nerve disease or damage. Diabetic neuropathy is nerve damage caused by
diabetes. People who have diabetes often have high blood
sugar levels. Over time, high blood sugar levels can damage nerves throughout
There are three kinds of diabetic neuropathy.
Over time, high
blood sugar levels from diabetes can damage nerves throughout your body. The
higher your blood sugar levels, the more likely you are to have nerve damage.
So controlling your blood sugar throughout your life is very important.
The older you get, and the longer you have diabetes, the more likely you
are to have nerve damage. People who have diabetes who drink too much alcohol are
also more likely to have nerve damage.
Your symptoms will depend
on which nerves are injured. You may not be able to feel pain, especially in
your feet. This can lead to serious infections, because sores or other problems
may not get treated.
When other parts of your body are affected,
symptoms may include:
will check how well you feel light touch and temperature and will test your
strength and your reflexes. Tests such as
nerve conduction studies may be done to confirm the
diagnosis. You may need other tests to see which type of neuropathy you have
and to help guide your treatment.
Doctors can't test for all types
of nerve damage. So it's important to tell your doctor about any pain or
weakness you feel. Also mention heavy sweating or dizziness and any changes in
digestion, urination, and sexual function.
Treatment involves keeping
blood sugar levels in your target range. This will not cure the nerve damage, but it can
help keep the damage from getting worse, and the pain might get better.
depends on your symptoms:
When you have diabetes, you could have a sore or other foot problem without noticing it. Check
your feet every day. An untreated problem on your foot can lead to a serious
infection or even amputation.
Be clear with your doctor about
what is helping you feel better and what is not. You and your doctor can work
together to find the treatment that helps you the most.
blood sugar levels in your target range, set with your doctor, may help prevent neuropathy from ever
developing. The best way to do this is by checking your blood sugar and adjusting your treatment. It is also important to get to and stay at a healthy
weight by exercising and eating healthy foods.
Learning about diabetic neuropathy:
Living with diabetic neuropathy:
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peripheral neuropathy—initially may not cause any
noticeable symptoms. If you have diabetes, it is important to have regular
medical checkups to check for signs of neuropathy and treat problems before
they become serious.
Symptoms of diabetic neuropathy may vary
depending on the type of neuropathy you have.
Peripheral neuropathy tends to develop slowly over months or years. In general, symptoms may include:
Autonomic neuropathy may affect digestion, the body's ability to regulate
temperature, urination, sexual function, and heart and blood vessel function,
including blood pressure. Symptoms may get worse during pregnancy. In general,
symptoms may include:
focal neuropathy usually appear suddenly. They may include:
Symptoms of focal neuropathy usually get better over
time. But focal neuropathy may be permanent.
A diagnosis of
diabetic neuropathy is based largely on your symptoms,
medical history and physical examination. During a physical exam, your
doctor may check how well you feel light touch, temperature, pain, vibration, and
movement. Your doctor may also check your strength and reflexes.
Electromyogram (EMG) and nerve conduction studies may
be done to confirm a diagnosis. These tests measure how well and how quickly
the nerves conduct electrical impulses. When nerve damage is
present, the speed of nerve function slows.
with autonomic neuropathy—which affects the nerves that control internal
functions—can be hard to diagnose. When new symptoms develop, more
testing may be needed to diagnose the problem, identify the cause, and guide
treatment. For example, a study that measures how fast your stomach empties may
be done if symptoms like bloating, indigestion, or vomiting suggest
gastroparesis, a condition that causes the stomach to
take too long to empty.
Nerve problems in people who have diabetes
may be caused by other conditions, such as kidney disease,
alcohol dependence, or a
vitamin B12 deficiency. A variety of
laboratory tests (such as a
complete blood count) may be used to screen for
conditions other than diabetes that could be causing symptoms. Your symptoms
and medical history will determine which tests are needed.
For some diseases, doctors can use screening
tests to look for problems before you have any symptoms. But doctors can't
test for all types of autonomic or focal neuropathy. So it is important to
report to your doctor any pain, weakness, or motor problems you have. Also
mention any changes in digestion, urination, sexual function, sweating, or
dizziness. Your doctor will also look for signs of autonomic neuropathy during
your physical exams.
The American Diabetes Association (ADA)
recommends that people who have diabetes see a doctor to examine their feet for
cracked or peeling skin, excessive or reduced sweating, blisters, calluses,
ulcers, signs of infection, bone and joint abnormalities, and walking and
balance—during each medical visit. The ADA also recommends a complete foot exam
by a doctor at least once a year.1 This examination
can detect a loss of sensation in your feet, which can lead to more serious
Good control of diabetes over time
is the key to treating diabetic neuropathy. There is no cure for neuropathy, but keeping your blood sugar within a target range can reduce symptoms and prevent them from getting worse.
To help control your diabetes, eat food that is
good for you and exercise. Controlling diabetes means maintaining blood sugar
levels (A1c) within the target range. This
will do more than anything else to help prevent diabetic neuropathy from
diabetic neuropathy depends on your symptoms and the
type of neuropathy that you have. In general, treatment focuses on reducing
current symptoms and preventing the condition from getting worse by keeping
your blood sugar level within your
target range. You can keep your blood sugar levels within the target range by taking
insulin or oral diabetes medicine as prescribed,
checking your blood sugar levels, following your diet for diabetes, exercising,
and seeing your doctor regularly.
Also, it is important to properly care for your feet when you have
diabetic neuropathy. Diabetic neuropathy may cause a loss of feeling in your
feet. It is possible for a sore or
other foot problem to go unnoticed. Without proper foot care, an untreated
foot sore can lead to a serious infection or possibly amputation.
It is also wise to maintain healthy habits such as
seeing your doctor regularly, controlling your blood pressure, eating a
balanced diet, exercising regularly, not smoking, and limiting or avoiding
alcohol. Further treatment depends on the specific type of diabetic
neuropathy that you have along with your current symptoms.
peripheral neuropathy have mild to severe pain in
specific parts of their bodies. Talk with your doctor about treatment that can
reduce your pain and improve your physical functioning, mood, and mental
well-being. Some people find these treatments helpful:
Autonomic neuropathy—which affects nerves that
regulate internal functions—can affect digestion, urination, sweating, sexual
function, blood pressure, and other involuntary body functions. Some symptoms
of autonomic neuropathy can be hard to manage, but others respond well to
diabetic neuropathy gets worse, you may have serious
problems such as severe
bladder infections, or
foot problems. In addition to keeping your blood sugars in your
target range and taking good care of your feet, you may need further treatment
if diabetic neuropathy progresses.
Diabetic neuropathy is a major
risk factor for foot infections or foot
ulcers leading to amputation. It is possible to have permanent disfigurement in one or both
of your feet (such as Charcot foot) from diabetic neuropathy. Surgery is
sometimes needed to correct deformed joints that can result from Charcot foot.
gastroparesis may require other treatment, such as
medicines that empty the stomach more quickly or a feeding tube that is
inserted into the stomach.
bladder infections or other bladder problems, such as loss of control, may
require further diagnostic testing and treatments such as medicines or surgery
to improve bladder function.
Also, it is common to experience
depression with any chronic disease, such as diabetes
or diabetic neuropathy. Seeking help for depression may improve your overall
well-being and aid in the treatment of your condition.
No matter what you or your doctor
try, you may not be pain-free. Be clear with your doctor about what is helping
and what is not. You and your doctor can work together to find the right
combination of medicine and other treatments to help you the most.
The National Institute of Neurological Disorders and
Stroke (NINDS), a part of the National Institutes of Health, is the leading
U.S. federal government agency supporting research on brain and nervous system
disorders. It provides the public with educational materials and information
about these disorders.
The American Diabetes Association (ADA) is a national organization
for health professionals and consumers. Almost every state has a local office.
ADA sets the standards for the care of people with diabetes. Its focus is on
research for the prevention and treatment of all types of diabetes. ADA
provides patient and professional education mainly through its publications,
which include the monthly magazine Diabetes Forecast,
books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also
provides information for parents about caring for a child with diabetes.
The National Diabetes Education Program (NDEP) is
sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers
for Disease Control and Prevention (CDC). The program's goal is to improve the
treatment of people who have diabetes, to promote early diagnosis, and to
prevent the development of diabetes. Information about the program can be found
on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC
This clearinghouse provides information about research
and clinical trials supported by the U.S. National Institutes of Health. This
service is provided by the National Institute of Diabetes and Digestive and
Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).
CitationsAmerican Diabetes Association (2013). Standards of medical care in diabetes—2013. Diabetes Care, 36(Suppl 1): S11–S66.Other Works ConsultedAmerican Diabetes Association (2005). Diabetic neuropathies. Position statement. Diabetes Care, 28(4): 956–962.American Diabetes Association (2013). Standards of medical care in diabetes—2013. Diabetes Care, 36(Suppl 1): S11–S66.Brannagan TH (2010). Acquired neuropathies. In LP Rowland, TA Pedley, eds., Merritt's Neurology, 12th ed., chap. 134, pp. 832–833. Philadelphia: Lippincott Williams and Wilkins.Brownlee M, et al. (2011). Complications of diabetes mellitus. In S Melmed et al., eds., Williams Textbook of Endocrinology, 12th ed., pp. 1462–1551. Philadelphia: Saunders.Freeman R (2010). Diabetic neuropathy. In RS Beaser, ed., Joslin’s Diabetes Deskbook: A Guide for Primary Care Providers, 2nd ed., pp. 499–522. Boston, MA: Joslin Diabetes Center.Hunt DL (2011). Diabetes: Foot ulcers and amputations, search date September 2010. Online version of BMJ Clinical Evidence: http://www.clinicalevidence.com.Masharani U, German MS (2011). Pancreatic hormones and diabetes mellitus. In DG Gardner, D Shoback, eds., Greenspan's Basic and Clinical Endocrinology, 9th ed., pp. 573–655. New York: McGraw-Hill.Molitch ME, Genuth S (2006). Complications of diabetes mellitus. In DC Dale, DD Federman, eds., ACP Medicine, section 9, chap. 3. New York: WebMD.National Institute of Diabetes and Digestive and Kidney Diseases (2008). Diabetic Neuropathies: The Nerve Damage of Diabetes (NIH Publication No. 08–3185). Available online: http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/neuropathies.pdf.
April 12, 2012
E. Gregory Thompson, MD - Internal Medicine & Barrie J. Hurwitz, MD - Neurology
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