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Diabetic Neuropathy

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Last updated May 20, 2024

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Care Plan


First steps to consider

  • See a healthcare provider to get a diagnosis and a treatment plan.
  • Treatment usually starts with controlling blood sugar levels.
  • Do daily footcare.
  • If you’ve been diagnosed with neuropathy, see a provider if your pain worsens or you notice an open sore on your foot.
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Emergency Care

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Call 911 or go to the ER if you have any of the following symptoms:

  • You’ve had diarrhea for more than 2 days.
  • You have a wound that won’t heal.
  • You have sudden loss of vision.

Diabetic neuropathy is nerve damage caused by longstanding or poorly controlled diabetes. It can also be caused by obesity and smoking. Symptoms of diabetic neuropathy include a loss of sensation, weakness, pain, nausea and vomiting, double vision, urine retention, and diarrhea.

What is diabetic neuropathy?

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.

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.

Diabetic neuropathy symptoms

Diabetic neuropathy can present as a number of distinct syndromes, each with different symptoms. 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. 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. Overall, about half of all people with diabetes will develop diabetic neuropathy. 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.

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.

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 and by about 60 percent over 15 years in type 2 diabetes.

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

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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

  • 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?
Hear what 1 other is saying
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Skin thinningPosted December 14, 2019 by S.
My problem may be a little off-topic, but I seriously have nothing else to go by other than what is in the articles that made me come to this link. My lower legs .. in fact, lower shins .. left more than right, feels like a stinging sensation occasionally and since the old days of riding motocross bikes and getting occasional injuries from logs and branches, even rocks and stones, the sores that formed have never really healed. Doctors have given me steroid creams and other things but even though the wetness of the injuries dries up they never really go away. On occasion, I get little blisters and itches, possibly due to the weather but lately, I have noticed that it appears I am losing the actual thickness of the skin. For example .. if you had tight socks on for a few hours it leaves a bump, groove, or similar from the elastic, well where my main sores are the most sore or uncomfortable it seems that the skin is getting eaten away internally. It is noticeable looking from the side. ... I am not sure who to turn to for this but I am hoping it is not something tooo serious....
Dr. Rothschild has been a faculty member at Brigham and Women’s Hospital where he is an Associate Professor of Medicine at Harvard Medical School. He currently practices as a hospitalist at Newton Wellesley Hospital. In 1978, Dr. Rothschild received his MD at the Medical College of Wisconsin and trained in internal medicine followed by a fellowship in critical care medicine. He also received an MP...
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