Diabetic Neuropathy

What is diabetic neuropathy?

Diabetic neuropathy is a disease of the nervous system. The nervous system includes the brain, spine, and nerves. Diabetes is a condition that causes high blood sugar levels. With diabetic neuropathy, the nerves that carry information to and from the brain or spine are damaged. Diabetic neuropathy decreases feeling in your hands, arms, legs, or feet. It may also affect other body areas, such as the heart and digestive or sexual organs.

What causes diabetic neuropathy?

High blood sugar levels may damage the nerves and blood vessels that carry oxygen and nutrients to the nerves. Long-term type 1 or type 2 diabetes that is not controlled is the main cause of diabetic neuropathy. You are more likely to have nerve problems the longer you have diabetes. The following can make your diabetic neuropathy worse:

• Retinopathy (eye problems)
  
  
• Nephropathy (kidney problems)
  
  
• Heart problems
  
  
• Hypertension (high blood pressure)

What are the signs and symptoms of diabetic neuropathy?

You may not be able to recognize that your blood sugar is too low because the normal warning signs, such as cold sweating and rapid heartbeat, may not occur because of damaged nerves. The signs and symptoms of neuropathy depend on which nerves are affected. You may have any of the following:

• Slow stomach emptying causing blood sugar levels to go up and down without a pattern, trouble swallowing, nausea, vomiting, diarrhea, or constipation
  
  
• Itchy or dry skin, hair loss on your arms or legs, or calluses
  
  
• Loss of bladder control, loss of bowel movement control, impotence (problems with erections in males), vaginal dryness in females, or decreased sexual desire
  
  
• Muscle weakness or problems with balancing or walking
  
  
• Pain, numbness, little or no movement, or cramping of your hands, arms, legs, or feet
  
  
• Problems exercising, or feeling more tired than usual
  
  
• High heart rate while resting, frequent dizziness, or dizziness when you stand up

How is diabetic neuropathy diagnosed?

You should have tests every year for diabetic neuropathy. It is diagnosed based on your symptoms and physical exam. Your sensitivity (awareness) to position changes, vibration, pinprick, and touch will be checked. 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. You may also need the following:

• Blood tests: You may need blood taken to give caregivers information about how your body is working. The blood may be taken from your hand, arm, or IV.
  
  
• Heart monitor: This test is also called an EKG or ECG. Sticky pads are placed on your skin to record your heart's electrical activity. An EKG gives information about how your heart is working. Lie as still as possible during the test.
  
  
• 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: This is a group of tests that are done to 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.
  
  
• Urine tests: A sample of your urine is collected and tested. A flow rate recording may be done to measure the speed of your urine stream. A catheter may be used to measure 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. This can be done if you keep your blood sugar levels within a normal range. Your treatment may depend on what problems you have. Diet 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 in men and gastroparesis. You may need these or other medicines:

• Insulin: This medicine may be given to decrease the amount of sugar in your blood. It helps your body move the sugar to your cells, where it is needed 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 caregiver.
  
  
• Exercise: Walk or do other exercise for at least 30 minutes 5 days a week. Exercise can help control diabetes and help you manage your weight. Ask your caregiver what type of exercise is right for you if you have a foot injury or open sores on your feet.
  
  
• Control your weight: Your risk for problems with your diabetes increases when you weigh more than you should. Talk to your caregiver about the best weight for you.

Where can I find support and more information?

Diabetic neuropathy may be life-changing for you and your family. It can be hard to accept that you have diabetic neuropathy. You may want to join a support group with others who have diabetes. Contact the following:

• American Diabetes Association
  1701 North Beauregard Street
  Alexandria , VA 22311
  Phone: 1- 800 - 342-2383
  Web Address: http://www.diabetes.org
  

Contact your caregiver if:

• Your signs or symptoms are getting worse.
  
  
• 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, such as difficulty having an erection in men or vaginal dryness in women, or decreased sexual desire.
  
  
• You have questions or concerns about your disease, medicine, or care.

Seek care immediately or call 911 if:

• Your legs or feet turn blue or black.
  
  
• Call 911 or an ambulance if you have any signs of a heart attack:
  
  
  • Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
    
    
  • Feeling sick to your stomach
    
    
  • Having trouble breathing
    
    
  • A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
    
    
  • Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing

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.

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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.

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