetes mellitus. This condition poses significant health concerns due to its diverse manifestations and potential complications. In severe cases, limb loss may occur, making prompt recognition and proper intervention crucial in managing and alleviating its impact.

What Is Diabetic Neuropathy?

Neuropathy, derived from the Greek words neuron (“nerve”) and pathos (“disease”), indicates disease within nerves throughout the body. It becomes classified as “diabetic” when directly linked to chronic hyperglycemia conditions observed in patients diagnosed with diabetes. Over time, elevated blood sugar can cause irreversible injury leading to impaired sensation and functionality of affected areas.

Types of Diabetic Neuropathies

At least four distinct subtypes of diabetic neuropathies exist based on varying clinical presentations:

Peripheral Neuropathy

Most commonly affecting feet, toes, fingers, legs, and arms—individuals experience numbing, prickling, burning, sharp pains, increased sensitivity to touch, reduced ability to feel changes in temperature or trauma, and difficulties with coordination and mobility.

Autonomic Neuropathy

Primarily targeting involuntary bodily functions controlled by the nervous system outside conscious awareness, individuals encounter challenges regulating digestion, urination, sexual response, heart rate, perspiration, and maintaining appropriate blood pressure levels. Alarmingly, nearly half of those suffering from longstanding diabetes develop some form of cardiac autonomic neuropathy.

Radicular/Proximal Neuropathy

Often striking suddenly without warning, radicular neuropathy affects specific regions, predominantly near the thigh, hip, buttocks, or lumbar spine. Severe muscular atrophy and discomfort mimicking sciatica frequently materialize, thus earning the alternative name of femoral or lumbosacral radiculoplexus neuropathy.

Mononeuropathy

Acute focal disturbances isolated to singular nerves surface abruptly and unexpectedly. Typical examples encompass Bell’s Palsy causing facial paralysis, oculomotor abnormalities triggering double vision, ulnar nerve entrapment producing hand muscle wasting, or median nerve involvement inducing carpal tunnel syndrome. Notably, mononeuropathies emerge independently of duration, severity, nor degree of glycemic control pertaining to underlying diabetes status.

Unfortunately, no known cure exists for diabetic neuropathy once established. Nevertheless, aggressive multidisciplinary approaches focusing on stringent metabolic regulation, neuroprotective pharmaceuticals, complimentary integrative therapies, and rigorous rehabilitation measures have demonstrated efficacy mitigating painful symptoms enhancing functional capacity whilst decelerating disease progression.

Early identification accompanied by diligent preventative efforts offers optimum outcomes reducing debilitating consequences engendered by diabetic neuropathy.

Causes of Diabetic Neuropathy

Diabetic neuropathy, a frequent complication faced by those battling diabetes, manifests as nerve damage rooted in erratic blood sugar levels. Though this daunting reality casts a shadow over many lives, comprehending its origin opens doors for prevention and symptom management. This article addresses the primary contributor and additional factors inciting diabetic neuropathy.

Persistently High Blood Sugar Levels

Long-lasting high blood sugar stealthily ravages tiny blood vessels and nerves, principally in the extremities, resulting in diabetic neuropathy. Several theories attempt explaining the correlation between high sugar and neuropathy, including the following:

• Glucose toxicity hypothesis: Chronically elevated blood sugar provokes a cascade of detrimental chain reactions, generating reactive oxygen species, inflammation, and permanent alterations in nerve linings.
• Metabolic theory: Erratic metabolic states induced by diabetes promote defective fuel transportation within nerve cells, ultimately hampering proper functioning.
• Microvascular mechanism: Capillaries supplying blood to nerves may sustain damage, disrupting nutrients and oxygen supplies, consequently impairing nerve health.

Contributory Factors Boosting Risks

Though high blood sugar serves as the principal villain, auxiliary factors intensify diabetic neuropathy development:

• Duration of Diabetes

Extensive disease duration magnifies neuropathy likelihood, reinforcing the significance of effective diabetes management from the moment of diagnosis.

• Obesity

Excess body mass index (BMI) escalates diabetes-related disorders, notably raising neuropathy danger. Weight management policies are instrumental in curtailing the risk.

• Abnormal Lipid Profile

Individuals exhibiting anomalous lipid levels—such as high triglycerides and low high-density lipoprotein (HDL)—run a higher risk of developing nerve damage. Modification of diet and prescription medications prove beneficial in tempering these statistics.

• Smoking History

Tobacco smoke irritants inflict considerable vascular harm, escalating diabetic neuropathy threats. Quitting smoking remains one of the foremost recommendations provided by healthcare experts aiming to minimize risks attributed to tobacco abuse.

• Kidney Disease Presence

An estimated 20-30% of diabetics grapple with kidney disease, a staggering statistic that underscores the bidirectional relationship between kidneys and nerves. Intervening appropriately in these scenarios averts escalating diabetic neuropathy complications.

Symptoms of Diabetic Neuropathy

Diabetic neuropathy, a debilitating complication arising from diabetes, encompasses damage to the nerves. Monitoring neuropathy symptoms enables early intervention, slowing the progression of nerve damage. In this chapter, we discuss peripheral and autonomic neuropathy symptoms while highlighting relevant medical terms.

Peripheral Neuropathy Symptoms

Peripheral neuropathy impacts nerves carrying information from the brain and central nervous system to the outer parts of the body, such as the hands and feet. The following symptoms characterize peripheral neuropathy:

• Numbness, tingling, or pain in hands and feet:

Initial symptoms include prickling or burning sensations in fingertips, hands, toes, and feet. Some people report stabbing pain that makes sleep difficult. Extreme sensitivity to touch is another hallmark symptom. As neuropathy progresses, the sense of warmth and cold may decrease.

• Muscle weakness and balance problems

Walking becomes challenging due to muscle weakness, lack of coordination, and balance issues. Standing for extended periods may cause leg cramps, while falling becomes a genuine concern due to diminished tactile feedback. People often describe the sensation as walking on cotton or pins and needles.

Monitoring these symptoms regularly helps in identifying the beginning stages of diabetic neuropathy. Consult healthcare professionals for advice on handling symptoms and implementing effective coping strategies.

Autonomic Neuropathy Symptoms

Autonomic neuropathy targets nerves regulating involuntary functions, affecting digestion, bowel movements, urination, sex drive, and cardiovascular health. Symptoms include:

• Digestion issues: Bloating, gas, diarrhea, constipation, and acid reflux are common complaints. Food may seem to move slower through the intestinal tract, resulting in uncomfortable feelings of fullness after meals.
• Sexual dysfunction: Women may notice vaginal dryness, lessened lubrication, and decreased desire; meanwhile, men often complain of difficulty achieving or maintaining erections. Both sexes might deal with lowered sexual satisfaction and enjoyment.
• Urinary problems: Loss of bladder control, hesitancy in starting urination, leaks, or frequent nighttime bathroom trips mark this type of neuropathy. Undetected or untreated urinary issues could evolve into more severe conditions such as urinary tract infection or kidney damage.
• Cardiovascular autonomic neuropathy: Irregular heartbeat, low blood pressure, and exercise intolerance represent common symptoms requiring urgent medical attention. Rapid heartbeats coupled with dizziness may accompany standing quickly. Swelling ankles and legs indicate fluid retention and compromised circulatory health.

Regular monitoring of autonomic neuropathy symptoms allows early intervention, avoiding dire health consequences. Focus on maintaining stable blood sugar levels to limit nerve damage from diabetes.

Symptoms of diabetic neuropathy in feet

Discovering foot-related symptoms caused by diabetic neuropathy (nerve damage due to diabetes) can save you from potentially severe complications. Knowledge of these warning signs equips you with the power to act promptly and preserve foot health, ensuring a continued, active life. Included below is a discussion of diabetic neuropathy causes, symptoms, and vital preventative measures centering on foot health.

Diabetic neuropathy broadly categorizes a collection of conditions characterized by injured nerves, usually due to high blood sugar (glucose) levels in people living with diabetes.

Diabetic neuropathy tends to creep in gradually, and the first symptoms might easily go ignored or misconstrued. Nonetheless, gathering familiarity with these initial indicators strengthens your defensive stance against foot-associated complications:

• Numbness, tingling, or piercing pain in the feet
• Burning or throbbing sensations in feet and/or toes
• Sensitive skin in the lower extremities, reacting strongly to slight touches
• Negligible or intense reactions to hot or cold temperatures
• Prickly or buzzing feelings, similar to standing barefoot on an electric blanket
• Serious or trivial injuries failing to heal properly, possibly opening the door to infection
• Cracked, brittle nails presenting an increased risk of fungal infection
• Hairlessness appearing on the lower legs and/or feet, indicating diminished circulation
• Cold or warm sensations in the feet unrelated to actual ambient temperatures
• Unexpected and pronounced muscle contractions or weakness, possibly causing balance challenges

Approximately half of all diabetic individuals exhibit neuropathic symptoms, some more profound than others. Yearly podiatrist visits coupled with diligent daily foot inspections stand among the cornerstone recommendations for people living with diabetes.

While fully reversing diabetic neuropathy presents a stiff challenge, practicing excellent foot care combined with stable blood sugar level management markedly slows its progression. Podiatrists specializing in diabetic foot therapy play a crucial role in crafting person-centered plans geared toward foot protection.

Prevention of further damage of diabetic neuropathy in feet

Secrets to effective diabetic foot care incorporate balancing cautiousness with resolve. Following a sequence of preventative steps guarantees enhanced foot safety:

• Control blood sugar thoroughly and continuously, preferably within suggested guidelines advised by healthcare professionals
• Complete daily visual and manual examinations searching for cuts, bruises, blisters, swelling, discolored spots, or strange odors. If unable to view or reach lower portions of feet, ask a partner or loved one for assistance or rely on mirrors and angled photography
• Bathe feet gently every day in lukewarm water, inspecting for missing or ingrown toenails, infected sores, and cracked heels needing moisturizer applications afterwards except in the spaces between toes
• Select clean, breathable socks manufactured from materials like cotton, silk, or wool, changing sock pairs frequently throughout the day as sweat dictates. Avoid stockings featuring elastic bands which might cut off circulation
• Moisten feet liberally, applying lotion to heel, sole, and toe surfaces, carefully rubbing it in
• Scrub debris from underneath toenails weekly or bimonthly, trim straight across while keeping lengths reasonable to circumvent potential ingrowns
• Opt for comfortable, supportive shoes suitable for all physical activities, paying particular attention to interior cushioning and arch support provision
• Restrict walking barefooted indoors and outdoors to eliminate accidental punctures, scrapes, or stubs
• Never apply heating pads or boiling water bottles to aching or sore feet as heat exacerbates nerve damage and could bring about second-degree burns
• Review pedicure salon standards ahead of scheduling appointments, confirming facilities observe sterilization protocols, and leaving wet nail polish on toes overnight.

Diagnostics of Diabetic Neuropathy

If suspicions arise that diabetic neuropathy has emerged, a systematic process commences with a thorough physical evaluation and exploration of the patient’s history, followed by an exhaustive investigation of possible nerve damage utilizing specialized tests.

Below, discover the steps undertaken to pinpoint and measure diabetic neuropathy accurately.

Physical Examination and Patient History

Physicians generally start by collecting extensive information regarding the patient’s general health, symptoms, and diabetes history. They scrutinize the patient’s capacity to perform everyday tasks, noting any:

• Balance and coordination problems
• Changes in sensory perception, particularly in hands and feet
• Indication of muscle strength and tone
• Reflexes, often comparing sides for consistency

By combining these observations with the patient’s reported experiences, doctors establish an initial profile suggestive of potential nerve damage.

Assessment of Nerve Damage

Subsequently, medical professionals utilize quantifiable evaluations to gauge the extent of nerve damage directly. These tests isolate particular attributes influenced by diabetic neuropathy, providing concrete evidence informing precise decision-making. Commonly employed techniques comprise:

• Quantitative Sensory Testing

These trials examine threshold variances distinguishing pleasant, unpleasant, and dangerous sensations. Utilizing vibration, cooling, warming, and light touching tools, physicians identify altered reaction times, thresholds, or intensities pointing to latent neuropathy.

• Electromyography (EMG)

Doctors deploy EMGs to survey electrical activity produced naturally by contracting muscles. Fine needle electrodes inserted into specified locations gather signals displayed graphically, illustrating anomalies suggesting nerve injury.

• Nerve Conduction Studies (NCS)

Similar to electromyography, nerve conduction studies inject minute electric currents along affected peripheral nerves, tracking velocity shifts reflecting damaged regions. Slower transmission rates indicate probable nerve damage indicative of neuropathy.

• Autonomic Reflex Screening

Specialized examinations catering specifically to the autonomic nervous system provide insight into hidden regulatory impairments stemming from diabetic neuropathy. Techniques embrace:

• Deep Breathing Tests,
• Bedside Heart Rate Variability Analyses,
• Sudomotor Function Checks,
• Blood Pressure Measurements during Postural Changes.

Each trial furnishes valuable data regarding possible nerve dysfunction necessitating close monitoring or immediate intervention.

Preventing and Managing Diabetic Neuropathy

Diabetic neuropathy, the nerve damage caused by unstable blood sugar levels, is a prevailing challenge among people with diabetes. However, taking preventive measures and pursuing proper management techniques can delay the onset of this complication or alleviate its impact. In this chapter, learn about practical ways to maintain ideal blood sugar levels, introduce lifestyle modifications, access medication for symptom relief, and explore alternative remedies.

1. Blood Glucose Management: Careful monitoring and controlling of blood sugar levels are critical components in warding off diabetic neuropathy.
2. Test your blood sugar regularly: Follow your doctor’s instructions for frequency and timing of tests, and log results to track trends.
3. Establish meal plan goals: Opt for wholesome foods, practice portion control, and pay attention to carbohydrate counts. Schedule consistent meal times to avoid unnecessary spikes in blood sugar.
4. Engage in routine physical activity: Engage in recommended exercises tailored to your health and interests, always checking blood sugar before and after engaging in sports or workout sessions.
5. Lifestyle Modifications: Simple tweaks in behavior and environment can positively impact neuropathy risk factors.
6. Quit smoking: Smoking narrows blood vessels, inhibiting sufficient blood flow and oxygen transportation to nerves. Speak to your physician for effective cessation strategies.
7. Limit alcohol intake: Excessive drinking may destabilize blood sugar levels, so drink moderately or refrain altogether depending on your doctor’s recommendation.
8. Prioritize foot care: Daily inspection of feet, wearing comfortable shoes, and protecting skin from cuts and burns are vital to avoiding infections. Report any unusual symptoms to your healthcare provider immediately.
9. Medications for Symptom Relief: Depending on individual needs, physicians may prescribe medications to ease distressing symptoms of diabetic neuropathy. Examples include:
10. Pain relievers: Over-the-counter medicines or prescription drugs can help manage mild to moderate pain.
11. Topical creams and patches: Anti-convulsant or capsaicin-based treatments can be applied directly to the affected area.
12. Antidepressants: Particular types can block pain messages sent to the brain.

Alternative Treatments

Integrative methods might complement conventional therapies, although evidence varies. Always confer with a healthcare professional before trying alternatives. Popular options are:

• Acupuncture: Targeted placement of thin needles can stimulate specific points on the body to potentially offer pain relief.
• Alpha-lipoic acid (ALA): This powerful antioxidant shows promise in easing nerve-related symptoms, though side effects may occur.

Preventing diabetic neuropathy calls for dedication to managing blood sugar, introducing helpful lifestyle modifications, considering medications when necessary, and remaining aware of available alternative treatments.

3 Key Points About Diabetic Neuropathy Summarized

Navigating the wealth of information on diabetic neuropathy can be daunting, but grasping a few essential ideas simplifies understanding. We break down the complex topic into digestible pieces, focusing on relationships among diabetes, nerve damage, and foot health. Learn why monitoring blood sugar and attending to foot care matter significantly.

Point 1: Connection Between Diabetes and Nerve Damage

Diabetic neuropathy, or nerve damage due to diabetes, results from uncontrolled blood sugar levels causing nerve fiber injury. Approximately half of all individuals with diabetes acquire some form of neuropathy, frequently manifesting in feet. Early detection is vital because late discovery raises infection risks, possibly requiring amputation. Effective blood sugar management largely prevents this complication, highlighting the necessity of regular check-ups and disciplined self-care.

Point 2: Nerves in Your Feet Are At Risk

People with diabetes must take extra caution with foot care because nerves in the region are susceptible to damage. Paying heed to minor wounds or changes saves from severe consequences later. Major neuropathic issues start as seemingly benign tingling, numbness, or burning sensations. These foot-focused concerns underscore the urgency of proper diabetes management and rigorous foot care.

Point 3: Fundamental Role of Blood Sugar Regulation

Steady blood sugar maintenance stands tall among proven methods to slow or stop nerve damage. Diet, exercise, and appropriate medication regimen under medical direction aim to stabilize glucose levels and decrease neuropathy risks. Curating a personalized strategy with healthcare professionals adds tremendous value, ensuring that expectations, objectives, and limitations align.