Diabetic Neuropathy

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black glucose meter and ketostix

Unfortunately, long-term high blood sugar levels can be the cause of several severe complications, one of which is diabetic neuropathy.

What Is Diabetic Neuropathy?

Diabetic neuropathy is a term used when referring to nerve damage caused by long-term high blood sugar and cholesterol levels, often occurring in people with some type of diabetes. It doesn’t happen overnight – instead, it develops slowly over the course of several years, even decades sometimes.

Treatment is crucial in the case of diabetic neuropathy. The condition isn’t reversible at the moment, despite the scientists’ efforts, so once the nerve is damaged, it cannot repair itself. What’s more, if left untreated, diabetic neuropathy can lead to infection and, in the worst-case scenario, even make amputation necessary.

Types of Diabetic Neuropathy

When it comes to the symptoms of diabetic neuropathy, it’s important to understand that there are different types of this condition that will cause different symptoms. What are the most common ones?

Diabetic Peripheral Neuropathy

When a patient has peripheral neuropathy, it means that there’s typically diabetes-related nerve damage to the nerves that branch out from the brain and spinal cord, the so-called peripheral nervous system. They serve as the communication channel between the central nervous system (CNS) and body parts, including limbs, organs, and skin, and work by sending information from parts of your body to your brain, as well as carrying out the commands your brain gives them to various body parts.

The nerves in your body are divided into three groups – motor, sensory, and automatic – and you might experience different symptoms depending on which group of nerves is affected by peripheral neuropathy.

It’s important to know that peripheral neuropathy is not limited in the sense that while it can affect one group of nerves, it can also affect all three of them.

Diabetic Motor Neuropathy

Motor nerves are responsible for muscle movement and allow you to do things like walk, talk, or use your hands. When they get damaged by neuropathy, you might experience:

  • muscle cramps
  • muscle weakness
  • muscle wasting, or muscle atrophy, which is the wasting or thinning of your muscle tissue
  • twitching
  • foot problems, in particular, foot drop, which is the difficulty with lifting the front part of your foot

 

Diabetic Sensory Neuropathy

The sensory muscles are responsible for sensory information, so for example, your feeling of pain, hotness, coldness, or touching. When it comes to the symptoms it can cause, those include:

  • prickling and tingling sensation
  • troubles with balance and coordination
  • increased pain from things that in normal circumstances wouldn’t cause it, such as light touch
  • reduced sensation of pain, or hot and cold

 

Diabetic Autonomic Neuropathy

The autonomic nerves are responsible for the processes in your body that you don’t see and that are happening without your conscious intervention, like breathing, heartbeat, or digestion. It also controls your internal organs, like your bladders, eyes, sweat glands, blood vessels, digestive system, and sex organs. Some symptoms of autonomic neuropathy include:

  • constipation or diarrhea
  • bloating and feeling of sickness
  • low blood pressure, which causes dizziness or fainting
  • urinary or sexual problems, which can lead to urinary tract infections
  • decreased sexual response, including erectile dysfunction
  • fast heartbeat

 

Diabetic Proximal Neuropathy

Proximal neuropathy is a condition that causes nerve damage to nerves in your thighs, hips, buttocks, and/or legs. This type of diabetes-related neuropathy is more common in those with type 2 diabetes, as well as older individuals. The symptoms of proximal neuropathy typically appear on one side of the body, although in some cases, it might spread to the rest of it. Symptoms of proximal neuropathy include:

  • severe pain in the affected areas
  • weak and shrinking thigh muscles
  • difficulty getting up from a sitting position
  • abdominal pain

Diabetic Focal Neuropathy

Focal neuropathy, also called mononeuropathy, is less common than the other types of diabetic neuropathy, and it’s more likely to happen to older adults. If a patient has focal neuropathy, it means that the nerve damage happened to a single nerve, typically in the face, torso, arm, or leg. The symptoms tend to appear suddenly, and while the condition can cause severe pain, there typically aren’t any long-term problems involved.

Since nerve damage can happen in different parts of the body, the symptoms you’ll experience will depend on which body part was affected. Some of the most common ones include:

  • pain in your shin or foot
  • pain in the front of your thigh
  • double vision or difficulty with focusing the eyes
  • paralysis on one side of the face

It’s important to know that mononeuropathy doesn’t only refer to when you develop nerve damage but also when a nerve is compressed. Carpal tunnel syndrome, which is the compression of a nerve in your wrist, is a good example of that. Some of the symptoms it might cause include:

  • numbness or tingling in your hands or fingers, usually in the thumbs, index, middle, and ring fingers
  • sense of weakness and loss of strength in your hands, which makes it difficult to hold things and can cause you to drop them

 

What Are the Risk Factors of Diabetic Neuropathy?

Based on what we know at the moment, some of the risk factors that can increase the chances of a person developing it include how long the patient has had diabetes, their age, their HbA1c levels, whether they smoke, and their BMI.

There’s one more factor that has been discovered through studies, and that is diabetic retinopathy. According to a study conducted between November 2017 and April 2018 that involved 500 patients above the age of 30 with type 2 diabetes, there is a significant correlation between diabetic retinopathy and diabetic neuropathy. According to the study, among patients with:

  • No diabetic retinopathy – 42.3% had no diabetic neuropathy, 32.3% had mild to moderate diabetic neuropathy, and 25.4% had severe diabetic neuropathy.
  • Mild to moderate diabetic retinopathy – 16.8% had no diabetic neuropathy, 38.1% had mild to moderate diabetic neuropathy, and 45.1% had severe diabetic neuropathy.
  • Severe diabetic retinopathy – 3% had no diabetic neuropathy, 10.4% had mild to moderate diabetic neuropathy, and 86.6% had severe diabetic neuropathy.

 

diabetic neuropathy

As for the other way round, according to the results, among patients with:

  • No diabetic neuropathy – 78% had no diabetic retinopathy, 20.6% had mild to moderate diabetic retinopathy, and 1.4% had severe diabetic retinopathy.
  • Mild to moderate diabetic neuropathy – 53.5% had no diabetic retinopathy, 42% had mild to moderate diabetic retinopathy, and 4.5% had severe diabetic retinopathy.
  • Severe diabetic neuropathy – 32.7% had no diabetic retinopathy, 38.6% had mild to moderate diabetic retinopathy, and 28.7% had severe diabetic retinopathy.
diabetic retinopathy map

Can You Treat Diabetic Neuropathy?

Patients who develop diabetic neuropathy often wonder if there’s any way to treat or reverse the effects of the condition. Unfortunately, if nerve damage occurs, it cannot be reversed. However, what can be treated are diabetic neuropathy symptoms.

As mentioned, the symptoms depend on the type of diabetic neuropathy diagnosed, so those with diabetic autonomic neuropathy might have different experiences than those who have focal neuropathy, and so on.

That’s why a doctor will prepare a specific treatment plan which will be dependent on the symptoms you’re experiencing and might include medications such as NSAIDs (nonsteroidal anti-inflammatory drugs), antidepressants, antiseizure drugs, prescription capsaicin patches, or opioid medicines, among other things.

Can You Prevent Diabetic Neuropathy?

In a way, yes. Diabetic neuropathy is a result of long-term high sugar levels, so one of the most important things you should do in order to prevent yourself from developing it is to keep your sugar levels as close to the norm as possible, either by a change of diet, medication such as Rybelsus or Ozempic, or insulin. There are different types of insulin available, including prandial insulin, insulin glargine, and insulin isophane – your doctor will prescribe the one they think will work best in your specific case.  

Some other things that can also help to prevent diabetic neuropathy, or at least slow it down, are:

  • regular exercise
  • maintaining a healthy weight
  • giving up smoking
  • reducing blood pressure and lipid levels, either by lifestyle and diet changes or, if required, through medication
  • consulting a doctor as soon as you notice any feelings of pain, numbness or tingling in your hands or feet.

 

Additionally, you should have your doctor, podiatrist, or diabetes educator check your feet once a year or more if there’s a need for it to ensure that any signs of foot problems or diabetes complications, diabetic neuropathy of which is one, are caught pretty quickly.

What Happens if Diabetic Neuropathy Remains Untreated?

Sugar level test

If diabetic neuropathy isn’t treated, it can lead to several dangerous complications, including:

  • Limb loss – Nerve damage can cause you to lose feeling, due to which sores and abrasions can go unnoticed, leading even to a severe infection. If the infection continues to develop and reaches the bone or causes tissue death, recovering the affected body part might not be possible.
  • Sexual dysfunction – If you have autonomic neuropathy, nerve damage can occur in your sexual organs, causing erectile dysfunction in men or problems with lubrication and arousal in women.
  • Digestive tract issues – Aside from nausea, bloating, or constipation, untreated neuropathy can also lead to gastroparesis, which is a condition where the stomach either doesn’t empty or does so at a significantly reduced rate.
  • Urinary problems – Untreated diabetic neuropathy can lead to urinary tract infections or even urinary incontinence, which is the unintentional loss of urine.

 

The Bottom Line

People with diabetes often have to face many diabetes-related complications, and diabetic neuropathy is one of them. This nerve disease, caused by long-term high blood glucose levels, can lead to several complications and, in the worst-case scenario, even lead to limb amputation, which is why it’s crucial that as soon as you notice any of the diabetic neuropathy symptoms, you get in touch with your doctor. It is possible to get diabetic neuropathy under control even if you get diagnosed with it, provided you act fast.