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Diabetic Neuropathy (Symptoms, Causes, Diagnosis, Treatment)

  • Medical Author: Melissa Conrad Stöppler, MD
  • Medical Editor: Charles Patrick Davis, MD, PhD

Diabetic neuropathy definition and facts

  • Diabetic neuropathy is damage to nerves that occurs as a result of diabetes.
  • Diabetes is thought to damage nerves as a result of prolonged elevated levels of blood glucose.
  • Different types of diabetic neuropathy include peripheral neuropathy, focal neuropathy, autonomic neuropathy, and proximal neuropathy.
  • Peripheral neuropathy most commonly causes:
    • pain,
    • burning,
    • tingling, and
    • numbness of the feet and lower legs.
  • Autonomic neuropathy causes symptoms related to dysfunction of an organ system, such as:
  • Diagnosis of diabetic neuropathy is usually done by a clinical exam.
  • There is no cure for diabetic neuropathy, but treatments are available to manage the symptoms.
  • Diabetic nerve pain may be controlled by medications such as tricyclic antidepressants, duloxetine (Cymbalta), or certain antiseizure medications.
  • Lidocaine and capsaicin are two topical agents that can help relieve nerve pain in many people.
  • Keeping tight control of blood sugar levels is the best way to prevent diabetic neuropathy and other complications of diabetes.

What is diabetic neuropathy?

Neuropathy is damage to nerves, and diabetic neuropathy is damage to nerves that occurs as a result of diabetes. Diabetes is thought to damage nerves as a result of prolonged elevated levels of blood glucose. Diabetic neuropathy can affect different parts of the body, and symptoms can range from mild to severe. Diabetic neuropathy is the most common complication of diabetes.

What are the symptoms and signs of diabetic neuropathy?

The symptoms and signs of diabetic neuropathy depend upon the type of neuropathy that is present. Signs and symptoms can also vary in severity among affected people.

Signs and symptoms of diabetic peripheral neuropathy include:

  • Numbness or tingling of the feet and lower legs
  • Pain or burning sensations
  • Loss of sensation in the feet or lower legs
  • Sometimes, but less commonly, these symptoms can occur in the hands or arms

Signs and symptoms of diabetic proximal neuropathy include:

  • Pain, usually on one side, in the hips, buttocks, or thighs
  • Weakness of the legs

Signs and symptoms of diabetic autonomic neuropathy depend upon the organ system that is involved and can include:

Signs and symptoms of diabetic focal neuropathy also depend upon the location of the affected nerve.

The symptoms can appear suddenly. It usually does not cause a long term problem, and symptoms often improve over weeks to months. Symptoms can include:

  • Chest pain
  • Eye pain
  • Changes in vision
  • Bell's palsy (paralysis on one side of the face)
  • Pain in a localized area of the body

What causes diabetic neuropathy?

The cause of nerve damage in diabetes is not well understood. Long-term exposure to high levels of blood glucose is able to damage nerve tissue, although the reason for this damage is unclear.

Can diabetic neuropathy be reversed?

Nerve damage typically cannot be reversed once it has occurred. However, there are medications and self-care measures that can help control the symptoms of diabetic neuropathy.

What are the types of diabetic neuropathy?

There are different types of diabetic neuropathy. The distinction depends upon which types and location of nerves are affected.

  • Diabetic peripheral neuropathy refers to damage to peripheral nerves, most commonly the nerves of the feet and legs.
  • Diabetic proximal neuropathy affects nerves in the thighs, hips, or buttocks.
  • Diabetic autonomic neuropathy affects the autonomic nervous system, the nerves that control body functions. For example, it can affect nerves of the gastrointestinal, urinary, genital, or vascular systems.
  • Diabetic focal neuropathy affects a specific nerve or area at any site in the body.

How is diabetic neuropathy diagnosed?

Diabetic neuropathy is usually presumptively diagnosed clinically by the patient's symptoms, medical history, and physical exam. However, there are other tests that can definitively diagnose the condition by actually measuring the loss of nerve function. Nerve conduction studies measure the speed of nerve signals in the arms and legs, while electromyography measures the electrical discharges produced in muscles. Other tests of nervous system function may be done on some patients. About 45% to 50% of all patients with diabetes are eventually diagnosed with some form of neuropathy.

What are treatments for diabetic neuropathy?

While diabetic neuropathy cannot be cured, there are treatments available to help manage some of the symptoms. Another treatment goal is keeping blood glucose levels under good control through a combination of diet and medication so that the neuropathy does not worsen. Keeping blood glucose levels under control has been shown to improve symptoms and prevent worsening of the pain.

What natural home remedies help relieve pain?

There are a number of self- and home care measures that you can take to relieve the symptoms of diabetic neuropathy. Examples are:

  • Using a device known as a bed cradle to keep bedcovers off of sensitive feet and lower legs
  • Using heat or cold patches, but since diabetic neuropathy can damage sensory nerves, care should be taken to avoid burns or freezing
  • Eating small, frequent meals and avoiding fatty foods may help those with digestive symptoms
  • Standing up slowly or wearing elastic compression stockings can improve orthostatic hypotension
  • Exercises, stretching, or massage may help relieve pain

What medications help relieve the pain from diabetic neuropathy?

The pain of diabetic neuropathy can sometimes be managed with certain medications. Certain prescription antidepressants and antiseizure medications have been shown to be effective in relieving pain that originates in the nerves.

For example:

  • duloxetine (Cymbalta) is an antidepressant that can relieve the pain of diabetic neuropathy in some people. The tricyclic antidepressant drugs, including nortriptyline (Pamelor, Aventyl) and desipramine (Norpramin), have also been used for this purpose.
  • Anti-seizure drugs such as gabapentin (Neurontin), carbamazepine (Tegretol), and pregabalin (Lyrica) are drugs that can also work to relieve pain in people with diabetic neuropathy.

In severe cases, opioid analgesic medications may be needed.

Other kinds of treatment for nerve pain include patches containing the topical anesthetic agent lidocaine. Capsaicin cream is an over-the-counter topical agent that has been shown to relieve nerve pain.

Medications can also help manage the troublesome symptoms of autonomic neuropathy. For example, antispasmodic or anticholinergic drugs can help prevent urinary incontinence. Drugs to treat erectile dysfunction like sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) may help some men with ED due to diabetic neuropathy. For women, vaginal estrogen creams and lubricants may provide relief of vaginal dryness and irritation.

Botulinum toxin (Botox) injections have been used to treat abnormal sweating.

Can diabetic neuropathy be prevented?

Keeping diabetes under control is the best way to prevent or stop the progression of diabetic neuropathy. Your doctor can advise you about the best target range for your blood glucose levels, and keeping tight control of blood sugar within this range can help prevent neuropathy and other complications of diabetes. Avoiding smoking, getting exercise, and eating a healthy diet are other measures that can help people with diabetes have the best long-term outcomes.

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Reviewed on 12/8/2017

REFERENCES:

Quan, DQ, MD. "Diabetic Neuropathy." Medscape. Updated: Oct 13, 2017.
<https://emedicine.medscape.com/article/1170337-overview>

NIH. Diabetic Neuropathy Information Page.
<https://www.ninds.nih.gov/Disorders/All-Disorders/Diabetic-Neuropathy-Information-Page>

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