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

• Diabetes-Related Neuropathy
• Diabetic Nerve Pain and Distal Polyneuropathy
• Neuropathy due to Diabetes

What is Diabetic 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
• Elevated levels of blood sugar cause injury to nerve fibers throughout the body, but Diabetic Neuropathy particularly damages the nerves present in the hands and feet
• Depending on the affected nerves, the condition can cause signs and symptoms that range from abnormalities in the digestive system, the urinary tract, the blood vessels and heart, to pain and numbness in the extremities. The symptoms vary and could be mild, painful, disabling and even fatal

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

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

Diabetic Peripheral Neuropathy:

• This type usually affects the feet and hands; in rare cases, the arms, abdomen, and back may be affected
• The symptoms include tingling, numbness, burning pain, stabbing pain, sensitivity to touch, lack of coordination, muscle weakness, ulcers, and other deformities in the feet
• Early symptoms usually get better when blood sugar is brought and kept under control

Diabetic Autonomic Neuropathy:

• The autonomic nervous system regulates involuntary movements in the body, such as those involved in heart function and digestion. This type of neuropathy could affect the digestive system (especially the stomach), urinary system, blood vessels, sex organs, and many other regions of the body
• Symptoms could include bloating, nausea, vomiting, heartburn, feeling full after small meals, constipation, diarrhea, heat intolerance, altered sweating, and dizziness
• Men may not be able to have or keep an erection; the symptoms may also include “dry” or reduced ejaculations. In women, vaginal lubrication may be affected. The affected women may also have fewer or no orgasms
• Medications and changes to one’s dietary habits may help alleviate the symptoms

Diabetic Proximal Neuropathy:

• The underlying pathology of this condition is not clearly understood
• The signs and symptoms include sudden severe pain in the thighs, hips, buttocks, and legs. The condition usually affects one side of the body, but may spread to the other side as well. A weakness in the legs is also reported in Proximal Neuropathy
• Medication and physical therapy help in managing the symptoms such as weakness and pain

Diabetic Focal Neuropathy:

• 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 the condition have reported symptoms such as localized severe pain (in the leg or lower back), pain in the eye, double vision, one side of the face being paralyzed (also known as Bell’s palsy), etc.
• There may be chest, stomach or abdominal pain that is sometimes mistaken for other conditions, such as heart attack or appendicitis
• These conditions are painful and unpredictable, but they tend to improve on their own and do not usually cause long-term damage

Who gets Diabetic Neuropathy? (Age and Sex Distribution)

• Individuals with non-insulin dependent diabetes mellitus (NIDDM) appear to have an earlier onset of neuropathy symptoms than those with insulin-dependent diabetes mellitus (IDDM)
• The symptoms of neuropathy are more prevalent in those with type 2 diabetes
• Prevalence of Diabetic Neuropathy is reported to increase the longer an individual has had diabetes. About 2% of diabetic children have neuropathy
• It has been reported that men develop neuropathy symptoms earlier than women. Though, according to a study conducted in the United Kingdom, the symptoms of Diabetic Neuropathy are more prevalent in women
• African-Americans and Native-Americans develop Diabetic 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 Neuropathy? (Predisposing Factors)

Any individual with diabetes may develop Diabetic 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 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 Neuropathy? (Etiology)

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

• Poor glycemic control is a key factor contributing to Diabetic 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
• Heavy alcohol consumption is known to be a cause of Peripheral Neuropathy
• 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 neuropathy

What are the Signs and Symptoms of Diabetic Neuropathy?

The signs and symptoms of the four types of Diabetes-Related Neuropathy are as follows:

Peripheral Neuropathy:

• Gradual development of numbness and tingling sensations in the hands and feet
• Burning or stabbing pain
• Sensitivity to touch
• Lack of coordination, muscle weaknesses

Autonomic Neuropathy:

• Inability to understand drop in blood sugar levels in oneself
• Digestive symptoms such as bloating, nausea, heartburn, a feeling of fullness after small meals, constipation, and diarrhea
• Bladder symptoms may include bloating, trouble emptying the bladder, incontinence (leaking urine), frequent bathroom trips at night, etc.
• The blood pressure of the affected individual might change
• Increased resting heart rate
• Sweat changes
• Light-headedness or dizziness
• Sexual health may be affected in both men and women:
  • In men, an inability to have or hold erections, along with “dry” or reduced ejaculations
  • Women may have fewer or no orgasms; also the vaginal lubrication may be affected

Proximal Neuropathy:

• Pain in the hips, buttocks, thighs, and legs
• Muscle weakness
• Trouble getting up from a seated position
• If the condition affects the abdomen, there may be swelling in the abdominal area
• Weight loss

Focal Neuropathy:

• Sudden weakness or pain in certain areas, such as the lower back or legs
• Double vision, pain in the eye
• 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 Neuropathy Diagnosed?

A healthcare provider may diagnose Diabetic 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)
• Some possible tests for sensation such as temperature, touch, and vibration, to assess how well an individual feels or responds to stimuli
• 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
• If an individual is suspected of having Autonomic Neuropathy, the physician may request special tests to observe blood pressure in different positions, as well as assess the individual’s ability to sweat

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 Neuropathy?

The complications could be several, since Diabetic Neuropathy can potentially affect multiple organs in the body. Some of the potential complications of Diabetic Neuropathy are:

• Ulcers: Owing to poor circulation, cuts and wounds to the feet could take a long time to heal. The wound(s) might get infected or ulcerated
• Gangrene: Infection in the wound could potentially spread to the bones and cause tissue death (gangrene). If it is not possible to treat the gangrene, a physician may advise amputation of a toe, foot, or lower leg, depending on the extent of infection
• Deformed joints: Called Charcot joint, this condition could develop owing to lack of sensation in the extremities, especially the feet. It could result in swelling and deformed joints
• Sweating issues: The improper functioning of sweat glands with Diabetic Neuropathy could result in one’s inability to regulate body temperature. Overactive sweat glands could lead to night-time sweating or sweating while eating food (gustatory sweating)
•  Digestive system related signs and symptoms: Nausea, constipation, diarrhea, alternating constipation/diarrhea, bloating, and other signs and symptoms, could lead to improper nutrition and therefore, poor glycemic control
• Urinary bladder related conditions:
  • Nerve damage could lead to loss of muscle control in the bladder. Leaking of urine or urinary incontinence could be the result of this complication
  • Nerve damage to the bladder could result in incomplete emptying of the bladder, which could potentially lead to bacterial build-up and therefore to urinary tract infections (UTIs)
• Low blood pressure: Poor circulation could lead to a sharp drop in blood pressure, specifically when an individual stands up from a sitting position (orthostatic hypotension), leading to dizziness or fainting spells
• Inability to notice symptoms of hypoglycemia or low blood sugar: When the blood sugar levels drop too low, individuals suffering from Diabetic Neuropathy may be unable to notice symptoms such as trembling, sweating, or a rapid heart beat
• Sexual dysfunction:
  • Erectile dysfunction in men
  • Lack of vaginal lubrication and orgasms in women

How is Diabetic Neuropathy Treated?

Currently, there is no cure for Diabetic Neuropathy. However, treatment options could be carefully chosen to ease pain, slow the progression of the disease, and reduce/manage complications.

Pain management:

• Capsaicin: Made from chili peppers, capsaicin cream can reduce pain in some individuals. The side effects may include a burning feeling and skin irritation
• Alpha-lipoic acid: An antioxidant, it is found in some foods and may help relieve the symptoms of Peripheral Neuropathy
• 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

The progression of Diabetic Neuropathy could be slowed by the following approaches:

• Proper glycemic control: Could be achieved by medication and maintaining overall health
• Proper nutrition
• Keeping blood pressure under control
• Physical activity: Getting plenty of exercise
• Achieving and maintaining a healthy body weight
• Smoking cessation
• Reducing consumption of alcohol
• Good foot-care

Reducing or managing complications by considering the following approaches:

• Digestive problems: Eating smaller meals more frequently or taking soups/semi-solid foods are known to relieve symptoms of bloating, nausea, and other conditions. Medications could be used to manage nausea, constipation, and diarrhea
• Urinary tract disorders: For bladder control, a physician may recommend using antispasmodic medications (anticholinergics). Following a timed urination could help one keep the bladder empty. In women, a device inserted into the vagina has been found to help in bladder control
• Orthostatic hypotension: This condition could be managed by drinking plenty of fluids, reducing alcohol consumption, and avoiding standing up too quickly from a seated position. Physicians often recommend compression support for the abdomen. Compression stockings, which help increase blood flow, are also known to help with orthostatic hypotension
• Sexual dysfunction:
  • Men: Medication for erectile dysfunction could help manage symptoms of sexual dysfunction, although such medications may not be effective or safe for every individual. Blood flow to the penis has been shown to increase with mechanical vacuum devices as well
  • Women: The use of lubricants could alleviate problems of vaginal dryness

How can Diabetic Neuropathy be Prevented?

The following measures could help diabetics prevent or delay the onset of Diabetic 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 Neuropathy? (Outcomes/Resolutions)

• Diabetic Neuropathy has no known cure, since the mechanisms of this condition is poorly understood
• At present, treatment options are available to alleviate pain and control some associated symptoms
• Good glycemic control and a healthy lifestyle, in combination with proper vigilance, could help one avoid, delay, or manage the symptoms successfully

Additional and Relevant Useful Information for Diabetic 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/