Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. Diabetic neuropathy is a common complication of both type 1 diabetes and type 2 diabetes.
The best way to prevent or treat diabetic neuropathy is to keep your blood sugar (glucose) and blood pressure well controlled, to attend regular diabetes checks and to avoid smoking. The outcome for early diabetic neuropathy can be good but severe neuropathy is often associated with a poor outcome.
How common is diabetic neuropathy?
Diabetic neuropathy is a common complication of both type 1 diabetes and type 2 diabetes. More than half of people with type 2 diabetes who are older than 60 years have peripheral neuropathy. Persistent painful neuropathy affects up to 1 in 4 people with diabetes.
Who is at risk of developing diabetic neuropathy?
All people with diabetes have a risk of developing diabetic neuropathy. The risk is increased by:
Smoking.Poor control of blood sugar (glucose) levels.Increasing length of time that you have had diabetes.Being overweight.High blood pressure.Coronary heart disease (if you have angina or have had a heart attack).
You are also more likely to develop diabetic neuropathy if you have other complications of diabetes, such as kidney disease or eye disease.
What are the symptoms of diabetic neuropathy?
Neuropathy is one of the long-term complications of diabetes. Diabetic neuropathy can cause problems with the sensory or motor nerves, or with the autonomic nervous system.
Sensory neuropathy affects the nerves that carry messages of touch, pain, temperature and other sensations to the brain. It mainly affects the nerves in the feet and the legs. The nerves to the arms and hands may also be affected but this is less common. The symptoms may include:
TinglingNumbness – unable to feel light touchBeing unable to feel painBeing unable to detect changes in temperatureBeing unaware of the position of a joint and so unable to coordinate movement of that joint.Burning or shooting pains, which tend to be worse during the night.
Your feet are at greatest risk from sensory neuropathy. The loss of feeling may make you unaware of minor injuries to the foot, such as when walking barefoot or your shoes rubbing against your skin. If any such minor injury is ignored then the wound may become infected or form an ulcer.
Damage to the autonomic nervous system may cause a variety of symptoms, such as:
Problems with the function of your gut (bowel), such as bloating, constipation or diarrhoea.Blood pressure problems, including low blood pressure (hypotension), which may cause dizziness or even cause you to collapse on to the ground.Loss of awareness of low blood sugar levels (hypoglycaemia).Loss of bladder control (incontinence of urine).Irregular heartbeats may cause a feeling of having a ‘thumping heart’ (palpitations).Problems with sweating, such as less ability to sweat, feeling unable to cope with warm or hot weather, or sweating whenever you eat food. Men may have difficulty with erections during sex – impotence (erectile dysfunction).
Damage to the motor nerves causes weakness and wasting of the muscles that receive messages from the affected nerves. The symptoms caused by motor neuropathy may include difficulty with walking, falls or problems using your hands for everyday tasks. Motor neuropathy may also cause muscle twitching and cramps.
Diabetic neuropathy may also cause severe pain, tingling, weakness and muscle wasting in the thighs and pelvis. This is called diabetic amyotrophy. This is usually caused by very poor control of blood sugar (glucose) levels. The symptoms usually improve when control of blood glucose levels improves.
How is diabetic neuropathy diagnosed and assessed?
if you have any symptoms suggesting diabetic neuropathy your doctor or nurse will make a thorough assessment of your diabetes and blood pressure control. You will also have some blood tests to check your diabetes control and to check whether there is any other cause for your symptoms. The investigations may also include testing the nerves and mucles (nerve conduction studies and electromyography).
What is the treatment for diabetic neuropathy?
You should see your Endocrinologist if you think you may have diabetic neuropathy or if you have any concerns about your feet.
Good blood sugar (glucose) and blood pressure control and not smoking are very important to prevent the symptoms of diabetic neuropathy becoming any worse. It is also very important to prevent any minor injuries to your feet, including avoiding walking barefoot and wearing comfortable well-fitted shoes.
There are many treatments available to relieve the symptoms caused by neuropathy.
The pain caused by neuropathy (called neuropathic pain) can also be treated.
Can diabetic neuropathy be prevented?
You can reduce your risk of diabetic neuropathy by:
Attending all of your diabetes review appointments. This will help to make sure you are receiving the best treatment for your diabetes. It will diagnose any problems at any early stage, when treatment can be more effective.
Keeping your blood sugar (glucose) and blood pressure levels within your target range.
Having your feet checked at least once each year.
For more information,