• Diabetic Neuropathy

    (Nerve Damage of Diabetes)

    Definition

    Diabetic neuropathy is a type of nerve damage associated with diabetes. It can result in damage to any nerve in the body. The types of neuropathy include:
    • Peripheral neuropathy (most common)—causes pain or loss of feeling in the toes, feet, legs, hands, and arms
    • Autonomic neuropathy causes changes in nerves controlling body function, including:
      • Digestion, bowel and bladder function
      • Sexual response
      • Sweating
      • Heart and blood pressure control
      • Breathing
      • Vision
    • Proximal neuropathy—causes pain in the thighs, hips, or buttocks and weakness in the legs
    • Focal neuropathy—only affects one nerve or a group of nerves
    Nerves of the Foot
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    Copyright © Nucleus Medical Media, Inc.

    Causes

    Diabetic neuropathy is likely caused by a combination of factors, including:
    • Metabolic factors such as elevated blood pressure, high blood glucose, longer duration of diabetes, high cholesterol, and possibly low levels of insulin
    • Damage to blood vessels going to nerves
    • Autoimmune factors causing inflammation of nerves
    • Nerve trauma
    • Genetics
    • Smoking or alcohol abuse

    Risk Factors

    This condition is more common in older adults.
    Factors that may increase your risk of diabetic neuropathy include:

    Symptoms

    Symptoms of diabetic neuropathy may include:
    • Numbness, tingling, or pain in the extremities
    • Weakness in the arms and/or legs
    • Indigestion
    • Nausea or vomiting
    • Diarrhea or constipation
    • Lightheadedness
    • Urination problems
    • Erectile dysfunction or vaginal dryness
    • Weakness of facial muscles resulting in a drooping eyelid, drooping mouth, facial droop, difficulty swallowing
    • Muscle cramps
    • A prolonged feeling of fullness after eating, and/or abdominal pain
    • Decreased ability to sweat normally
    • Blurred or double vision
    If you have diabetic neuropathy, you are at increased risk for developing other types of neuropathies, such as carpal tunnel syndrome.
    Diabetic neuropathy can lead to serious complications, including foot ulcers, infection, and limb loss.

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. A foot exam will also be done.
    Your nerve function may be tested, especially if you have muscle weakness. This can be done with:
    • Nerve conduction studies
    • Electromyography
    • Quantitative sensory testing—the use of stimuli to check for neuropathy
    • Quantitative sudomotor axon reflex test—a test to evaluate the nerve supply of sweat glands
    Images may be taken of your bodily structures. This can be done with an ultrasound.
    Your nerves may need to be tested. This can be done with a biopsy.

    Treatment

    Treatment may include:

    Blood Glucose Management

    It is important to regularly monitor blood glucose levels. Meal planning, exercise, and/or medications can help.

    Foot Care

    Footcare will be needed to avoid ulcers. The nerves in the feet are the ones most often affected by neuropathy. This care will involve regular visits to a foot doctor and careful cleaning, inspection, moisturizing, and grooming of the feet. In addition, always wear well-fitting shoes and thick, soft, seamless socks to help protect your feet from injuries.

    Surgery

    Nerve decompression surgery may be done to reduce pain.

    Other Treatments

    Other treatments will depend on symptoms.
      Medications can be used to relieve pain, burning, tingling, or numbness from peripheral neuropathy.
      • Often, the medications used to treat these symptoms are the same ones used to treat seizures and depression.
      • Another option to treat pain is called transcutaneous electrical nerve stimulation (TENS). With TENS, a machine sends painless electrical signals through the skin to the nerves.
      • Other options include relaxation training, biofeedback, yoga, massage, acupuncture
    • Medications and treatment may also be needed to control symptoms from autonomic neuropathy, such as gastrointestinal, heart, or urinary problems

    Prevention

    The best way to prevent diabetic neuropathy is to regularly monitor and manage your blood glucose levels. Your doctor can instruct you about how often to check your levels and what the numbers mean.

    RESOURCES

    American Diabetes Association http://www.diabetes.org

    National Institute of Diabetes and Digestive and Kidney Diseases https://www.niddk.nih.gov

    CANADIAN RESOURCES

    Canadian Diabetes Association http://www.diabetes.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Diabetic neuropathies: the nerve damage of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://www.niddk.nih.gov/health-information/health-topics/Diabetes/diabetic-neuropathies-nerve-damage-diabetes/Pages/diabetic-neuropathies-nerve-damage.aspx. Updated November 2013. Accessed September 19, 2017.

    Diabetic peripheral neuropathy. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115259/Diabetic-peripheral-neuropathy. Updated July 27, 2017. Accessed August 24, 2017.

    Izenberg A, Perkins BA, Bril V. Diabetic neuropathies. Semin Neurol. 2015 Aug;35(4):424-30.

    Russell J, Zilliox L. Diabetic neuropathies. Continuum (Minneap Minn). 2014 Oct;20(5 Peripheral Nervous System Disorders):1226-40.

    Types of peripheral neuropathy: pre-diabetic/diabetic University of Chicago Center for Peripheral Neuropathy website. Available at: http://peripheralneuropathycenter.uchicago.edu/learnaboutpn/typesofpn/diabetes/diabetes.shtml. Updated May 16, 2010. Accessed September 19, 2017.

    2/4/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115259/Diabetic-peripheral-neuropathy: Dubinsky RM, Miyasaki J. Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology. 2010;74(2):173-176.

    6/16/2015 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115259/Diabetic-peripheral-neuropathy: Macaré van Maurik JF, Oomen RT, et al. The effect of lower extremity nerve decompression on health-related quality of life and perception of pain in patients with painful diabetic polyneuropathy: a prospective randomized trial. Diabet Med. 2015;32(6):803-809.

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