Neuropathy:
Nerve damage from diabetes is called diabetic neuropathy (new-ROP-uh-thee). About half of all people with diabetes have some form of nerve damage. It is more common in those who have had the disease for a number of years and can lead to many kinds of problems.
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Peripheral Neuropathy-
Symptoms
Look at the list below, make a note about any symptoms you have and share it with your doctor during your next office visit.
Tingling
My feet tingle.
I feel "pins and needles" in my feet.
Pain or Increased Sensitivity
I have burning, stabbing or shooting pains in my feet.
My feet are very sensitive to touch. For example, sometimes it hurts to have the bed covers touch my feet.
Sometimes I feel like I have socks or gloves on when I don't.
My feet hurt at night.
My feet and hands get very cold or very hot.
Numbness or Weakness
My feet are numb and feel dead.
I don't feel pain in my feet, even when I have blisters or injuries.
I can't feel my feet when I'm walking.
The muscles in my feet and legs are weak.
I'm unsteady when I stand or walk.
I have trouble feeling heat or cold in my feet or hands.
Other
It seems like the muscles and bones in my feet have changed shape.
I have open sores (also called ulcers) on my feet and legs. These sores heal very slowly.
Diagnosis
Foot Exams
Your health care provider should look at your feet at each office visit to check for injuries, sores, blisters or other problems. As a reminder, take off your shoes and socks when you're in the exam room.
Have a complete foot exam once a year. If you already have foot problems, have your feet checked more often. A complete foot exam includes a check of the skin on your feet, your foot muscles and bones, and your blood flow. Your provider will also check for numbness in your feet by touching your foot with a monofilament. It looks like a stiff piece of nylon fishing line or a bristle in a hairbrush.
Other ways to check your nerves include using a tuning fork. It may be touched to your foot to see if you can feel it moving.
Nerve Conduction Studies and Electromyography (EMG)
If the doctor thinks you might have nerve damage, you may have tests that look at how well the nerves in your arms and legs are working. Nerve conduction studies check the speed with which nerves send messages. An EMG checks how your nerves and muscles work together.
Treatment
To treat nerve damage, you will need to keep your blood glucose levels in your target range, manage your pain and protect your feet. Many people get depressed when they have nerve damage and may need medication for depression as well as counseling.
Medications
Medications to relieve pain and reduce burning, numbness and tingling are available. Some of these are known for their use in other conditions but they still seem to help those with nerve damage.
Speak with your doctor to find out what treatments are best for you.
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Autonomic Neuropathy
Autonomic neuropathy affects the autonomic nerves, which control the bladder, intestinal tract, and genitals, among other organs.
Paralysis of the bladder is a common symptom of this type of neuropathy. When this happens, the nerves of the bladder no longer respond normally to pressure as the bladder fills with urine. As a result, urine stays in the bladder, leading to urinary tract infections.
Autonomic neuropathy can also cause erectile dysfunction (ED) when it affects the nerves that control erection with sexual arousal. However, sexual desire does not usually decrease.
Diarrhea can occur when the nerves that control the small intestine are damaged. The diarrhea occurs most often at night. Constipation is another common result of damage to nerves in the intestines.
Sometimes, the stomach is affected. It loses the ability to move food through the digestive system, causing vomiting and bloating. This condition, called gastroparesis, can change how fast the body absorbs food. It can make it hard to match insulin doses to food portions.
Scientists do not know the precise cause of autonomic neuropathy and are looking for better treatments for his type of neuropathy.
Symptoms
This type of nerve damage affects the nerves in your body that control your body systems. It affects your digestive system, urinary tract, sex organs, heart and blood vessels, sweat glands, and eyes. Look at the list below and make a note about any symptoms you have. Bring this list to your next office visit.
About my digestive system
I get indigestion or heartburn.
I get nauseous and I vomit undigested food.
It seems like food sits in my stomach instead of being digested.
I feel bloated after I eat.
My stomach feels full, even after I eat only a small amount.
I have diarrhea.
I have lost control of my bowels.
I get constipated.
My blood glucose levels are hard to predict. I never know if I'll have high or low blood glucose after eating.
About my urinary tract
I have had bladder control problems, such as urinating very often or not often enough, feeling like I need to urinate when I don't, or leaking urine.
I don't feel the need to urinate, even when my bladder is full.
I have lost control of my bladder.
I have frequent bladder infections.
About my sex organs
(For men) When I have sex, I have trouble getting or keeping an erection.
(For women) When I have sex, I have problems with orgasms, feeling aroused, or I have vaginal dryness.
About my heart and blood vessels
I get dizzy if I stand up too quickly.
I have fainted after getting up or changing my position.
I have fainted suddenly for no reason.
At rest, my heart beats too fast.
I had a heart attack but I didn't have the typical warning signs such as chest pain.
About my body's warning system for low blood glucose levels (hypoglycemia)
I used to get nervous and shaky when my blood glucose was getting too low, but I no longer have those warning signals.
About my sweat glands
I sweat a lot, especially at night or while I'm eating.
I no longer sweat, even when I'm too hot.
The skin on my feet is very dry.
About my eyes
It's hard for my eyes to adjust when I go from a dark place into a bright place or when driving at night.
Diagnosis
To diagnose this kind of nerve damage, you will need a physical exam and special tests as well. For example, an ultrasound test uses sound waves to check on your bladder. Stomach problems can be found using x-rays and other tests. Reporting your symptoms plays a big part in making a diagnosis.
Treatment
There are a number of treatments for damage to nerves that control body systems. For example, a dietitian can help you plan meals if you have nausea or feel full after eating a small amount. Some medications can speed digestion and reduce diarrhea. Problems with erections can be treated with medications or devices.
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Additional Types of Neuropathy
Charcot's Joint
Charcot's Joint, also called neuropathic arthropathy, occurs when a joint breaks down because of a problem with the nerves. This type of neuropathy most often occurs in the foot.
In a typical case of Charcot's Joint, the foot has lost most sensation. The person no longer can feel pain in the foot and loses the ability to sense the position of the joint. Also, the muscles lose their ability to support the joint properly. The foot then becomes unstable, and walking just makes it worse.
An injury, such as a twisted ankle, may make things even worse. Joints grind on bone. The result is inflammation, which leads to further instability and then dislocation. Finally, the bone structure of the foot collapses. Eventually, the foot heals on its own, but because of the breakdown of the bone, it heals into a deformed foot.
People at risk for Charcot's Joint are those who already have neuropathy. They should be aware of symptoms such as:
swelling
redness
heat
strong pulse
insensitivity of the foot.
Early treatment can stop bone destruction and aid healing.
Cranial Neuropathy
Cranial neuropathy affects the 12 pairs of nerves that are connected with the brain and control sight, eye movement, hearing, and taste.
Most often, cranial neuropathy affects the nerves that control the eye muscles. The neuropathy begins with pain on one side of the face near the affected eye. Later, the eye muscle becomes paralyzed. Double vision results. Symptoms of this type of neuropathy usually get better or go away within 2 or 3 months.
Compression Mononeuropathy
Compression mononeuropathy occurs when a single nerve is damaged. It is a fairly common type of neuropathy. There seem to be two kinds of damage. In the first, nerves are squashed at places where they must pass through a tight tunnel or over a lump of bone. Nerves of people with diabetes are more prone to compression injury. The second kind of damage arises when blood vessel disease caused by diabetes restricts blood flow to a part of the nerve.
Carpal tunnel syndrome is probably the most common compression mononeuropathy. It occurs when the median nerve of the forearm is compressed at the wrist. Symptoms of this type of neuropathy include numbness, swelling, or prickling in the fingers with or without pain when driving a car, knitting, or resting at night. Simply hanging your arm by your side usually stops the pain within a few minutes. If the symptoms are severe, an operation can give complete relief from pain.
Femoral Neuropathy
Femoral neuropathy occurs most often in people with type 2 diabetes. A pain may develop in the front of one thigh. Muscle weakness follows, and the affected muscles waste away. A different kind of neuropathy that also affects the legs is called diabetic amyotrophy. In this case, weakness occurs on both sides of the body, but there is no pain. Doctors do not understand why it occurs, but blood vessel disease may be the cause.
Focal Neuropathy
Focal Neuropathy affects a nerve or group of nerves causing sudden weakness or pain. It can lead to double vision, a paralysis on one side of the face called Bell's palsy, or a pain in the front of the thigh or other parts of the body.
Thoracic/Lumbar Radiculopathy
Thoracic or lumbar radiculopath is another common mononeuropathy. It is like femoral neuropathy, except that it occurs in the torso. It affects a band of the chest or abdominal wall on one or both sides. It seems to occur more often in people with type 2 diabetes. Again, people with this neuropathy get better with time.
Unilateral Foot Drop
Unilateral foot drop is when the foot can't be picked up. It occurs from damage to the peroneal nerve of the leg by compression or vessel disease. Foot drop can improve.
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Steps to Prevent or Delay Nerve Damage
There's a lot you can do to prevent or delay nerve damage. And, if you already have diabetic neuropathy (nerve damage), these steps can prevent or delay further damage and may lessen your symptoms.
Keep Your Blood Glucose Levels in Your Target Range
Meal planning, physical activity and medications, if needed, all can help you reach your target range. There are two ways to keep track of your blood glucose levels:
Use a blood glucose meter to help you make decisions about day-to-day care.
Get an A1C test (a lab test) at least twice a year to find out your average blood glucose for the past 2 to 3 months.
Checking your blood glucose levels will tell you whether your diabetes care plan is working or whether changes are needed.
Report symptoms of diabetic neuropathy.
If you have problems, get treatment right away. Early treatment can help prevent more problems later on. For example, if you take care of a foot infection early, it can help prevent amputation.
Take good care of your feet. Check your feet every day. If you no longer can feel pain in your feet, you might not notice a foot injury. Instead, use your eyes to look for problems. Use a mirror to see the bottoms of your feet. Use your hands to feel for hot or cold spots, bumps or dry skin. Look for sores, cuts or breaks in the skin. Also check for corns, calluses, blisters, red areas, swelling, ingrown toenails and toenail infections. If it's hard for you to see or reach your feet, get help from a family member or foot doctor.
Protect your feet. If your feet are dry, use a lotion on your skin but not between your toes. Wear shoes and socks that fit well and wear them all the time. Use warm water to wash your feet, and dry them carefully afterward.
Get special shoes if needed. If you have foot problems, Medicare may pay for shoes. Ask your health care team about it.
Be careful with exercising. Some physical activities are not safe for people with neuropathy. Talk with a diabetes clinical exercise expert who can guide you.
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There's a lot you can do to prevent or delay nerve damage. And, if you already have diabetic neuropathy (nerve damage), these steps can prevent or delay further damage and may lessen your symptoms.
Keep Your Blood Glucose Levels in Your Target Range
Meal planning, physical activity and medications, if needed, all can help you reach your target range. There are two ways to keep track of your blood glucose levels:
Use a blood glucose meter to help you make decisions about day-to-day care.
Get an A1C test (a lab test) at least twice a year to find out your average blood glucose for the past 2 to 3 months.
Checking your blood glucose levels will tell you whether your diabetes care plan is working or whether changes are needed.
Report symptoms of diabetic neuropathy.
If you have problems, get treatment right away. Early treatment can help prevent more problems later on. For example, if you take care of a foot infection early, it can help prevent amputation.
Take good care of your feet. Check your feet every day. If you no longer can feel pain in your feet, you might not notice a foot injury. Instead, use your eyes to look for problems. Use a mirror to see the bottoms of your feet. Use your hands to feel for hot or cold spots, bumps or dry skin. Look for sores, cuts or breaks in the skin. Also check for corns, calluses, blisters, red areas, swelling, ingrown toenails and toenail infections. If it's hard for you to see or reach your feet, get help from a family member or foot doctor.
Protect your feet. If your feet are dry, use a lotion on your skin but not between your toes. Wear shoes and socks that fit well and wear them all the time. Use warm water to wash your feet, and dry them carefully afterward.
Get special shoes if needed. If you have foot problems, Medicare may pay for shoes. Ask your health care team about it.
Be careful with exercising. Some physical activities are not safe for people with neuropathy. Talk with a diabetes clinical exercise expert who can guide you.