Diabetic neuropathy

Description

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerves throughout the body. Diabetic neuropathy most often damages nerves in the legs and feet.

Depending on the affected nerves, diabetic neuropathy symptoms include pain and numbness in the legs, feet and hands. It can also cause problems with the digestive system, urinary tract, blood vessels and the heart. Some people have mild symptoms. But for others, diabetic neuropathy can be very painful and disabling.

Diabetic neuropathy is a serious complication of diabetes that can affect up to 50% of people with diabetes. But you can often prevent diabetic neuropathy or slow its progress with a constant blood sugar management and a healthy lifestyle.

Symptoms

There are four main types of diabetic neuropathy. You may have a type or more of a type of neuropathy.

The symptoms depend on the type and which nerves are affected. Usually, the symptoms develop gradually. You may not notice anything is wrong until a considerable amount of damage to the nerves that has occurred.

Peripheral neuropathy

This type of neuropathy can also be called distal symmetric peripheral neuropathy. It is the most common type of diabetic neuropathy. It affects the feet and legs first, followed by the hands and arms. The signs and symptoms of peripheral neuropathy are often worse at night, and may include:

  • Numbness or reduced ability to feel pain or temperature changes
  • Feeling a tingling or burning sensation
  • Sharp pains or cramps
  • Muscle weakness
  • Extreme sensitivity to touch — for some people, even a sheet of weight can be painful
  • Serious foot problems, such as ulcers, infections, and bone and joint damage

Autonomic neuropathy

The autonomic nervous system controls blood pressure, heart rate, sweating, eyes, bladder, digestive system, and sex organs. Diabetes can affect the nerves in any of these areas, possibly causing signs and symptoms, including:

  • A lack of awareness that the blood sugar levels are low (hypoglycemia unawareness)
  • Drops in blood pressure when rising from a sitting or lying position, which can cause dizziness, lightheadedness, or fainting (orthostatic hypotension).
  • Bladder or bowel problems
  • Slow the emptying of your stomach (gastroparesis), causing nausea, vomiting, feeling of fullness and loss of appetite
  • Difficulty swallowing
  • Changes in the shape of the eyes adjust from light to darkness or from far to near
  • Increased or decreased sweating
  • Problems with sexual response, such as vaginal dryness in women and erectile dysfunction in men

Proximal neuropathy (diabetic polyradiculopathy)

This type of neuropathy often affects the nerves in the thighs, hips, buttocks or legs. It can also affect the abdominal and the chest area. The symptoms are usually on one side of the body, but can be extended to the other side. Proximal neuropathy can include:

  • Pain in the buttock, hip or thigh
  • Weak and shrinking of the muscles of the thigh
  • Difficulty getting up from a sitting position
  • Chest wall, or abdominal pain

Mononeuropathy (focal neuropathy)

Mononeuropathy is damage to a single nerve-specific. The nerve can be in the face, the torso, the arm or the leg. The condition can lead to:

  • Difficulty focusing or double vision
  • Paralysis on one side of the face
  • Numbness or tingling in the hands or fingers
  • Weakness in the hand that can result in dropping things
  • Pain in the calf or foot
  • Weakness causing difficulty lifting the front part of the foot (foot drop)
  • Pain in the front of the thigh

When to see a doctor

Call your health care provider for an appointment if you have:

  • A cut or sore on your foot that is infected or not heal
  • Burning, tingling, weakness, or pain in the hands or feet that interferes with daily activities or sleep
  • Changes in digestion, urination or sexual function
  • Dizziness and fainting

The American Diabetes Association (ADA) recommends that screening of diabetic neuropathy start immediately after someone is diagnosed with type 2 diabetes, or five years after the diagnosis of type 1 diabetes. After that, it is recommended that a test once a year.

Causes

The exact cause of each type of neuropathy is unknown. The researchers think that, over time, uncontrolled high blood sugar damages the nerves and interferes with their ability to send signals, which leads to diabetic neuropathy. High blood sugar also weakens the walls of small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.

Risk factors

Any person who has diabetes can develop neuropathy. But these factors of risk of harm to the nerves most likely:

  • Poor blood sugar control. Uncontrolled blood sugar increases the risk of each complication of diabetes, including nerve damage.
  • The Diabetes of the story. The risk of diabetic neuropathy increases the longer a person has diabetes, especially if the blood sugar is not well controlled.
  • Kidney disease. Diabetes can damage the kidneys. The kidney damage sends the toxins in the blood, which can lead to nerve damage.
  • The overweight. Have a body mass index (BMI) of 25 or more can increase the risk of diabetic neuropathy.
  • The habit of smoking. Smoking narrows and hardens the arteries, reducing the flow of blood to the legs and feet. This makes it more difficult for wounds to heal and the damage to the peripheral nerves.

Complications

Diabetic neuropathy can cause a number of serious complications, including:

  • Hypoglycemia unawareness. Blood sugar levels below 70 milligrams per deciliter (mg/dL) — 3.9 millimoles per liter (mmol/L) — often cause tremors, sweating and a fast heartbeat. But people who have autonomic neuropathy may not experience these warning signs.
  • The loss of a toe, foot or leg. The nerve damage can cause a loss of sensation in the feet, so that even minor cuts can turn into open sores or ulcers without being noticed. In severe cases, an infection can spread to the bones or lead to death of the tissue. Removal (amputation of a toe, foot, or even part of the leg may be necessary.
  • Urinary tract infections and urinary incontinence. If the nerves that control the bladder are damaged, it is possible that the bladder does not empty completely when you urinate. Bacteria can build up in the bladder and kidneys, causing infections of the urinary tract. Nerve damage can also affect the ability of feeling the need to urinate or for the control of the muscles that release urine, which leads to the leakage (incontinence).
  • Sharp drop in blood pressure. Damage to the nerves that control the blood flow can affect the ability of the body to adjust the blood pressure. This can cause a sharp drop in pressure when standing up after sitting or lying down, which can lead to dizziness and fainting.
  • The digestive problems . If nerve damage occurs in the digestive tract, constipation or diarrhea, or both are possible. Diabetes-related nerve damage can lead to gastroparesis, a condition in which the stomach empties too slowly or not at all. This can cause bloating and indigestion.
  • Sexual dysfunction. Autonomic neuropathy often causes damage to the nerves that affect the sex organs. Men can experience erectile dysfunction. Women may have difficulties with lubrication and arousal.
  • Increased or decreased sweating. The nerve damage can alter how the sweat glands of the work and make it difficult for the body to control its temperature properly.

Prevention

You can prevent or delay diabetic neuropathy and its complications close to the management of their blood sugar and take good care of your feet.

Blood sugar management

The American Diabetes Association (ADA) recommends that people living with diabetes have a glycosylated hemoglobin (A1C) test at least two times a year. This test indicates your average blood sugar level over the past 2 to 3 months.

the glycosylated hemoglobin (A1C) goals may need to be individualized, but for many adults, the ADA recommends an A1C level of less than 7.0%. If your blood sugar levels are higher than your goal, you may need changes in their daily management, such as add or adjust your medicines or change your diet or physical activity.

Foot care

Foot problems, including sores that do not heal, ulcers and even amputation, are common complications of diabetic neuropathy. But you can avoid many of these problems by having a thorough foot exam at least once a year. You also have your health care provider will check your feet at each visit to the office and take good care of your feet at home.

Follow your health care provider recommendations for the proper care of the feet. To protect the health of your feet:

  • Check your feet every day. Look for blisters, cuts, bumps, cracks, and peeling of the skin, redness, and swelling. Use a mirror or ask a friend or family member to help examine the parts of the feet which are difficult to see.
  • Keep your feet clean and dry. Wash your feet every day with lukewarm water and mild soap. Do not soak your feet. Dry your feet and between the toes of the feet completely.
  • Moisturize your feet. This helps to prevent cracking. But don't lotion between your toes, because it can encourage the growth of fungi.
  • Trim your toenails carefully. Cut toenails straight across. File the edges carefully so that you have smooth edges. If you can't do this by yourself, a specialist in foot problems (chiropodist) can help.
  • Wear clean, dry socks. Look for socks made of cotton or moisture-wicking fibers that do not have tight bands or thick seams.
  • Wear cushioned shoes that fit well. Wear closed-toe shoes or slippers to protect your feet. Make sure that your shoes fit properly and allow toes to move. A foot specialist can teach you how to buy properly fitted shoes and to avoid problems such as corns and calluses. If you qualify for Medicare, your plan may cover the cost of at least one pair of shoes each year.

Diabetic neuropathy

Diagnosis

Your doctor can usually diagnose diabetic neuropathy by performing a physical exam and carefully review your symptoms and medical history.

Your health care provider will normally verify your:

  • General muscle strength and tone
  • Tendon reflexes
  • Sensitivity to touch, pain, temperature, and vibration

Along with the physical examination, the doctor may perform or order specific tests to help diagnose diabetic neuropathy, such as:

  • Filament test. A soft nylon fiber (monofilament) is brushed over the areas of your skin to test your sensitivity to touch.
  • The sensory tests. This non-invasive test is used to indicate how your nerves respond to the vibrations and temperature changes.
  • Nerve conduction test. This test measures the speed with which the nerves of the arms and legs, conduct electrical signals.
  • Electromyography. Needle test, this test is often done along with nerve conduction studies. It measures the electrical discharges produced in muscles.
  • Autonomic testing. Special tests may be done to determine how it changes your blood pressure while you are in different positions, and if the sweating is within the standard range.

Treatment

Diabetic neuropathy has no known cure. The goals of treatment are to:

  • Slow progression
  • Relieve the pain
  • Manage complications and restore function

Slowing progression of the disease

Constantly keep your blood sugar within your target range is the key to prevent or delay nerve damage. The blood sugar management may even improve some of the current symptoms. Your healthcare provider will figure out the best target range for you, based on factors that include age, the time that you have had diabetes and your overall health.

Blood sugar levels should be individualized. But, in general, the American Diabetes Association (ADA) recommends the following target blood sugar levels for the majority of people with diabetes:

  • 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

The American Diabetes Association (ADA) has recommended glycated hemoglobin (A1C) of 7.0% or less for the majority of people with diabetes.

The Mayo Clinic encourages slightly lower levels of sugar in the blood for the majority of young people with diabetes, and levels slightly higher for older people with other medical conditions and may have an increased risk of low blood sugar complications. The Mayo Clinic recommends the following target blood sugar levels before meals:

  • Between 80 and 120 mg/dL (4.4 to 6.7 mmol/L) to persons of the age of 59 years and younger who have no other medical conditions
  • Between 100 and 140 mg/dL (5.6 to 7.8 mmol/L) to persons 60 years of age and older, or for those who have other medical conditions, including heart, lung or kidney disease

Other important aspects to help you reduce or prevent neuropathy from getting worse include keeping your blood pressure under control, the maintenance of a healthy weight and regular physical activity.

Relieve the pain

Many prescription medications are available for the diabetes-related nerve pain, but it doesn't work for everyone. When considering any medication, talk with your health care provider about the benefits and possible side effects to find what works best for you.

To relieve the pain of the prescription of treatments may include:

  • Anti-seizure drugs. Some of the medicines used to treat seizure disorders (epilepsy), they are also used to relieve nerve pain. The ADA recommends starting with pregabalin (Lyrica). Gabapentin (Gralise, Neurontin) is also an option. Side effects can include drowsiness, dizziness, swelling in the hands and feet.
  • Antidepressants.Some anti-depressants to relieve the pain of the nerves, even if they are not depressed. Tricyclic antidepressants may help with mild to moderate pain of the nerves. Drugs in this class include amitriptyline, nortriptyline (Pamelor), and desipramine (Norpramin). The side effects can be bothersome and include dry mouth, constipation, drowsiness, and difficulty concentrating. These medications can also cause dizziness when changing position, such as lying down to standing up (orthostatic hypotension). The serotonin and noradrenaline reuptake inhibitors (Snris) are another type of antidepressant that can help with the nerve pain and have fewer side effects. TheADArecommends duloxetine (Cymbalta, Drizalma Sprinkle) as a first treatment. Another one that can be used is venlafaxine (Effexor XR). Possible side effects include nausea, drowsiness, dizziness, decreased appetite, and constipation.

Antidepressants. Some anti-depressants to relieve the pain of the nerves, even if they are not depressed. Tricyclic antidepressants may help with mild to moderate pain of the nerves. Drugs in this class include amitriptyline, nortriptyline (Pamelor), and desipramine (Norpramin). The side effects can be bothersome and include dry mouth, constipation, drowsiness, and difficulty concentrating. These medications can also cause dizziness when changing position, such as lying down to standing up (orthostatic hypotension).

The serotonin and noradrenaline reuptake inhibitors (Snris) are another type of antidepressant that can help with the nerve pain and have fewer side effects. The ADA recommends duloxetine (Cymbalta, Drizalma Sprinkle) as a first treatment. Another one that can be used is venlafaxine (Effexor XR). Possible side effects include nausea, drowsiness, dizziness, decreased appetite, and constipation.

Sometimes, an antidepressant can be combined with an anti-seizure drug. These drugs can also be used to relieve pain medicines, such as medicines available without a prescription. For example, you can find relief from acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) or a patch to the skin with lidocaine (a substance anesthetic).

Management of complications and the restoration of function

To manage complications, you may need care from various specialists. These may include a specialist that deals with problems of the urinary tract (urologist) and a heart specialist (cardiologist) that can help to prevent or treat complications.

The treatment that you need depends on neuropathy associated with the complications that have:

  • Problems in the urinary tract. Some drugs affect the function of the bladder, so that your health care provider may recommend stopping or changing medications. A strict schedule to urinate or urinate every few hours (timed voiding), while the application of gentle pressure in the bladder area (below the navel) can help to alleviate some of the problems of the bladder. Other methods, including self-catheterization may be necessary to remove the urine from the bladder nerves damaged.
  • The digestive problems. To relieve mild signs and symptoms of gastroparesis — indigestion, belching, nausea, or vomiting — eat more small frequent meals can help. Changes in diet and medication can help to relieve gastroparesis, diarrhea, constipation, and nausea.
  • Low blood pressure on standing up (orthostatic hypotension).The treatment starts with simple lifestyle changes, such as not using alcohol, drink lots of water, and the change of the positions from sitting to standing slowly. Sleeping with the head of the bed elevated 4 to 6 inches helps prevent high blood pressure during the night. Your doctor may also recommend the compression of support for the abdomen and the thighs (abdominal binder and compression shorts or tights). Several medications, either alone or in conjunction, can be used to treat orthostatic hypotension.
  • Sexual dysfunction. The medicines taken by mouth or injection may improve sexual function in some men, but they are not safe and effective for all. Mechanical vacuum devices can increase the blood flow to the penis. Women can benefit from vaginal lubricants.

Low blood pressure on standing up (orthostatic hypotension). The treatment starts with simple lifestyle changes, such as not using alcohol, drink lots of water, and the change of the positions from sitting to standing slowly. Sleeping with the head of the bed elevated 4 to 6 inches helps prevent high blood pressure during the night.

Your doctor may also recommend the compression of support for the abdomen and the thighs (abdominal binder and compression shorts or tights). Several medications, either alone or in conjunction, can be used to treat orthostatic hypotension.

Self-care

These measures can help you feel better in general and reduce the risk of diabetic neuropathy:

  • Keep your blood pressure under control. If you have high blood pressure and diabetes, you have a higher risk of complications. Try to keep your blood pressure in the range recommended by your health care provider, and make sure you have marked on each office visit.
  • Make healthy food choices. Eat a balanced diet that includes a variety of healthy foods, especially vegetables, fruit and whole grains. To limit the size of the portions in order to help achieve or maintain a healthy weight.
  • Be active every day.Exercise helps lower blood sugar, enhances blood flow and maintains healthy heart. Goal of 150 minutes of moderate exercise or 75 minutes of aerobic activity, vigorous week, or a combination of moderate and vigorous exercise. It is also a good idea to take a break from sitting every 30 minutes to get a couple of quick bursts of activity. Talk with your doctor or physical therapist before you start to do exercise. If you have decreased sensation in the legs, some types of exercise, such as walking, may be safer than others. If you have a foot injury or pain, stick with the exercise that does not require you put weight on the injured foot.
  • Stop smoking. The use of tobacco in any form makes them more likely to develop poor circulation in the feet, which can cause problems with healing. If you use tobacco, talk to your health care provider about ways to quit smoking.

Be active every day. Exercise helps lower blood sugar, enhances blood flow and maintains healthy heart. Goal of 150 minutes of moderate exercise or 75 minutes of aerobic activity, vigorous week, or a combination of moderate and vigorous exercise. It is also a good idea to take a break from sitting every 30 minutes to get a couple of quick bursts of activity.

Talk with your doctor or physical therapist before you start to do exercise. If you have decreased sensation in the legs, some types of exercise, such as walking, may be safer than others. If you have a foot injury or pain, stick with the exercise that does not require you put weight on the injured foot.

Alternative medicine

There are many alternative therapies that can help with pain relief on its own or in combination with medications. But check with your health care provider before using any alternative therapies or dietary supplement to ensure that you do not have any potential interactions.

For diabetic neuropathy, you can try:

  • The capsaicin. Capsaicin cream applied to the skin, can reduce sensations of pain in some people. Side effects may include a burning sensation and irritation of the skin.
  • Alpha-lipoic acid. This powerful anti-oxidant that is found in some foods and can help to relieve nerve pain symptoms in some people.
  • Acetyl-L-carnitine. This nutrient is naturally made in the body and is available as a supplement. You can relieve nerve pain in some people.
  • Transcutaneous electrical nerve stimulation (TENS). This recipe therapy can help prevent pain signals from reaching the brain. transcutaneous electrical nerve stimulation (TENS) delivers small electrical impulses to the specific nerve pathways through small electrodes placed on the skin. Although safe and painless, does not work for everyone or for all types of pain.
  • Acupuncture. Acupuncture can help relieve the pain of neuropathy, and usually have no side effects. Please note that you may not get an immediate relief with acupuncture and may require more than one session.

Coping and support

Living with diabetic neuropathy can sometimes be difficult. Support groups can offer support and advice about living with diabetic neuropathy. Ask your health care provider if there are any in your area, or for a referral to a therapist. The ADA offers online support through its website. If you are feeling depressed, it can help to talk with a counselor or therapist.

Preparing for your appointment

If you don't already see a specialist in the treatment of metabolic disorders and diabetes (endocrinologist), probably refers to one if you begin to show signs of the complications of diabetes. It can also be referred to a specialist in the brain and problems with the nervous system (neurologist).

To prepare for your appointment, you can:

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there is something that you need to do in advance, such as restrict your diet.
  • Make a list of the symptoms you are experiencing, including any that may seem unrelated to the reason for the appointment.
  • Make a list of the personal information, including any major stresses or recent life changes.
  • Make a list of all the medications, vitamins, herbs, and supplements you are taking and the dose.
  • Keep a record of your recent blood sugar levels if you check them in the house.
  • 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.
  • Make a list of questions to ask your health care provider.

Some basic questions to ask may include:

  • Is diabetic neuropathy, the most likely cause of my symptoms?
  • I need tests to confirm the cause of my symptoms? How do I prepare for these tests?
  • Is this condition temporary or long-term?
  • If I can manage my blood sugar, these symptoms will improve or disappear?
  • There are treatments available, and I 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 that I can take with me? What sites do you recommend?
  • What do I need to see a certified diabetes care and education specialist, a registered dietitian, or other specialists?

What to expect from your doctor

Your health care provider is likely to ask a series of questions, such as:

  • How effective is your diabetes management?
  • When did you start having symptoms?
  • Do you always have symptoms, or the symptoms come and go?
  • How severe are the symptoms?
  • Nothing seems to improve the symptoms?
  • What, if anything, appears to worsen your symptoms?
  • What is challenging about managing your diabetes?
  • What could help you manage your diabetes better?
Symptoms and treatment of Diabetic neuropathy