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Diabetic Neuropathy by Krisha McCoy, MS

Definition

Diabetic neuropathy is a type of nerve damage associated with diabetes. It results in damage to the nerves in a person’s feet, legs, and eyes, and to the nerves that control bodily functions, such as digestion, blood pressure, and heart rate. Diabetic neuropathy can lead to serious complications, including ulcers , infection, and limb loss.

Nerves of the Foot

Causes

Researchers believe that diabetic neuropathy is likely caused by a combination of factors, including:

Metabolic problems (eg, high blood glucose)
Damage to blood vessels
Autoimmune factors
Genetics
Lifestyle factors (eg, smoking , alcohol use , high blood pressure )

Risk Factors

The following factors are thought to increase the risk of diabetic neuropathy:

Older age
Having diabetes for 25 years or more
Having type 2 diabetes
High blood pressure
Smoking
Obesity
Lack of exercise
Peripheral vascular disease
High cholesterol

Symptoms

Symptoms of diabetic neuropathy may include:

Numbness in the extremities
Tingling in the extremities
Pain in the extremities
Wasting of the muscles of the feet or hands
Indigestion
Nausea or vomiting
Diarrhea or constipation
Dizziness or fainting
Urination problems
Impotence or vaginal dryness
Weakness in arms and or legs
Foot drop
Weakness of facial muscles resulting in drooping eyelid, drooping mouth, facial droop, difficulty swallowing
Muscle cramps
A prolonged feeling of fullness after eating, and/or abdominal pain
Heat intolerance due to a decreased ability to sweat normally

If you have diabetic neuropathy, you are at increased risk for developing other types of neuropathies, such as carpal tunnel syndrome .

Diagnosis

Your doctor will ask about your symptoms and medical history. He will also do a physical exam. Other tests may include:

Foot exam—to assess sensation in the foot
Nerve conduction studies —to test nerve activity
Electromyography —to determine how muscles respond to nerve signals
Quantitative sensory testing—the use of stimuli (eg, vibration) to check for neuropathy
Quantitative sudomotor axon reflex test—a test to evaluate the nerve supply of sweat glands
Heart rate tests—to determine how the heart responds to changes
Ultrasound—a test that uses sound waves to view internal organs
Biopsy —to remove a sample of nerve or skin tissue for examination

Treatment

Talk with your doctor about the best treatment plan for you. Treatment options include:

Blood Glucose Management

It is important to regularly monitor blood glucose levels. You can bring them within normal range with meal planning, exercise, and/or medicines.

Foot Care

If you have diabetic neuropathy, you will need to take special care of your feet. The nerves in the feet are the ones most often affected by neuropathy. This care will involve regular visits to a foot doctor and careful cleaning, inspection, moisturizing, and grooming of your feet. In addition, always wear well-fitting shoes and thick, soft, seamless socks to help protect your feet from injuries.

Other Treatments

Other treatments will depend on your symptoms. Medicines can be used to relieve pain, burning, tingling, or numbness. Often, the medicines used to treat these symptoms are the same ones used to treat seizures and depression . Another option to treat pain is called transcutaneous electrical nerve stimulation (TENS). With TENS, a machine sends painless electrical signals through the skin to the nerves. Your doctor may offer this treatment.

If you have gastrointestinal problems, modifying your diet and/or taking an antibiotic can help. Taking care when sitting or standing, increasing salt intake, or taking medicines can help manage dizziness and weakness. An antibiotic can be prescribed to treat a urinary tract infection . Medicines can be used to treat erectile dysfunction, and vaginal lubricants are recommended to treat vaginal dryness.

Prevention

The best way to prevent diabetic neuropathy is to regularly monitor and manage your blood glucose levels. Your doctor can instruct you about how often to check your levels and what the numbers mean.

RESOURCES:

American Diabetes Association http://www.diabetes.org/
National Diabetes Information Clearinghouse http://diabetes.niddk.nih.gov/

CANADIAN RESOURCES:

Canadian Diabetes Association http://www.diabetes.ca/
Health Canada http://www.hc-sc.gc.ca/index_e.html

References:

American Academy of Neurology practice parameters for diagnostic testing for distal symmetric polyneuropathy. Neurology . December 3, 2008.
DynaMed Editorial Team. Diabetic peripheral neuropathy. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated November 2, 2010. Accessed November 4, 2010.
Harati Y, Bosch EP. Disorders of peripheral nerves. In: Bradley WG, ed. Neurology in Clinical Practice . 5th ed. Philadelphia, PA: Butterworth Heinemann Elsevier; 2008.
National Institute of Diabetes and Digestive and Kidney Diseases. Diabetic neuropathies: the nerve damage of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/ . Accessed May 24, 2007.
Ogawa K, Sasaki H, Yamasaki H, et al. Peripheral nerve functions may deteriorate parallel to the progression of microangiopathy in diabetic patients. Nutr Metab Cardiovasc Dis . 2006;16:313-321.
Stewart JD. Diabetic neuropathies. In: Gilman S, ed. Medlink website. Available at: http://www.medlink.com . Accessed August 10, 2007.
University of Chicago, Center for Peripheral Neuropathy website. http://millercenter.uchicago.edu/learnaboutpn/typesofpn/diabetes/index.shtml . Accessed January 15, 2010.
Vinik AI. Diabetic neuropathies. Med Clin North Am . 2004;88:947-999.
2/4/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : Dubinsky RM, Miyasaki J. Assessment: efficacy of transcutaneous electric nerve stimulation in the treatment of pain in neurologic disorders (an evidence-based review): report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology . 2010;74(2):173-176.

Last reviewed December 2011 by J. Thomas Megerian, MD, PhD, FAAP

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