Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet.
Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to problems with your digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild; for others, diabetic neuropathy can be painful, disabling and even fatal.
Diabetic neuropathy is a common serious complication of diabetes. Yet you can often prevent diabetic neuropathy or slow its progress with tight blood sugar control and a healthy lifestyle.
There are four main types of diabetic neuropathy. You may have just one type or symptoms of several types. Most develop gradually, and you may not notice problems until considerable damage has occurred. For some people with type 2 diabetes, symptoms of neuropathy develop before diabetes is ever diagnosed.
The signs and symptoms of diabetic neuropathy vary, depending on the type of neuropathy and which nerves are affected.
Autonomic neuropathy is most likely to occur in people who have had poorly controlled diabetes for many years.
Radiculoplexus neuropathy (diabetic amyotrophy)
Sometimes mononeuropathy occurs when a nerve is compressed. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes.
Signs and symptoms of carpal tunnel syndrome include:
When to see a doctor
These symptoms don't always indicate nerve damage, but they may signal other problems that require medical care. In either case, early diagnosis and treatment offer the best chance for controlling symptoms and preventing more-severe problems.
Even minor sores on the feet that don't heal can turn into ulcers. In the most severe cases, untreated foot ulcers may become gangrenous — a condition in which the tissue dies — and require surgery or even amputation of your foot. Early treatment can help prevent this from happening.
Damage to nerves and blood vessels
Anyone who has diabetes can develop neuropathy, but these factors make you more susceptible to nerve damage:
Diabetic neuropathy can cause a number of serious complications, including
Preparing for your appointment
You probably already see your primary care doctor or an endocrinologist on a regular basis. If you don't already see an endocrinologist, you'll likely be referred to one if you start showing signs of diabetes complications. An endocrinologist is a doctor who specializes in treating metabolic disorders, such as diabetes. You may also be referred to a doctor who specializes in treating nervous system problems (neurologist).
Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to arrive well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.
What you can do
Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. List your questions from most important to least important in case time runs out. For diabetic neuropathy, some basic questions to ask your doctor include:
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment any time you don't understand something.
What to expect from your doctor
Tests and diagnosis
Diabetic neuropathy is usually diagnosed based on your symptoms, your medical history and a physical exam. During the exam, your doctor is likely to check your muscle strength and tone, tendon reflexes, and sensitivity to touch, temperature and vibration.
Other tests that may be conducted include:
The American Diabetes Association recommends that all people with diabetes have a comprehensive foot exam — either by a doctor or by a foot specialist (podiatrist) — at least once a year. In addition, your feet should be checked for sores, cracked skin, calluses, blisters, and bone and joint abnormalities at every office visit.
If you already have diabetic neuropathy, you'll likely be referred to a podiatrist or other specialist for monitoring and treatment.
Treatments and drugs
Diabetic neuropathy has no known cure. Treatment for diabetic neuropathy focuses on:
Slowing progression of the disease
For intense blood sugar control, your goals will likely be:
A1C is the amount of sugar that has attached to hemoglobin — the substance that carries oxygen inside red blood cells — in your blood. The higher your average blood sugar level for the past two or three months, the higher your A1C number will be. People who don't have diabetes have an A1C between 4 and 6 percent.
To help slow nerve damage:
Among the pain-relieving treatments that may be tried are the following:
Managing complications and restoring function
Lifestyle and home remedies
These measures can help reduce your risk of diabetic neuropathy:
There are a number of alternative treatments that may help relieve the pain of diabetic neuropathy, such as:
Coping and support
Living with diabetic neuropathy can be difficult and frustrating because there are often no outward signs, making it hard for people to understand your condition. If you find yourself getting down, it may help to talk to a counselor or therapist. Or, some people find that support groups — either in person or online — are helpful because you're talking to others who truly understand what you're going through. In addition, members of support groups can offer you encouragement, as well as advice about living with diabetic neuropathy. Ask your doctor if there are any support groups in your area, or for a referral to a therapist. The American Diabetes Association offers online support through its Web site.
You can help prevent or delay diabetic neuropathy and its complications by keeping your blood sugar consistently well controlled, taking good care of your feet and following a healthy lifestyle.
Blood sugar control
For the best control, aim for a blood glucose level from 70 to 130 mg/dL (3.9 to 7.2 mmol/L) before meals and an A1C reading that is less than 7 percent. An A1C test measures your average blood sugar level over a period of two to three months. The American Diabetes Association recommends that people with diabetes have an A1C test at least twice a year if blood sugar levels are consistently in a healthy range. If your blood sugar isn't well controlled or you change medications, you should be tested more often.
To protect the health of your feet:
Last Updated: 2010-03-17
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