Diabetic neuropathy
Diabetic neuropathy
Everything you need to know about
Diabetic neuropathy
Diabetes can cause diabetic neuropathy, which is a type of nerve injury. High blood sugar levels (glucose) can harm nerves all over the body. Nerves in the legs and feet are the most commonly affected by diabetic neuropathy.
Diabetic neuropathy symptoms include discomfort and numbness in the legs, foot, and hands, depending on which nerves are affected. It can also affect the digestive system, the urinary tract, blood vessels, and the heart. Some folks only experience minor symptoms. Diabetic neuropathy, on the other hand, can be extremely unpleasant and devastating for some people.
Diabetic neuropathy is a significant diabetes consequence that affects up to 50% of patients with the disease. However, continuous blood sugar management and a healthy lifestyle can typically avoid or slow the progression of diabetic neuropathy.
Symptoms
Diabetic neuropathy is divided into four categories. You can have one type of neuropathy or multiple types.
The type you have and which nerves are impacted determine your symptoms. Symptoms usually appear gradually. It’s possible that you won’t notice anything is wrong until significant nerve damage has happened.
Peripheral neuropathy
Distal symmetric peripheral neuropathy is another name for this form of neuropathy. Diabetic neuropathy of this sort is the most frequent. It first affects the feet and legs, then the hands and arms. The following are some of the signs and symptoms of peripheral neuropathy that are often worse at night:
- Numbness or a diminished ability to perceive pain or changes in temperature
- A feeling of tingling or burning
- Cramping or sharp aches
- Muscle wasting
- Extreme sensitivity to touch – even the weight of a bedsheet can be bothersome for some people.
- Ulcers, infections, and bone and joint degeneration are all serious foot disorders.
Autonomic neuropathy
Blood pressure, heart rate, perspiration, eyes, bladder, digestive system, and sex organs are all controlled by the autonomic nervous system. Diabetes can impair nerves in any of these regions, resulting in the following signs and symptoms:
- A lack of awareness about low blood sugar levels (hypoglycemia unawareness)
- Blood pressure drops when standing or lying down, which can produce dizziness or fainting (orthostatic hypotension)
- Problems with the bladder or bowels
- Gastroparesis (slow stomach emptying) causes nausea, vomiting, a feeling of fullness, and a loss of appetite.
- Swallowing problems
- Changes in the way the eyes adjust from light to dark or far to near
- Sweating increases or decreases
- Vaginal dryness in women and erectile dysfunction in males are examples of sexual response issues.
Proximal neuropathy (diabetic polyradiculopathy)
Nerves in the thighs, hips, buttocks, and legs are commonly affected by this type of neuropathy. It can also cause problems in the abdomen and chest. The symptoms normally appear on one side of the body, although they can migrate to the other. Symptoms of proximal neuropathy include:
- Buttock, hip, or thigh pain that is severe
- Thigh muscles that are weak and decreasing
- Having trouble getting out of a seated position
- Pain in the chest or abdomen
Mononeuropathy (focal neuropathy)
Damage to a single, unique nerve is referred to as mononeuropathy. The nerve can be found in the face, the thorax, the arm, or the leg. Mononeuropathy can result in:
- Double vision or difficulty focusing
- One side of the face is paralysed.
- Numbness or tingling in the fingers and hand
- Hand weakness that could lead to items being dropped
- Inflammation of the shin or foot
- Lifting the front half of the foot is difficult due to weakness (foot drop)
- Thigh pain in the front
Diagnosis
A physical exam and a thorough assessment of your symptoms and medical history are generally enough for your doctor to diagnose diabetic neuropathy.
Your health care professional will usually examine:
- Overall muscle tone and strength
- Tendon reactions
- Touch, pain, temperature, and vibration sensitivity
Your health care provider may perform or prescribe specialised tests to assist diagnose diabetic neuropathy in addition to the physical exam, such as:
- Filament testing. To assess your sensitivity to touch, a delicate nylon fibre (monofilament) is rubbed over parts of your skin.
- Sensory testing. This non-invasive test determines how your nerves react to vibration and temperature changes.
- Nerve conduction testing. This test determines how rapidly your arms and legs’ nerves conduct electrical signals.
- Electromyography. This examination, known as needle testing, is frequently performed in conjunction with nerve conduction investigations. It measures the electrical discharges that your muscles create.
- Autonomic testing. Special tests may be performed to see how your blood pressure fluctuates in different situations and whether your sweating is within normal limits.
Causes
Complications
Hypoglycemia unawareness
Shakiness, perspiration, and a fast heartbeat are common symptoms of blood sugar levels below 70 milligrammes per deciliter (mg/dL) — 3.9 millimoles per litre (mmol/L). Autonomic neuropathy patients, on the other hand, may not notice these warning signals.
Loss of a toe, foot or leg
Because nerve damage can cause a loss of feeling in the foot, even slight cuts can quickly grow into sores or ulcers. An infection might spread to the bone or cause tissue death in severe situations. Amputation of a toe, foot or even a portion of the leg may be required.
Urinary tract infections and urinary incontinence
The bladder may not empty entirely when urinating if the nerves that control it are injured. Urinary tract infections are caused by bacteria building up in the bladder and kidneys. Nerve damage can make it difficult to detect the need to urinate or control the muscles that release urine, resulting in urine leakage (incontinence).
Sharp drops in blood pressure
Damage to the nerves that govern blood flow can make it difficult for the body to regulate blood pressure. When you stand up after sitting or lying down, your blood pressure drops dramatically, which can produce lightheadedness and fainting.
Digestive problems
Constipation, diarrhoea or both may occur if nerve injury occurs in the digestive tract. Gastroparesis is a condition in which the stomach empties too slowly or not at all due to nerve loss caused by diabetes. Bloating and indigestion are possible side effects.
Sexual dysfunction
The nerves that control the genital organs are frequently damaged by autonomic neuropathy. Erectile dysfunction can affect men. Lubrication and arousal may be a problem for women.
Increased or decreased sweating
Nerve injury can cause sweat glands to malfunction, making it harder for the body to regulate its temperature adequately.
Coping and support
Living with diabetic neuropathy can be difficult at times. Diabetic neuropathy support groups can provide encouragement and advice on how to live with the condition. Request a referral to a therapist from your health care provider if there are any in your region. If you’re depressed, speaking with a counsellor or therapist may be beneficial.
Support Groups
Pure Medical is dedicated to supporting organisations that help our patients. We invite Health Groups/Patient Advocacy Groups (PAGS) from around the world to present links to their separate web pages on this page as part of that commitment. To be included in this list, please email info@pure-medical.co.uk.
United Kingdom Patient Resources:
- Brain and Spine Foundation
- The Brain Charity
- British Polio Fellowship
- Charcot-Marie-Tooth UK
- Chartered Society of Physiotherapy
- Diabetes UK
- GAIN (Guillain-Barré and Associated Inflammatory Neuropathies)
- Muscular Dystrophy UK
- Motor Neurone Disease Association
- Neurological Alliance
- Pain Concern
- Vasculitis UK
What to expect from your doctor
Your doctor will most likely ask you a series of questions, including:
- How well do you control your diabetes?
- When did you first notice the symptoms?
- Do you have symptoms all of the time or do they come and go?
- What is the severity of your symptoms?
- Is there anything that seems to help your symptoms?
- What, if anything, seems to aggravate your symptoms?
- What is the most difficult aspect of controlling diabetes?
- What can you do to better control your diabetes?
Preparing for your appointment
If you don’t currently see an endocrinologist (a specialist who treats metabolic diseases including diabetes), you’ll almost certainly be sent to one if you begin to show signs of diabetes problems. You can also be referred to a brain and nerve system specialist (neurologist).
You might wish to do the following to prepare for your appointment:
- Be aware of any pre-appointment restrictions. Ask whether there is anything you need to do ahead of time, such as restrict your food, when you book the appointment.
- Make a list of any symptoms you have. Include any that appear unrelated to the appointment’s purpose.
- Make a list of key personal information. Detail any recent life changes or major concerns
- Make a list of all medications. What vitamins, herbs, and supplements are you taking, as well as the dosages?
- Take a record of your recent blood sugar levels. If you have checked it at home.
- Ask a family member or friend to come with you. It can be difficult to keep track of everything your doctor says during an appointment. Someone accompanying you may recall something you overlooked or forgot.
- Make a list of questions. Ask your doctor…
Some basic questions to consider are:
- Is it most likely that my symptoms are caused by diabetic neuropathy?
- Do I need tests to figure out what’s causing my symptoms?
- What should I do to prepare for these tests?
- Is this a short-term or long-term condition?
- Will these symptoms improve or go if I control my blood sugar?
- Are there any treatments available, and which ones would you suggest?
- What are the possible side effects of treatment?
- I have other health issues that plague me. How can I best manage them?
- Are there brochures or other printed material I can take with me?
- What websites would you suggest?
- Do I need to see a certified diabetes educator, a qualified nutritionist, or any other specialists?
Treatment
There is no cure for diabetic neuropathy. The treatment’s objectives are to:
- Pain relief
- Restore function and manage concerns
- Slow advancement
Slowing advancement
The key to preventing or delaying nerve damage is to keep your blood sugar within your goal range. Blood sugar control may potentially help alleviate some of your existing symptoms. Based on your age, the length of time you’ve had diabetes, and your overall health, your health care physician will determine the ideal target range for you.
Individualized blood sugar levels are required. However, for most people with diabetes the following target blood sugar levels:
Before meals, between 80 and 130 mg/dL (4.4 and 7.2 mmol/L)
Two hours after meals, less than 180 mg/dL (10.0 mmol/L)
Most patients with diabetes should have an A1C of 7.0 percent or lower.
Most younger individuals with diabetes should have somewhat lower blood sugar levels, while older people with other medical issues should have slightly higher blood sugar levels since they are more at risk of low blood sugar consequences. Before meals, the Pure Medical Clinic advises the following blood sugar levels:
- For those aged 59 and younger with no underlying medical concerns, the blood sugar level should be between 80 and 120 mg/dL (4.4 and 6.7 mmol/L).
- For adults 60 and older, or those with other medical issues such as heart, lung, or kidney illness, between 100 and 140 mg/dL (5.6 and 7.8 mmol/L)
Keeping your blood pressure under control, maintaining a healthy weight, and obtaining regular physical activity are all significant measures to help halt or prevent neuropathy from getting worse.
Restore function and manage concerns
You may require the assistance of several specialists to manage difficulties. A urologist (a doctor who handles urinary tract disorders) and a cardiologist (a doctor who treats cardiac problems) are two examples of specialists who can assist avoid or treating complications.
The treatment you’ll need is determined by the issues caused by your neuropathy:
- Urinary tract problems. Because some medications impact bladder function, your doctor may advise you to stop taking them or change them. Some bladder problems can be helped by following a rigorous urination schedule or urinating every few hours (timed urination) while providing light pressure to the bladder area (below your bellybutton). To evacuate pee from a nerve-damaged bladder, other procedures, such as self-catheterization, may be required.
- Digestive problems. Smaller, more frequent meals may help ease mild indications and symptoms of gastroparesis, such as indigestion, belching, nausea, and vomiting. Gastroparesis, diarrhoea, constipation, and nausea may be relieved with dietary changes and medications.
- Low blood pressure on standing (orthostatic hypotension). Simple lifestyle modifications, such as not drinking alcohol, drinking plenty of water, and slowly shifting positions such as sitting to standing, begin treatment. High blood pressure can be avoided by sleeping with the head of the bed raised 4 to 6 inches. Compression support for your abdomen and thighs may also be recommended by your doctor (abdominal binder and compression shorts or stockings). Orthostatic hypotension can be treated with a variety of drugs, either alone or in combination.
- Sexual dysfunction. Some men may benefit from medications given by mouth or injection, but they aren’t safe or effective for everyone. Vacuum devices that improve blood flow to the penis may help. Vaginal lubricants may be beneficial to women.
Pain Relief
Many prescription drugs exist to treat diabetes-related nerve pain, but not all of them are effective. When contemplating any medicine, speak with your doctor about the benefits and potential side effects to determine which one is right for you.
Prescription treatments for pain relief may include:
- Anti-seizure drugs. Some drugs that are used to treat epilepsy are also used to relieve nerve pain. It is suggested that you begin with pregabalin (Lyrica). Gabapentin (Gralise, Neurontin) is another possibility. Drowsiness, dizziness, and swelling in the hands and feet are all possible side effects.
- Antidepressants. Even if you aren’t depressed, some antidepressants can help with nerve pain. Mild to moderate nerve pain may benefit from tricyclic antidepressants. Amitriptyline, nortriptyline (Pamelor), and desipramine are examples of this class of drugs (Norpramin). Dry mouth, constipation, tiredness, and difficulty concentrating are all possible side effects. When shifting positions, such as from lying down to standing, some drugs may produce dizziness (orthostatic hypotension). Another type of antidepressant that may help with nerve pain and has fewer adverse effects is serotonin and norepinephrine reuptake inhibitors (SNRIs). As an initial treatment, the ADA recommends duloxetine. Venlafaxine is another possibility. Nausea, tiredness, dizziness, decreased appetite, and constipation is all possible adverse effects.
Antidepressants and anti-seizure medications are sometimes used together. These medications can also be combined with pain relievers that aren’t available without a prescription. For example, paracetamol, ibuprofen or a lidocaine skin patch may provide relief (a numbing substance).
Risk Factors
Neuropathy can affect anyone with diabetes. However, the following circumstances increase the likelihood of nerve damage:
- Poor blood sugar control. Every diabetic problem, including nerve damage, is increased by uncontrolled blood sugar.
- Diabetes history. Diabetic neuropathy becomes more likely the longer a person has diabetes, especially if blood sugar levels aren’t effectively managed.
- Kidney disease. Diabetes can cause kidney damage. Kidney disease causes toxins to enter the bloodstream, which can cause nerve damage.
- Being overweight. A BMI of 25 or higher may raise the risk of diabetic neuropathy.
- Smoking. The arteries shrink and stiffen as a result of smoking, limiting blood flow to the legs and feet. This makes wound healing more difficult and affects peripheral nerves.
Prevention
By closely monitoring your blood sugar and taking appropriate care of your feet, you can prevent or delay diabetic neuropathy and associated effects.
Blood sugar management
It is recommended that individuals with diabetes get an A1C test at least twice a year. This test shows your average blood sugar level over the last two to three months.
Individual A1C goals may be necessary, but also an A1C of fewer than 7.0 percent for many adults. If your blood sugar levels are higher than your target, you may need to make adjustments to your daily routine, such as adding or adjusting medications, changing your food, or increasing your physical activity.
Foot care
Diabetic neuropathy can cause foot problems such as open sores that don’t heal, ulcers, and even amputation. However, many of these issues can be avoided by having a comprehensive foot inspection at least once a year. Have your health care practitioner examine your feet at every office visit, and take proper care of them at home.
For proper foot care, follow your health care provider’s recommendations. To keep your feet healthy, do the following:
- Check your feet every day. Blisters, cuts, bruises, broken and peeling skin, redness, and swelling are all things to look for. Use a mirror or enlist the assistance of a friend or family member to check the parts of your foot that are difficult to view.
- Keep your feet clean and dry. Every day, wash your feet with lukewarm water and light soap. Avoid soaking your feet. Thoroughly dry your feet and between your toes.
- Moisturize your feet. This reduces the risk of cracking. However, avoid getting lotion between your toes because it may promote fungal growth.
- Trim your toenails carefully. Toenails should be cut straight across. Carefully file the edges to provide smooth edges. If you can’t do it yourself, a foot specialist (podiatrist) can assist you.
- Wear clean, dry socks. Socks made of cotton or moisture-wicking fibres with no tight bands or heavy seams are ideal.
- Wear cushioned shoes that fit well. To protect your feet, wear closed-toed shoes or slippers. Make sure your shoes are comfortable and allow you to move your toes. A foot specialist can show you how to choose shoes that fit properly and how to avoid problems like corns and calluses.