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Diabetic Focal Neuropathy

Last updated Aug. 24, 2018

Diabetic Focal Neuropathy affects a single nerve. A characteristic of this type of neuropathy is that it can appear abruptly, usually in the head, leg, or torso of an individual.


What are the other Names for this Condition? (Also known as/Synonyms)

  • Focal Neuropathy due to Diabetes
  • Mononeuropathy due to Diabetes

What is Diabetic Focal Neuropathy? (Definition/Background Information)

Diabetic Neuropathy is a type of nerve damage that affects individuals who have diabetes. The term neuropathy indicates nerve dysfunction causing symptoms such as weakness and loss of sensation.

There are four types of Diabetes-Related Neuropathy. These include:

  • Diabetic Peripheral Neuropathy
  • Diabetic Autonomic Neuropathy
  • Diabetic Proximal Neuropathy
  • Diabetic Focal Neuropathy

Diabetic Focal Neuropathy affects a single nerve. A characteristic of this type of neuropathy is that it can appear abruptly, usually in the head, leg, or torso of an individual.

  • Individuals with Focal Neuropathy have reported symptoms such as localized severe pain (in the leg or lower back), pain in the eye, double vision, one side of face being paralyzed (also known as Bell’s palsy), and many other symptoms
  • Chest, stomach, or abdominal pain that is sometimes mistaken for another condition, such as heart attack or appendicitis could be a result of nerve damage in Focal Neuropathy
  • The symptoms of this condition could be painful and unpredictable. But they tend to improve on their own and do not usually cause long-term damage

Who gets Diabetic Focal Neuropathy? (Age and Sex Distribution)

  • Individuals with non-insulin dependent diabetes mellitus (NIDDM) appear to have an earlier onset of Diabetic Focal Neuropathy symptoms than those with insulin-dependent diabetes mellitus (IDDM)
  • The symptoms are more prevalent in those with type-2 diabetes
  • Diabetic Focal Neuropathy is reported to affect individuals who have suffered from diabetes for a prolonged time. The prevalence of Diabetic Neuropathy is reported to increase the longer an individual has had diabetes
  • It has been reported that men develop Focal Neuropathy symptoms earlier than women. Though, according to a study conducted in the United Kingdom, the symptoms of Diabetic Focal Neuropathy are more prevalent in women
  • African-Americans and Native-Americans develop Diabetic Focal Neuropathy earlier than Caucasians. When compared to Europeans, Asian Indians have a lower risk of developing neuropathy. However, despite a lower risk of developing neuropathy associated with diabetes, the South Asians are reported to have more painful symptoms

What are the Risk Factors for Diabetic Focal Neuropathy? (Predisposing Factors)

Any individual with diabetes may develop Diabetic Focal Neuropathy. However, the following factors could make one more susceptible to nerve damage:

  • Poor glycemic control
  • The time period (years) one has had diabetes
  • Poor body weight management, obesity
  • Racial preference: African and native Americans appear to be more susceptible to Diabetic Focal Neuropathy
  • Hypertension
  • Smoking
  • Diabetic nephropathy (or diabetic kidney disease) is a risk factor, as it could lead to toxin build-up in blood. These toxins could potentially affect the nervous system

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Diabetic Focal Neuropathy? (Etiology)

The following factors may be responsible for Focal Neuropathy due to Diabetes:

  • Poor glycemic control is a key factor contributing to Diabetic Focal Neuropathy. High blood sugar over an extended period of time could cause nerve damage
  • Smoking, which has been proved to be a causative agent for diabetes, could also lead to narrowing of the blood vessels, thereby restricting blood flow. Poor circulation could lead to nerve dysfunction
  • Some studies have shown unique gene expression profiles in individuals with Diabetic Neuropathy. Thus, genes related or unrelated to diabetes, could potentially contribute to nerve damage
  • Nerve inflammation, as a response to an autoimmune disorder in the individual affected by diabetes, could also lead to Focal Neuropathy

What are the Signs and Symptoms of Diabetic Focal Neuropathy?

Diabetic Focal Neuropathy affects specific nerves and could result in a sudden onset of symptoms, which could include:

  • Sudden weakness or pain in certain areas, such as the lower back or legs
  • Foot-drop, which is a sudden weakness in the ankle
  • Double vision, pain in the eye
  • Inability to focus
  • Intense pain in the pelvic region or lower back; pain in the thigh
  • Bell’s palsy, in which one side of the face is paralyzed
  • Pain in the chest, stomach, or abdomen that may be mistaken for conditions such as heart attack or appendicitis

How is Diabetic Focal Neuropathy Diagnosed?

A healthcare provider may diagnose Diabetic Focal Neuropathy after carefully evaluating the individual based on their medical history, duration of diabetes, glycemic control, and symptoms reported. Additionally, the physician will also check for muscle strength and muscle tone, tendon reflexes, and sensitivity to touch, temperature, and vibration.

Based on an individual’s symptoms, a physician may require one or a combination of the following tests to be performed, in order to arrive at an accurate diagnosis:

  • Blood tests that include fasting plasma glucose, hemoglobin A1c, and complete blood count (CBC)
  • Electrolytes and liver panel (complete metabolic panel)
  • Genetic screens
  • Sequential multiple analysis-7 (renal function and electrolyte imbalances)
  • Nerve conduction velocity (NCV) test to determine how fast nerve impulses travel
  • An electromyography (EMG) test in conjunction with NCV test to see how well the muscles receive signals from the nerves

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Diabetic Focal Neuropathy?

Since Diabetic Focal Neuropathy affects a single nerve, there could potentially be a debilitating pain associated with the condition. The pain could last for days, weeks, or even months.

How is Diabetic Focal Neuropathy Treated?

Diabetic Focal Neuropathy could be effectively treated by:

  • Achieving and maintaining glycemic control
  • Leading an active life
  • Proper nutrition
  • Pain management that could include the following measures:
    • Capsaicin: Made from chili peppers, capsaicin cream can reduce pain in some individuals. The side effects may include a burning feeling and skin irritation
    • Use of oral medication for pain, such as acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs)
    • Acupuncture: Acupuncture may be able to offer help in relieving the pain of neuropathy. No side effects have been reported with this technique. One will likely require more than one session for pain relief
    • Transcutaneous electrical nerve stimulation (TENS): TENS delivers tiny electrical impulses to specific nerve pathways through small electrodes placed on the skin. It is considered safe and painless, but TENS does not work for every individual, or for all types of pain
    • Anti-seizure medications have been successfully used for pain management
    • Anti-depressants: These medications interfere with an individual’s ability to feel pain. Anti-depressants have been used successfully to relieve mild to moderate nerve pain
  • Smoking cessation
  • Reducing alcohol consumption

How can Diabetic Focal Neuropathy be Prevented?

The following measures could help diabetics prevent or delay the onset of Diabetic Focal Neuropathy:

  • Maintaining good glycemic control: Following the recommended medication regimen and steadily maintaining blood sugar in the target range, go a long way in preventing or delaying neuropathy. Blood tests to check for A1c levels could help the patient and physician monitor blood sugar levels
  • Maintaining a healthy lifestyle: Avoiding a sedentary lifestyle and maintaining a healthy body weight play important roles in managing diabetes
  • Smoking cessation
  • Reducing or minimizing alcohol consumption
  • Taking care of one’s feet: Foot problems are common in diabetes, and hence it is important to pay attention to their care. Getting one’s feet examined by a doctor, keeping the feet clean, checking them on a regular basis for wounds and ulcers, keeping them moisturized, and wearing well-fitting footwear are crucial to good foot care. Additionally, care must be taken while trimming toenails to avoid injuring the foot in any way, since these injuries are the staring points of infections

What is the Prognosis of Diabetic Focal Neuropathy? (Outcomes/Resolutions)

Diabetic Focal Neuropathy symptoms could be painful and unpredictable. Nevertheless, the condition tends to improve spontaneously and frequently does not lead to a long-term damage.

Additional and Relevant Useful Information Diabetic Focal Neuropathy:

  • Type 2 diabetes is a chronic disease in which the blood contains high levels of glucose (sugar), the body’s main source of fuel

The following article link will help you understand type 2 diabetes:

http://www.dovemed.com/diseases-conditions/type-2-diabetes/

What are some Useful Resources for Additional Information?


References and Information Sources used for the Article:


Helpful Peer-Reviewed Medical Articles:


Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 18, 2015
Last updated: Aug. 24, 2018