What is Diabetic Neuropathy?

Diabetes can affect every major system in your body, including your nervous system. Nerve damage resulting from diabetes is called diabetic neuropathy. High blood sugar harms the vessels supplying blood to the nerves. 

There are four major types of neuropathy: autonomic, peripheral, focal, and diabetic amyotrophy. These are distinguished in part by the areas of the body they impact. Peripheral neuropathy is the most common form; it affects the legs, feet, arms, and hands.

What Causes Diabetic Neuropathy?

The exact cause of diabetic neuropathy is unknown. Several factors contribute, most importantly prolonged elevated blood sugar levels associated with poorly managed diabetes. Genetics, age, and the presence of other health conditions may also increase risk. 

What Are the Symptoms of Diabetic Neuropathy?

These are the most common symptoms of diabetic neuropathy:

• Numbness in the hands or feet
• Pain in the hands, feet, or legs
• Multiple foot problems, including calluses, dry skin and skin breaks, claw toes, and ankle collapse
• Problems with your internal organs, which can manifest in many ways

Diagnosing diabetic neuropathy can be difficult, due to the wide range of symptoms related to the internal organs. If you have questions or concerns, be sure to ask your physician. 

What Are the Complications of Diabetic Neuropathy?

Diabetic neuropathy can result in a number of serious complications:

• Bladder problems: Paralysis of the bladder muscles can lead to urinary tract infections or bladder control problems.
• Sexual dysfunction: Neuropathy can affect the nerves that control penile erection in men. Women can also experience problems related to sexual function. There are treatments available to address these problems. 
• Gastrointestinal issues: Possible symptoms include chronic bloating, diarrhea, constipation, and vomiting.
• Cardiac issues: Dizziness and fainting can result when the nerves to the heart fail to assist in maintaining adequate blood pressure with changes in posture.
• Vision issues: Problems with eyesight can develop due to changes in the vessels supplying blood to the retina. Over time, this can lead to vision loss and blindness. 
• Hypoglycemia unawareness: You may lose the warnings signals of low blood sugar, such as nervousness and shakiness.
• Instability/Risk of Falls: Due to having sensory changes in the feet and legs.

How Is Neuropathy Diagnosed?

The diagnostic process involves a physical exam and other medical tests. These may include X-rays, ultrasounds, and an electrocardiogram or EKG. In addition, your physician will likely check muscle strength and reflexes, as well as nerve response to temperature, touch, and vibration. 

Other possibilities include: 

• A nerve conduction study to analyze the flow of electrical current through a nerve.
• Electromyography or EMG to see how muscles react to electrical impulses.
• A biopsy to collect nerve samples for additional testing.
• Stomach emptying study to evaluate how food is moving throughout the gastrointestinal tract, which is control by nerve stimulation.

How Is Diabetic Neuropathy Treated?

The goal of treatment is to ease pain, discomfort, and ease unpleasant symptoms. It is also important to prevent further damage. Treatment may include:

• Pain medicines.
• Antidepressants.
• Topical creams.
• Transcutaneous electronic nerve stimulation (TENS) therapy.
• Hypnosis.
• Relaxation training.
• Biofeedback.
• Acupuncture.
• Special footwear
• Medical devices
• Physical or occupational therapy
• Adaptive equipment (home aids)
• Smoking/tobacco cessation
• Special medical nutrition plan (for gastroparesis)

A number of approaches may be prescribed to individualize the care of each person for symptom management and to prevent progressive damage. You may benefit from seeing a specialist, such as a Bap neurologist, who can help assess and treat neuropathy conditions.