Neuropathy, denoting nerve disease or damage, becomes diabetic neuropathy when caused by diabetes. Rather than a standalone condition, diabetic neuropathy represents a group of nerve disorders stemming from diabetes.
Nerve damage is a common occurrence among individuals with diabetes, with approximately 60 to 70 percent of diabetics experiencing some form of neuropathy. While diabetes can impact any nerve at any time, the risk of nerve damage escalates with age and the duration of diabetes, particularly prevalent in those with long-standing diabetes of 25 years or more. Additional risk factors include poorly controlled blood sugar levels, elevated blood fat and pressure levels, and being overweight or obese.
Over time, diabetes can inflict nerve damage throughout the body, with early stages often devoid of symptoms. Some individuals may experience pain, tingling, numbness, or loss of sensation in the hands, arms, feet, and legs, while others may remain asymptomatic. Diabetic neuropathy can affect nerves in various organ systems, including the digestive tract, heart, and sexual organs.
The primary cause of diabetic neuropathy is nerve damage resulting from prolonged high blood sugar levels. Poorly controlled blood sugar levels significantly heighten the risk of nerve damage, underscoring the importance of maintaining blood sugar within target ranges.
Diabetic neuropathy manifests in three main types:
Peripheral Neuropathy: Damage to peripheral nerves affecting movement, muscle strength, and sensation, primarily observed in the feet and lower legs. This can lead to severe foot problems, with nerve damage worsening gradually over time.
Autonomic Neuropathy: Damage to autonomic nerves governing functions such as heartbeat, blood pressure, sweating, digestion, urination, and sexual function.
Focal Neuropathy: Involves damage to a single nerve, such as those in the wrist, thigh, or foot. Focal neuropathy typically develops suddenly.
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Table 1: Nerves affected by diabetic neuropathy (it can affect almost every part of the body)
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Diffuse (Peripheral) Neuropathy Affects
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Diffuse (Autonomic) Neuropathy Affects
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Focal Neuropathy Affects
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Diabetic neuropathy can affect almost every part of the body |
Treatment for diabetic neuropathy primarily focuses on controlling blood glucose levels to normalize them as much as possible, along with the use of medications such as pain relievers as needed, depending on the type of nerve damage.
Diagnosis of diabetic neuropathies is typically made by healthcare professionals based on symptoms and a thorough physical examination. During the examination, the doctor will assess blood pressure, heart rate, and conduct a detailed neurological evaluation. This evaluation includes assessing muscle strength, reflexes, and sensitivity to various stimuli such as position changes, vibration, temperature, or light touch. Special tests may be conducted if necessary to determine the underlying cause of symptoms and guide treatment.
Foot exams are recommended for individuals with diabetes, with annual examinations conducted by a doctor or podiatrist to screen for peripheral neuropathy. If diagnosed with peripheral neuropathy, more frequent foot exams are advised. During these exams, the skin, muscles, bones, circulation, and sensation of the feet are evaluated. A filament test may be performed to assess protective sensation in the feet, which involves touching the foot with a nylon monofilament or pricking it with a pin to gauge sensitivity. Reduced sensation increases the risk of foot sores that may not heal properly.
Nerve conduction studies or electromyography may be performed to evaluate the type and extent of nerve damage by assessing the transmission of electrical signals through nerves and muscle response to these signals.
Autonomic testing can assess the function of autonomic nerves by examining heart rate variability, changes in blood pressure, and posture.
Ultrasound imaging may be used to evaluate structures inside the body, such as the bladder and urinary tract, to determine if the bladder empties completely after urination.
In some cases, a nerve biopsy may be conducted to obtain a sample of nerve tissue for examination, typically in research settings.
Additionally, if autonomic neuropathy is suspected, the doctor may refer the patient to a gastroenterologist for further evaluation and testing.