If you’ve just been diagnosed with diabetes or have had it for a while, an important part of your care is understanding the complication of diabetic neuropathy (new-ROP-uh-thee). Diabetic neuropathy is nerve damage that’s very common in people who have diabetes. At least half of all patients with diabetes have some type of nerve damage. The longer you have diabetes, the more likely you are to develop this potentially serious complication of diabetes.
Diabetic Neuropathy Causes
When your blood sugar (glucose) is too high or is elevated for a long time (uncontrolled), it can injure nerves throughout your body. Damaged nerves may stop sending messages or send incorrect messages to your body. The result can be pain and numbness. Having numb feet, legs or hands makes it hard to carry on your normal daily activities.
You are more likely to have diabetic neuropathy if you:
- Have had diabetes for a long time; neuropathy risk increases the longer you have diabetes
- Have poorly controlled glucose levels
- Have kidney disease; kidney damage allows toxins into your blood, leading to nerve damage
- Are overweight
- Have high blood pressure and/or high cholesterol
- Smoke, because smoking narrows and hardens your arteries, reducing blood circulation to your feet and legs, and damaging peripheral nerves, making it harder for wounds to heal
Diabetic Neuropathy Symptoms
Symptoms tend to develop gradually and can range from mild to severe pain, even cause physical disability. You may not notice mild symptoms until a lot of nerve damage has occurred. Numbness in the legs and feet is a common symptom. The digestive system, heart, blood vessels, and urinary tract can also be affected by neuropathy. Your specific symptoms depend on the type of neuropathy you have.
There are four main types of diabetic neuropathy. You may only have one type or several types at the same time. They include:
- Peripheral neuropathy is the most common type. It starts in the feet and legs, progressing to hands and arms. Symptoms are often worse at night. Symptoms may include numbness, reduced ability to feel pain or temperature changes, tingling or burning, cramps, sharp pains, increased sensitivity to touch, and foot problems such as infections, ulcers, or joint pain.
- Autonomic neuropathy affects the nerves that control internal organs, including your heart, bladder, stomach and intestines, sweat glands, eyes, and sexual organs. Symptoms can include being unaware that glucose levels are too low, bladder or bowel problems, nausea, vomiting, loss of appetite, eyes that are slow to adjust to the darkness, and lower sexual response.
- Proximal neuropathy is rare and can affect nerves in the thighs, hips, buttock, and stomach and chest areas. While symptoms may start on one side of your body, they sometimes spread to the other side. Symptoms can include severe hip, thigh, or buttock pain, difficulty standing from a chair, severe stomach pain, and, eventually, shrunken and/or weak thigh muscles.
- Mononeuropathy (of focal neuropathy) includes damage to the cranial nerve and peripheral nerve damage. Symptoms can include double vision or problems focusing your eyes, aching behind one eye, Bell’s palsy (paralysis on one side of the face), numbness or tingling in the hand or fingers, or muscle weakness in your hand.
Diabetic neuropathy complications
While the symptoms of diabetic neuropathy can be painful and debilitating, neuropathies can cause even worse or permanent complications. These can include:
- Amputations are often due to a neuropathy-caused lack of sensation in your toes, feet, or legs. Numbness and the inability to feel temperature or pain can set you up for wounds or sores that don’t heal and become infected. The infection can spread to the bone.
- Glucose that’s dropped to a potentially dangerous level (hypoglycemia) will cause shakiness, sweating, and a rapid heartbeat. With autonomic neuropathy, you may not be aware of these warning signs.
- Sharp drops in blood pressure because of damage to the nerves that adjust blood pressure. You may feel dizzy or faint if you stand up too quickly.
- Stomach problems, such as diarrhea and/or constipation, bloating, and indigestion, are caused by nerve damage that makes the stomach empty too slowly (gastroparesis).
- An increase or decrease in sweating, making it hard for your body to control its temperature. This is due to nerve damage that affects how your sweat glands work.
- Urinary tract infections can be caused by damage to the nerves that control your bladder. Nerve damage can limit your ability to know when you need to urinate and/or to control the muscles that release urine, leading to bladder leakage (incontinence).
- Sexual function problems, including erectile dysfunction in men; women may have problems with arousal and vaginal dryness.
Diabetic Neuropathy Treatment
Prevention of diabetic neuropathy is far easier, less painful, and far less expensive than treatment. Neuropathies can be prevented by careful management of your glucose levels. This treatment should begin immediately after you are diagnosed with diabetes.
Treatment should focus on:
- Manage your glucose level, which starts with an A1C test at least twice a year. A1C tests measure your average glucose level during the past two to three months. Follow your doctor’s instructions on staying within a safe glucose range – your A1C goal. Glucose levels can vary from person to person, and your doctor will set a glucose management goal specifically for your needs.
- Get screened for diabetic neuropathy immediately after a type 2 diabetes diagnosis and five years after a type 1 diabetes diagnosis.
- Take good care of your skin, especially your feet. Inspect your feet every day to look for wounds, blisters, bruises, cracked skin, redness, and swelling. Numbness can keep you from feeling these injuries, and an infection can quickly develop before you are aware of it. Keep feet clean and dry and avoid soaking them. Moisturize if your feet are dry. Wear cotton or moisture-wicking socks without tight bands. Trim toenails straight across and file to avoid sharp edges.
- Always wear well-fitting, cushioned shoes to protect your feet.
- Eat a healthy diet, including limiting alcohol.
- Get regular exercise.
- Take your medications as instructed.
- Keep blood pressure under control.
- Report any numbness or tingling to your doctor. Also, report any sore that doesn’t heal, changes in digestion or urination, and any dizziness or fainting. Prompt treatment can prevent further nerve damage.
Schedule Your Appointment
If you are living with diabetes, you likely have other questions about neuropathy. Don’t hesitate to reach out to us to learn more about your condition and the treatment options that may be available to you.