Diabetes is one of the most common diseases in the United States. Neuropathy (nerve pain) can exist due to several reasons. In fact, there are many types of neuropathy.

Diabetic neuropathy is the most common complication of diabetes mellitus that causes pain, numbness, and tingling in the hands, legs, and feet.

It is primarily experienced by those with a long history of diabetes or a history of uncontrolled diabetes and is the leading cause of neuropathy in the United States. Approximately 60-70% of diabetic patients report having neuropathy. According to nlm.nih.gov, “People with diabetes are at risk for blood vessel injury, which may be severe enough to cause tissue damage in the legs and feet.”

The incidence of Diabetic Neuropathy

Diabetic Neuropathy is the “greatest source of morbidity and mortality in Diabetes patients”  affecting approximately 30% of people hospitalized and approximately 20% of diabetes patients in the community. It is estimated to affect more than 20 million people.

What Causes Diabetic Neuropathy?

Diabetes causes a decreased blood flow (and therefore oxygen) to the nerves and nerve tissue. This decrease in blood flow, over time, affects kidney function. Due to kidney dysfunction, waste increases in the bloodstream and causes additional damage to the nerves.

What Are The Symptoms of Diabetic Neuropathy?

Symptoms include:

  • Pain in the hands, arms, feet, and legs
    • Nerve damage (and therefore pain) occurs from the bottom up (feet then legs) and from the outermost extremities in towards the center (hands to arms)
    • For some, there is no pain
  • Numbness
  • Tingling
  • Weakness
  • Loss of balance
  • Decreased reflexes
  • Decreased sensation (inability to feel hot or cold)
  • Muscle twitching
  • Pain from non-painful stimuli
  • Burning sensation
  • Increased heart rate

How Is Diabetic Neuropathy Diagnosed?

Diagnosis begins with a physical exam where the doctor will check for any of the above signs and symptoms. A neurological exam is likely to be done as well.

Diagnostic testing may also include:

  • NCV (nerve conduction velocity test)
    • To measure the speed of electrical signals through the nerves
  • EMG (electromyography)
    • To measure the electrical activity of a muscle
  • MRI (magnetic resonance imaging)
    • Provides a closer look at the anatomy
  • Nerve biopsy
    • A portion of the nerve is removed for closer examination in a lab
  • Spinal tap
    • A needle is inserted into the spinal canal, spinal fluid is obtained for closer study in a lab

What Is The Treatment for Diabetic Neuropathy?

The initial, primary focus for treatment of diabetic neuropathy is to treat the underlying cause or condition, i.e. manage diabetes.

Untreated diabetes can lead to many other complications including non-healing wounds and amputation. Strict control of diabetes is paramount. Depending on the situation, diabetes treatment and pain (and other symptoms) control may be addressed at the same time. However, the focus is to control the cause…diabetes.

Once the neuropathy is present, it can be treated, but not cured. Nerve pain is difficult to control, and diabetic nerve pain is no different. Pain is addressed with NSAID (non-steroidal analgesics), narcotics, topical medications, TENS, acupuncture, massage, and herbal medications. In severe cases, surgery may be performed.

What Are The Complications of Diabetic Neuropathy?

The complications of diabetic neuropathy vary based on the severity of the disease and diabetes management.

Due to the decreased sensation in the extremities, there is a higher risk of cuts, blisters, and non-healing (or difficult to heal) ulcers.

The risk of infection is higher as well. People with diabetic neuropathy, especially untreated, have a much higher risk of amputation, muscle wasting, impotence, kidney failure, and heart attack (with or without symptoms).

What Are the Risk Factors for Diabetic Neuropathy?

Risk factors include:

  • Diagnosis of Diabetes Mellitus (type 1 or 2)
  • Over the age of 40
  • Obesity
  • Hypertension
  • High cholesterol
  • Smoker

How Do I Prevent Diabetic Neuropathy?

The primary preventative step for diabetic neuropathy is the close management of diabetes.

Foot care and general skin care also helps to prevent the disease. People with diabetes should use a mirror (or have a loved one) to check for sores, blisters, and cracked skin in the feet. Keep the skin moisturized.

Treat any sores or blisters immediately. Inform your physician of any symptoms of neuropathy as soon as possible and keep them abreast of any changes (including injuries or wounds).

Although there is no cure for diabetic neuropathy, strict monitoring and control of diabetes can help to decrease the incidence and severity of this disease.

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Resources:
Previous knowledge
ninds.nih.gov (BRAIN)
acpa.org (American Chronic Pain Association)
diabetes.co.uk
diabetes.org
medscape.com
fda.gov

The information in this article is to be used for informational purposes only. It is NOT to be used in place of, or in conjunction with, professional medical advice. Anyone with questions regarding this or other medical issues discussed on this site must consult their physician for further information and treatment.

   

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