If you buy something through a link on this page, we may earn a small commission. How this works. Diabetic neuropathy is a complication of diabetes that results in damage to the nervous system. It is a progressive disease, and symptoms get worse over time. Neuropathy happens when high levels of fats or sugar in the blood damage the nerves in the body. It can affect virtually any nerve in the body, with a wide range of symptoms. Nerves are essential to how the body works. They enable people to move, send messages about how things feel, and control automatic functions, such as breathing. There are several types. Some involve the peripheral nerves, while others damage the nerves that supply the internal organs, such as the heart, the bladder, and the gut. In this way, it can affect many body functions. Between one-third and a half of people with diabetes have neuropathy, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). In this article, we explore the different types, effects, and risks of diabetic neuropathy.

Types Share on Pinterest Peripheral neuropathy can lead to a loss of sensation in the feet. Four main types of neuropathy can impact on the nervous system, including: Peripheral symmetric neuropathy: This affects the feet and hands. It is the most common form of diabetic neuropathy.

This affects the feet and hands. It is the most common form of diabetic neuropathy. Autonomic neuropathy: This occurs in the nerves that control involuntary functions of the body, such as digestion, urination, or heart rate.

This occurs in the nerves that control involuntary functions of the body, such as digestion, urination, or heart rate. Thoracic and lumbar root, or proximal, neuropathy : This damages nerves along a specific distribution in the body, such as the chest wall or legs.

: This damages nerves along a specific distribution in the body, such as the chest wall or legs. Mononeuropathies: These can affect any individual nerve. The symptoms of neuropathy depend on the type and the nerves involved.

Symptoms The signs and symptoms of diabetic neuropathy usually take several years to appear. Signs and symptoms will depend on which type of neuropathy and nerves it affects. Peripheral neuropathy The symptoms of peripheral neuropathy include: numbness, pain, tingling, and burning sensations starting in the toes and fingers then continuing up the legs or arms

loss of muscle tone in the hands and feet

not being able to feel heat, cold, or physical injury

loss of balance

Charcot’s joint, in which a joint breaks down because of nerve issues, often in the feet Peripheral neuropathy that affects the feet can make it difficult for a person to stand and walk. It can increase the risk of falling. When a person cannot feel heat, cold or injury, this can lead to new problems. For example, a blister on the foot can become ulcerated because the person did not feel pain in the early stages. As the infection progresses, gangrene can develop. Eventually, amputation may be necessary. Click here to find out more about peripheral neuropathy. Autonomic neuropathy The effects of autonomic neuropathy include: heartburn and bloating

nausea, constipation or diarrhea

hypoglycemic unawareness, in which a person does not feel the effects of low sugar levels

difficulties speaking or swallowing

feeling full after eating small amounts of food

vomiting several hours after eating

orthostatic hypotension, or feeling light-headed and dizzy when standing up

a faster heart rate than normal

excessive sweating, even in cool temperatures or while at rest

bladder problems, for example, difficulty emptying the bladder completely when urinating, leading to incontinence

sexual dysfunction in men and women

dysesthesia, or a distorted sense of touch

significant drooping of the face and eyelids

muscle contractions and weakness Other types There are many types of neuropathy. Proximal neuropathy can lead to pain in the lower body, often on one side, and weakness in the legs. Symptoms of focal neuropathy can vary widely, depending on the nerve affected. Focal neuropathy and cranial neuropathy can both lead to visual disturbances, such as double vision. People with diabetic neuropathy often do not realize they have it until the symptoms are more advanced.

Images Not all of the symptoms of peripheral neuropathy are visible, but people should be aware of any wounds on their feet.



Diagnosis Share on Pinterest A physician will carry out a foot exam and may check blood pressure. A physician will carry out a physical exam and foot exam to check for: ankle reflexes

loss of sensation

changes in skin texture

changes in skin color Other tests may include a check of blood pressure and fluctuations in heart rate. If the doctor suspects diabetic neuropathy, they may run some diagnostic tests, such as: an electromyogram (EMG), which records electrical activity in the muscles

a nerve conduction velocity test (NCV) which records the speed at which induced signals pass through the nerves

Treatment Most types of diabetic neuropathy gets worse over time. The first step for people with any type is to bring blood sugars within a target range agreed with a doctor and manage high blood pressure and cholesterol levels. Managing glucose levels will minimize the risk of diabetic neuropathy. A key part of treatment focuses on reducing pain and managing some of the symptoms. Certain medications and types of physical therapy can help to control the pain of diabetic neuropathy, alongside other treatments. However, they cannot repair the nerves. People should also avoid or stop smoking and limit their alcohol intake to a maximum of one drink a day for women and two for men. Medications Drugs that can help to manage pain include: anticonvulsant drugs

tricyclic antidepressants

opioids and nonopioid pain relief medication Opioid use can lead to dependency, so doctors should prescribe as low a dose as possible. A person with diabetic neuropathy might use other types of antidepressants, such as serotonin-norepinephrine inhibitors, to target other painful symptoms of diabetic neuropathy. Topical lotions, compound creams, and some supplements, such as ALA or topical capsaicin, may also provide relief. Capsaicin cream is available for purchase online. Physical therapy Physical therapy, used in combination with medications, might help relieve pain and reduce the risk of dependency on opioids. It may also help alleviate: burning and tingling sensations in the legs and feet

muscle cramps

muscle weakness

sexual dysfunction Electrical nerve stimulation is a painless type of physical therapy that might help to reduce feelings of stiffness and enhance the healing of foot ulcers. Gait training involves relearning how to walk. It helps to prevent and stabilize foot complications, such as ulcers and injury. This type of physical re-education is crucial for people using prosthesis after losing limbs if diabetic neuropathy leads to an amputation. A good physical therapist will ensure that exercises for people with diabetic neuropathy do not hurt the feet, which can be sensitive. Other therapies include devices that a person can use to keep painful or sensitive extremities from touching the bed or chair. A chiropractor, massage therapist, or osteopath can carry out regular massages or manual therapy to stretch the muscles. Massage can inhibit muscle contractions, spasms, and atrophy due to poor blood supply. Specific exercises, such as swimming or aerobics, can help an individual develop and maintain muscle strength and reduce the loss of muscle mass. Therapeutic ultrasound is another type of physical therapy that uses very high-frequency sound waves to stimulate the tissue beneath the skin. This can help some people to regain sensitivity in their feet.

Complications Share on Pinterest Some types of neuropathy can affect a person’s vision. Diabetic neuropathy can contribute to a number of high-risk complications, ranging from heart rate changes to visual disturbances. Possible complications include losing sensation in the feet. This can lead to an inability to feel cuts or sores, and infection might occur as a result. Untreated infection in a limb can result in the need for amputation. Severe bladder and kidney infections might also occur, causing health problems. To prevent the complications of diabetic peripheral neuropathy, good foot care is essential. People with the condition should inspect their feet every day for injuries or sores. Smoking also increases the risk of foot problems in people with certain types of diabetic neuropathy. A podiatrist can help with foot care, and a healthcare provider can give advice on quitting smoking.