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Diabetic Neuropathy Symptoms, Causes & Treatment Options

Learn about diabetic neuropathy, including symptoms, causes, treatment options, and when to seek consultation. Or take a quiz to get a second opinion on your diabetic neuropathy from our A.I. health assistant.

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Diabetic Neuropathy Symptom Checker

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Contents

  1. Overview
  2. Symptoms
  3. Potential Causes
  4. Treatment, Prevention and Relief
  5. When to Seek Further Consultation
  6. Questions Your Doctor May Ask
  7. References

What Is Diabetic Neuropathy?

Summary

Diabetic neuropathy is nerve damage caused by longstanding or poorly controlled diabetes mellitus (DM). Other risk factors for developing diabetic neuropathy include obesity, smoking, cardiovascular disease, and abnormal lipid levels.

Diabetic neuropathy can present as a number of distinct syndromes, including distal symmetric polyneuropathy, autonomic polyneuropathy, cranial neuropathy, or truncal neuropathy. Symptoms may include loss of sensation, weakness, pain, cardiovascular abnormalities, nausea or vomiting, diarrhea, retention of urine, and/or double vision.

The diagnosis is initially made by clinical examination. Treatment includes controlling blood sugar, medications to relieve pain, and regular foot care.

Recommended care

You should visit your primary care physician when convenient, a diagnosis can be made with testing. If diagnosed, your physician can create a treatment plan to manage the pain and motor restrictions that come with this condition.

How common is diabetic neuropathy?

Rare

Diabetic neuropathy is also known as

  • Diabetic polyneuropathy
  • Distal symmetric polyneuropathy
  • Length-dependent diabetic polyneuropathy

Diabetic Neuropathy Symptoms

Diabetic neuropathy can present as a number of distinct syndromes, each with different symptoms [1]. The common syndromes and their symptoms are described below.

Distal symmetric polyneuropathy

More than 80 percent of people have a form of diabetic neuropathy called distal symmetric polyneuropathy [1]. People with this form of diabetic neuropathy usually first develop:

  • Sensation changes in the feet and legs: A loss of touch, pain, and temperature sensation in the feet. The sensory loss will then gradually progress up the legs, and will later affect the hands and spread up the arms. Some people may develop a feeling of pain or burning in their feet.
  • Motor weakness in the arms or legs: Eventually, people with this condition may develop a motor weakness in the arms or legs, although this usually develops after the sensory loss.
  • Painless foot ulcers: Many people may not notice when they injure their feet and thus do not properly treat or protect the wound. This is exacerbated by poor wound healing that occurs in diabetes.
  • Charcot arthropathy: This condition is also known as Charcot foot and ankle. It involves bony deformities in the foot and/or ankle that result from repeated injury to the bones and joints in the foot.
  • Unstable posture: This can occur especially when anyone with this condition closes their eyes. This can occur if the neuropathy damages nerves that are responsible for sensing body position.

Autonomic neuropathies

Some people with diabetic neuropathy may develop autonomic neuropathies, which affect nerves that regulate different body systems, such as the following.

  • Cardiovascular autonomic neuropathy: This is a specific autonomic neuropathy of the cardiovascular system, which may include a fast heart rate at rest, as well as a drop in blood pressure upon standing up (orthostatic hypotension), which can lead to dizziness or passing out.
  • Gastroparesis: This results in the stomach being delayed in emptying. This can cause nausea, vomiting, bloating, and/or early fullness.
  • Diabetic diarrhea: This is watery diarrhea that usually occurs at night or after meals.
  • Retention of urine: Some people with autonomic neuropathy may develop retention of urine due to an inability to sense a full bladder. This can cause a decrease in the frequency of urination and leaking of urine when the bladder becomes too full (incontinence).

Cranial neuropathy

Less commonly, some people with diabetic neuropathy may develop cranial neuropathies, which are dysfunctions of the cranial (head) nerves. This can cause symptoms such as:

  • Double vision (diplopia)
  • Droopy eyelids (ptosis)
  • Facial pain
  • Facial paralysis

Truncal neuropathy

Some people with diabetic neuropathy may develop truncal neuropathies, which are isolated dysfunctions of the nerves in the body. This can cause:

  • Pain or a loss of sensation
  • Motor weakness in an arm, leg, or part of the body
  • Median nerve neuropathy: This is a common example that causes numbness, tingling, and weakness of the thumb, index, and middle finger.

Diabetic Neuropathy Causes

Diabetic neuropathy is caused by damage to the nerves that occurs with longstanding or poorly-controlled diabetes, as well as a few other key risk factors.

Having longstanding or poorly controlled diabetes

Having diabetes for a longer period of time and having a more poorly controlled case of diabetes were both associated with a greater risk of developing diabetic neuropathy and are considered the main risks [2]. Overall, about half of all people with diabetes will develop diabetic neuropathy [3]. In a study of more than 1000 people with type 1 diabetes, 23.5 percent developed diabetic neuropathy at a mean follow-up of 7.3 years. Diabetes is thought to cause diabetic neuropathy due to a combination of low blood flow to nerve cells and metabolic changes such as the formation of substances called "advanced glycosylation end products" that cause inflammation [4].

Other risk factors

Other independent risk factors associated with diabetes include the following.

  • Obesity
  • Smoking
  • Cardiovascular disease
  • Abnormal lipid levels (hyperlipidemia): This is specifically a higher level of total cholesterol, low-density lipoprotein cholesterol, or triglycerides.

Diabetic Neuropathy Symptom Checker

If you have been diagnosed with diabetic neuropathy, challenge our a.i. health assistant to see if it gets the right answer (5 min max). you'll be training buoy to help patients like you.

Treatment Options and Prevention for Diabetic Neuropathy

Treatment and prevention for diabetic neuropathy focus on controlling blood sugar, treating pain, and preventing the development of complications such as diabetic foot ulcers.

Control blood sugar

Controlling blood sugar is important for both preventing the development of diabetic neuropathy and slowing the progression of diabetic neuropathy once it develops. Among people with diabetes but without diabetic neuropathy, control of blood sugar has been shown to reduce the risk of developing diabetic neuropathy by about 60 to 70 percent over five years in type 1 diabetes [5] and by about 60 percent over 15 years in type 2 diabetes [6].

Medications for painful neuropathy

People who develop painful diabetic neuropathy may benefit from medications to relieve the pain. Possible options include carbamazepine (Tegretol), amitriptyline (Elavil), duloxetine (Cymbalta), or pregabalin (Lyrica), among others.

Practice daily foot care

People with diabetic neuropathy should practice daily foot care to prevent the development of diabetic foot ulcers. This involves:

  • Checking the feet on a daily basis
  • Treating any injuries or calluses
  • Going to a podiatrist (foot doctor) for regular foot examinations

When to Seek Further Consultation for Diabetic Neuropathy

If you are diagnosed with diabetes you should go to your physician to establish care. He or she can help you develop a plan to control your blood sugar and reduce your risk of developing diabetic neuropathy.

If you develop symptoms of diabetic neuropathy

You should go to your physician. Your physician can perform an examination to determine if you have developed diabetic neuropathy.

Questions Your Doctor May Ask to Determine Diabetic Neuropathy

To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.

  • Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
  • Are your symptoms causing difficulty at work, socializing, or spending time with friends & family?
  • Are you sleepy during the day?
  • Do you currently smoke?
  • Are you experiencing a headache?

The above questions are also covered by our A.I. Health Assistant.

Diabetic Neuropathy Symptom Checker

If you have been diagnosed with diabetic neuropathy, challenge our a.i. health assistant to see if it gets the right answer (5 min max). you'll be training buoy to help patients like you.

References

  1. Said G. Diabetic neuropathy -- a review. Nature Clinical Practice Neurology. 2007;3(6):331-340. NCBI Link
  2. Tesfaye S, Chaturvedi N, Eaton SE, et al. Vascular risk factors and diabetic neuropathy. The New England Journal of Medicine. 2005;352(4):341-350. NCBI Link
  3. Juster-Switlyk K, Gordon Smith A. Updates in diabetic peripheral neuropathy. F1000Research. 2016;5:F1000 Faculty Review-738. NCBI Link
  4. Feldman EL, Nave KA, Jensen TS, Bennett DLH. New horizons in diabetic neuropathy: Mechanisms, bioenergetics, and pain. CellPress: Neuron Review. 2017;93:1296-1313. CellPress Link
  5. Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine. 1993;329(14):977-986. NCBI Link
  6. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. The Lancet. 1999;354(9178):602. NCBI Link
  7. Juster-Switlyk K, Gordon Smith A. Updates in diabetic peripheral neuropathy. F1000Research. 2016;5:F1000 Faculty Review-738. NCBI Link