Diabetic neuropathy is an injury to the nervous system caused by underlying diabetes mellitus.
Diabetes mellitus, often called diabetes, is a condition that affects the body's ability to regulate the level of glucose in the blood. Glucose is the main form of sugar in the body.
It is suspected that a high concentration of glucose is neurotoxic, that is, that it damages the nerve cells. If blood sugar levels are elevated significantly for a period of time, the damage can be permanent.
Some evidence of neuropathy is present in 60% of all individuals with diabetes. Thirty to 40 percent of those individuals have not yet developed symptoms.
When symptoms do occur, they may include any or all of the following: abdominal distressback painchest painconstipation or diarrheadiminished sexual response and erectile dysfunctiondizzinessextreme sensitivity to touchgastroparesis, a condition in which the stomach empties too slowlyhearing impairmentheart attackloss of balance and coordinationnausea and vomitingnumbness or burning in the hands, feet, and legsorthostatic hypotension, or a drop in blood pressure when standing upproblems with urination that lead to urinary tract infectionsvisual impairment, including double visionweakness
Diabetic neuropathy is a complication of high blood glucose in people who have diabetes.
A 10-year study by the National Institute of Diabetes and Digestive and Kidney Diseases showed that blood sugar control is key in preventing diabetic neuropathy. People who kept their blood sugar levels as close to the normal range as possible were able to delay the onset and progression of neuropathy.
Diabetic neuropathy is also more common in people who are more than 40 years old, and in those who smoke. Because some people are more susceptible to nerve damage than others, a genetic predisposition to the condition is suspected.
The diagnosis of diabetic neuropathy begins with a medical history and physical exam. The healthcare provider may order tests such as the following: blood glucose testselectromyography (EMG) studies, which record electrical impulses in musclesnerve biopsies to look for nerve damagenerve conduction velocity (NCV) studies, which measure the speed of nerve impulsesscreening tests to measure sensation in the feetultrasounds to look for damage to internal organs
If diabetic neuropathy is not treated effectively, it can have devastating effects. Muscles may waste and become weak. Sensory involvement may produce progressive numbness and pain. In extreme cases, lack of sensation can result in lead to diabetic ulcers and amputation because the person fails to protect him- or herself from an injury that would normally be painful.
Diabetic neuropathy is not contagious, and poses no risk to others.
Good control of blood sugar levels prevents further nerve damage and can reverse the pain or numbness. Treatment for pain caused by diabetic neuropathy includes the following therapies: acupuncturebiofeedbackhypnosismassagephysical and occupational therapies for treatment of motor involvementregular moderate walkingrelaxation trainingtranscutaneous electronic nerve stimulation (TENS), which uses small bursts of electricity to block pain signalswarm bathswrapping the legs in elastic stockings
The following medications may be used for treatment of pain caused by diabetic neuropathy:antidepressant medications, such as amitriptyline (i.e., Elavil) and an antipsychotick medication, fluphenazine (i.e., Prolixin), to relieve paincapsaicin (i.e., Zostrix), a topical cream that helps relieve paincodeine, a powerful narcotic, for short term relief of severe painmedications commonly used for seizures, which may relieve nerve pain. These include carbamazepine (i.e., Carbatrol, Equetro, Tegretol) and phenytoin sodium (i.e., Dilantin, Phenytek).over-the-counter analgesic ointmentpain medications for burning, tingling, or numbness. These include aspirin, acetaminophen (i.e., Tylenol), and ibuprofen (i.e., Advil, Motrin).newer medications designed to decrease the perception of pain
Gastroparesis may be treated by taking the following steps: Avoid excess fat in the diet.Eat less fiber.Eat small, frequent meals.
Medications that can be used in the treatment of gastroparesis are as follows:erythromycin, an antibioticmedications that reduce excess stomach acidmetoclopramide, a medication that speeds digestion
Diarrhea and other intestinal problems may be treated with the following:antibiotics, such as tetracyclineclonidine, a medication normally used to treat high blood pressurea wheat-free diet, since diarrhea can be caused by gluten in wheat flour
Antibiotics are used to treat urinary tract infections. The affected person may be taught to empty the bladder frequently. He or she may be advised to increase fluid intake. Men who have erectile dysfunction may be treated with medication, or sometimes with a penile implant. Counseling may be helpful to reduce stress
Antibiotics and other medications may cause stomach upset or allergic reactions.
Good control of blood sugar levels is important. It can help prevent the onset and progression of neuropathy. Once sensation is impaired to an area, the person will need to be careful to avoid injury. Good diabetic foot care, for example, is especially important if the feet are numb.
The individual and his or her healthcare provider can monitor diabetic neuropathy. Repeat electromyography and nerve conduction velocity studies may be helpful. Any new or worsening symptoms should be reported to the healthcare provider.
