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Diabetic Neuropathy

What is diabetic neuropathy?

Diabetic neuropathy (DN) is a condition caused by nerve damage from long-term high blood sugar levels. DN is a complication of diabetes that is not controlled. The most common nerve damage occurs in the legs, feet, arms, or hands. Nerves in your eyes, heart, digestive system, or sexual organs may also be damaged.

What are the signs and symptoms of diabetic neuropathy?

  • Muscle weakness or problems balancing or walking

  • Pain, cramping, numbness, or little or no movement of your hands, arms, legs, or feet

  • Problems exercising, or feeling more tired than usual

  • Trouble swallowing, nausea, vomiting, diarrhea, or constipation

  • Feeling full after you eat a small amount of food, or fluctuations in your blood sugar levels

  • Itchy or dry skin, hair loss on your arms or legs, or calluses

  • Loss of bladder control, loss of bowel movement control, impotence, vaginal dryness, or decreased sexual desire

  • High resting heart rate, or dizziness

How is diabetic neuropathy diagnosed?

Your healthcare provider will ask about your symptoms and when they started. Your sensitivity to position changes, vibration, pinprick, temperature, and touch will be tested. The reflexes, strength, and flexibility of your toes, feet, and ankles will also be tested. Your feet will also be checked for ulcers, calluses, bunions, or tender areas.

  • Electromyography: This is also called an EMG. An EMG is done to test the function of your muscles and the nerves that control them. Electrodes (wires) are placed on the area of muscle being tested. Needles that enter your skin may be attached to the electrodes. The electrical activity of your muscles and nerves is measured by a machine attached to the electrodes. Your muscles are tested at rest and with activity.

  • Nerve conduction studies: These tests check how surface nerves and related muscles in the body respond to stimulation.

  • Radioisotope gastric-emptying scan: A special x-ray machine uses a special camera to take pictures of your stomach. You are given food to eat that has a small, safe amount of radioactive material in it before taking the pictures. Caregivers then watch the pictures to see how quickly the food leaves your stomach. People who are allergic to shellfish (crab, lobster, or shrimp) may be allergic to the material. Tell your caregiver if you are allergic to any of these foods.

  • Heart monitor: Your healthcare provider may order an EKG or other tests to measure your heart rate and record your heart's electrical activity.

  • Urine tests: Tests may be done to check bladder control and how much urine is left in your bladder after you finish urinating.

How is diabetic neuropathy treated?

The main treatment of diabetic neuropathy is to prevent more nerve damage. Keep your blood sugar level within the range that healthcare providers have told you it should be. Your treatment may depend on the problems you have. Nutrition changes can decrease problems such as vomiting and constipation. You may be given medicines to ease pain or to treat problems such as erectile dysfunction and gastroparesis. You may need these or other medicines:

  • Insulin: This medicine will help decrease your blood sugar level by moving the sugar into cells so it can be used for energy.

  • Hypoglycemic medicine: This medicine may be given to decrease the amount of sugar in your blood. Hypoglycemic medicine helps your body move the sugar to your cells, where it is needed for energy.

  • Antinausea medicine: This medicine may be given to calm your stomach and prevent vomiting.

  • Motility medicine: This medicine is given to help your stomach muscles move food and liquids out of your stomach faster. This medicine also may help you digest food better.

  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.

    • Do not wait until the pain is severe to ask for your medicine. Tell caregivers if your pain does not decrease. The medicine may not work as well at controlling your pain if you wait too long to take it.

    • Pain medicine can make you dizzy or sleepy. Prevent falls by calling a caregiver when you want to get out of bed or if you need help.

What can I do to manage diabetic neuropathy?

  • Eat the right foods: Talk to your dietitian about a meal plan that is right for you.

  • Take your medicines: Take medicine exactly as ordered by your healthcare provider.

  • Exercise: Exercise for at least 30 minutes, 5 days a week. Exercise can help keep your blood sugar level steady, decrease your risk for heart disease, and help you manage your weight. Ask your healthcare provider what exercise is right for you if you have a foot injury or a foot ulcer (sore). You will need to exercise carefully so you do not make the injury or sore worse.

  • Ask about your weight: Ask your healthcare provider if you need to lose weight, and how much to lose. Work with healthcare providers to lose weight safely. Even a 10 to 15 pound weight loss can help you manage your blood sugar levels.

  • Limit alcohol: Alcohol affects your blood sugar levels and can make it harder to manage your diabetes. Women should limit alcohol to 1 drink a day. Men should limit alcohol to 2 drinks a day. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor.

What are the risks of diabetic neuropathy?

You may have ulcers on your feet and not notice them. These foot ulcers may become infected and need surgery. Diabetic neuropathy makes it hard for your heart to cope with exercise and for your body to control your temperature. Damaged nerves may prevent you from recognizing that your blood sugar level is too low. The normal warning signs, such as cold sweats and a rapid heartbeat, may not occur. High blood pressure and heart disease are common with diabetic neuropathy. Diabetic neuropathy can also cause problems with vision, digestion, urination, and sexual function.

When should I contact my healthcare provider?

  • Your signs or symptoms are getting worse.

  • Your blood sugar level is higher or lower than healthcare providers have told you it should be.

  • You have redness, calluses, or sores on your feet.

  • You have a wound that does not heal or is red, swollen, or draining fluid.

  • You have diarrhea, constipation, nausea, or vomiting.

  • You have new sexual problems.

  • You have questions or concerns about your condition or care.

When should I seek immediate care or call 911?

  • Your legs or feet turn blue or black.

  • You have pain, pressure, or fullness in your chest that lasts longer than a few minutes or returns.

  • You have pain or discomfort in your back, neck, jaw, stomach, or arm.

  • You have an upset stomach.

  • You have a sudden cold sweat.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment. The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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