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Diabetic Neuropathy

What is diabetic neuropathy?

Diabetic neuropathy is nerve damage due to diabetes. Over time, high blood glucose can damage the tiny blood vessels that supply your nerves, especially in the legs. 

Nerves send messages to and from your brain about pain, temperature, and touch. They tell your muscles when and how to move. They also control the systems in the body that digest food and pass urine.

If you have diabetes, you can develop nerve problems at any time. Serious nerve problems can develop within the first 10 years after being diagnosed with diabetes. The risk of getting neuropathy grows the longer you have diabetes. About half of people with diabetes have some form of nerve damage.

What causes diabetic neuropathy?

The exact cause of diabetic neuropathy is unknown. Several things may contribute to it, including:

  • High blood glucose. High blood glucose or high blood sugar causes chemical changes in nerves. This impairs the nerves' ability to send signals. It can also damage blood vessels that carry oxygen and nutrients to the nerves.
  • Your genes. Certain genetic traits can increase risk for nerve disease.

What are the symptoms of diabetic neuropathy?

The following are the most common symptoms of diabetic neuropathy:

  • Numbness in the hands or feet
  • Pain in the hands, feet, or legs
  • Problems with your internal organs, such as the digestive tract, heart, sex organs, or eyes. This can lead to:
    • Indigestion
    • Diarrhea or constipation
    • Dizziness
    • Bladder infections
    • Erectile dysfunction
    • Weakness
    • Weight loss
    • Depression
    • Visual changes

The symptoms of diabetic neuropathy may look like other conditions or medical problems. Consult your doctor for a diagnosis.

There are several different types of diabetic neuropathy. They include:

Peripheral neuropathy. This type affects nerves in the legs, feet, arms, and hands.

Symptoms include:

  • Numbness
  • Tingling, burning, or prickling
  • Sharp pains or cramps
  • Extreme sensitivity to touch
  • Loss of balance or coordination
  • Insensitivity to pain or temperature changes

Autonomic neuropathy. This type affects nerves that serve internal organs. This includes the heart, digestive system, sex organs, urinary tract, and sweat glands.

Symptoms include:

  • Incontinence
  • Digestive problems
  • Low blood pressure
  • Dizziness
  • Fainting
  • Impaired perception of pain
  • Low blood glucose (hypoglycemia)
  • Profuse sweating
  • Erectile dysfunction

Focal neuropathy. Sometimes neuropathy affects a single, specific nerve and part of the body. This can be nerves of the eyes, face muscles, hearing, pelvis and lower back, thighs, and abdomen.

Symptoms include:

  • Pain in the thighs
  • Severe pain in lower back or pelvis
  • Pain in the chest, stomach, or flank
  • Chest or abdominal pain that mimics angina, heart attack, or appendicitis
  • Aching behind the eyes
  • Inability to focus the eyes
  • Double vision
  • Paralysis on one side of face
  • Hearing problems

How is neuropathy diagnosed?

To diagnose neuropathy, you will need a physical exam and other special tests. For example, ultrasound is used to check urinary issues. Ultrasound uses sound waves to visualize your bladder. Stomach issues can be identified with X-rays and other diagnostic tests.

In addition, your health care provider may:

  • Check muscle strength
  • Check muscle reflexes

Check muscle sensitivity to the following:

  • Position
  • Vibration
  • Temperature
  • Light touch

Request more tests, such as:

  • Nerve conduction studies to check flow of electrical current through a nerve
  • Electromyography (EMG) to see how muscles respond to electrical impulses
  • Ultrasound to determine how parts of the urinary tract are working
  • Nerve biopsy to remove a sample of nerve for testing

How is diabetic neuropathy treated?

Your health care provider will figure out the best treatment based on:

  • How old you are
  • Your overall health and medical history
  • How sick you are
  • How well you can handle specific medications, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

The goal of treatment is to ease pain and discomfort. It’s also important to prevent more tissue damage. Treatment may include:

  • Pain medications
  • Antidepressants that act on the nervous system to ease pain and discomfort
  • Creams you apply to the skin
  • Transcutaneous electronic nerve stimulation (TENS) therapy
  • Hypnosis
  • Relaxation training
  • Biofeedback training
  • Acupuncture

Treatment may also be prescribed for complications of neuropathy. This could be gastrointestinal problems, dizziness and weakness, and urinary or sexual problems.

What are the complications of diabetic neuropathy?

Bladder problems

One complication of neuropathy can occur when the bladder becomes paralyzed.  When this happens, the nerves of the bladder no longer respond normally as the bladder fills with urine. As a result, urine remains in the bladder, leading to urinary tract infections.

Erectile dysfunction

Neuropathy may cause erectile dysfunction (ED) when it affects the nerves that control erection. However, the desire for sex does not usually fall.

Gastrointestinal

Diarrhea may occur when the nerves that control the small intestine are damaged. The diarrhea occurs mostly at night. Constipation is another result of damage to nerves in the intestines.

Sometimes, the stomach is also affected. It may lose the ability to move food easily through the digestive system, causing vomiting and bloating. This is called gastroparesis. It changes how fast the body absorbs food. It can make it more difficult to match insulin doses to food portions.

Vision

Vision can also be affected by retinopathy, which begins with changes in blood vessels of the retina. This affects the light-sensitive tissues at the back of the eye. In some cases, the blood vessels can swell or leak fluid. In other cases, there is abnormal growth of new blood vessels on the surface of the retina. Over time, this can lead to vision loss and blindness. 

Your eye care doctor may treat retinopathy by using a laser to make tiny burns. These burns seal the blood vessels and stop them from growing and leaking.

Key points

  • Diabetic neuropathy is nerve damage due to diabetes.
  • Nerve problems can develop within the first 10 years after being diagnosed with diabetes. The risk of developing neuropathy grows the longer you have diabetes. About half of people with diabetes have some form of nerve damage.
  • Common symptoms of diabetic neuropathy include numbness in the hands or feet, and pain in the hands, feet, or legs. Problems with internal organs, such as the digestive tract, heart, sex organs, or your eyes may also occur.
  • If you have high blood sugar or diabetes, see a health care provider who specializes in diabetes and its complications.

Next steps

Tips to help you get the most from a visit to your health care provider:

  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.
Diabetic Neuropathy - WellSpan Health

Online Medical Reviewer: Grantham, Paula, RN, BSN
Online Medical Reviewer: MMI board-certified, academically affiliated clinician
Last Review Date: 2013-10-25T00:00:00
Last Modified Date: 2015-11-08T00:00:00
Published Date: 2015-11-08T00:00:00
Last Review Date: 2007-03-30T00:00:00
© 2016 WellSpan Health. All Rights Reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.

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