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Diabetic neuropathies

Medically reviewed by Drugs.com. Last updated on Jul 25, 2023.

What are Diabetic neuropathies?

Harvard Health Publishing

Diabetic neuropathies are nerve disorders that may affect people with diabetes. They occur more often in people with persistently high blood sugar levels.

There are several different diabetic neuropathies. They include:

Diabetic neuropathies occur in both type 1 and type 2 diabetes. They are most common in people whose blood glucose (blood sugar) levels are not well controlled.

Diabetic neuropathies can occur in people who have had diabetes for a short time. But they are most likely to affect those who have had the disease for more than a decade. It is also more common in people older than 40. People with diabetes who smoke are especially at risk.

Diabetic neuropathy results from several changes in the nerves. A persistently high concentration of blood sugar surrounding nerve cells definitely plays a role. The nerve cells must adjust their internal sugar content to be in balance with their surroundings. To do so, nerve cells make and store the sugar sorbitol. Sorbitol can gradually damage nerve cells.

Damage to blood vessels also contributes to diabetic neuropathy. When blood vessels that feed nerve cells are damaged, the nerves may not get enough oxygen and nourishment.

Symptoms

Most people who have had diabetes for 25 years have some form of neuropathy. Symptoms depend on the specific type of neuropathy.

If your feet are numb, you may not be aware when shoes don't fit properly. This can lead to the formation of a callus. These thickened skin areas can break down over time. They can change into an open sore (ulcer) that may become infected.

Diagnosis

Your doctor usually can diagnose diabetic neuropathy based on your:

When necessary, more specialized testing may be done, such as:

Expected duration

Peripheral and autonomic neuropathies are usually long-term problems. Focal neuropathy may last a few months, but may be chronic.

Prevention

Diabetic neuropathy is caused by abnormally high levels of blood glucose. Therefore, diabetics can help to prevent neuropathy by keeping blood sugar levels under good control.

In addition, avoiding smoking can help to prevent or delay neuropathies.

Treatment

Treatment of diabetic neuropathy focuses on

Healthy eating and regular exercise can keep blood sugar under control in some people with diabetes. For others, treatment with one or more medication or with insulin may be needed.

To relieve the pain of peripheral neuropathy, your doctor may first prescribe acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen.

There are many other medications available to reduce nerve pain. These include

Your doctor may also recommend that you rub on a pain-relieving cream containing capsaicin or apply a lidocaine patch to the painful area. Other options include isosorbide dinitrate topical spray or transcutaneous electrical nerve stimulation (TENS) in which a patch of skin receives tiny electrical shocks intended to interrupt pain signals from the affected area.

If you have gastroparesis, eating small, frequent meals low in fat and fiber may help. Your doctor may prescribe metoclopramide (Reglan) to help the stomach empty.

There are many available treatments for constipation and diarrhea.

To help relieve constipation, drink plenty of fluids and exercise regularly. You also can take

Use laxatives sparingly. Overuse may lead to dependence and make constipation worse.

For diarrhea, your doctor may prescribe

If you have poor emptying of the urinary bladder, your doctor will help you minimize medicines that could contribute to the problem of incomplete bladder emptying. Catheters can be used to empty the bladder when neuropathy is severe. Bladder infections requiring antibiotics commonly occur in people with abnormal bladder function.

For erectile dysfunction (impotence), your doctor may prescribe

Other possible treatments for erectile dysfunction include

Dizziness when standing can be treated by drinking more fluids. Medicines that increase your body salt and water can also help.

For carpal tunnel syndrome, splints, an injection of a corticosteroid, or surgery may be recommended.

If peripheral neuropathy affects your feet, you should:

When to call a professional

See your doctor if you develop new or worsening symptoms of neuropathy.

Call your doctor whenever you have a cut or sore that isn't healing or looks like it is infected. It is extremely important to react promptly to injuries and infections, however minor.

Prognosis

In most cases of focal neuropathy, muscle weakness and/or pain subsides within a few months.

Peripheral neuropathies are persistent problems. The pain can last for years. Some people find that symptoms are easier to tolerate if the painful areas lose sensation and become numb. However, complete loss of feeling increases the risk of foot ulcers.

Additional info

National Institute of Diabetes and Digestive and Kidney Disorders
https://www.niddk.nih.gov/

American Diabetes Association
https://www.diabetes.org/


Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.