Diabetic Neuropathy

Causes

Diabetic neuropathy is likely caused by a mix of things, such as:

• Metabolic factors like:
• Elevated blood pressure
• High blood glucose
• Longer duration of diabetes
• High cholesterol
• Possibly low levels of insulin
• Damage to blood vessels going to nerves
• Autoimmune factors causing inflammation of nerves
• Nerve trauma
• Genetics
• Smoking or alcohol abuse

Risk Factors

Diabetic neuropathy is more common in older adults.

Things that may raise the risk include:

• Having diabetes for 25 years or more
• Having type 2 diabetes
• High blood pressure
• Obesity
• Lack of exercise
• Peripheral artery disease (PAD)
• High cholesterol

Symptoms

Symptoms of diabetic neuropathy may include:

• Numbness, tingling, or pain in the extremities
• Digestive problems, such as:
• Stomach fullness or discomfort after eating
• Nausea or vomiting
• Loose stools (poop) or stools that are hard to pass
• Lightheadedness
• Urination (peeing) problems
• Erectile dysfunction or vaginal dryness
• Problems with muscles, such as:
• Weakness of face muscles
• Problems swallowing
• Weakness in the arms and/or legs
• Muscle cramps
• Less sweating
• Blurred or double vision

Other neuropathies may also happen, such as carpal tunnel syndrome.

Diabetic neuropathy can lead to serious problems, such as:

• Foot ulcers
• Infection
• Limb loss

Diagnosis

The doctor will ask about symptoms and past health. A physical exam will be done. A foot exam will also be done.

Tests will be done to make the diagnosis and rule out other causes. Tests will depend on the specific problems. They may include:

• Blood tests—to look for abnormalities
• Nerve function tests, such as:
• Nerve conduction studies
• Electromyography
• Imaging of body structures with:
• Magnetic resonance neurography (MRN)
• Ultrasound
• Barium study of stomach—to check for a blockage
• Electrocardiography (ECG)—to check for heart effects
• Biopsy—to test the nerves

Treatment

Treatment may include:

Blood Glucose Management

It is important to regularly monitor blood glucose levels. Meal planning, exercise, and/or medicines can help.

Foot Care

Footcare will be needed to avoid foot ulcers. The nerves in the feet are the ones most often affected by neuropathy. This care will involve:

• Regular visits to a foot doctor
• Careful cleaning, checking, moisturizing, and grooming of the feet
• Wearing well-fitting shoes and thick, soft, seamless socks—to protect feet

Surgery

Nerve decompression surgery may be done to reduce pain.

Other Treatments

Other treatments will depend on symptoms. Options may include:

• Medicines to ease pain, burning, tingling, or numbness from peripheral neuropathy
• Transcutaneous electrical nerve stimulation (TENS)—to ease pain from nerve damage
• Medicines to control any digestive, heart, or urinary symptoms
• Other activities to help improve symptoms and coping, such as:
• Counseling
• Relaxation methods, such as mindfulness, yoga, massage
• Physical activities, such as Tai Chi

Prevention

To help prevent diabetic neuropathy, regularly check and manage:

• Blood glucose levels
• Blood pressure
• Cholesterol levels

The doctor can tell you how often to do this and what the numbers mean.