Diabetic Neuropathy

Overview

What is diabetic neuropathy?

Diabetic neuropathy refers to nerve damage caused by high blood sugar due to diabetes.

Your nerves carry electrical signals from your brain to other parts of your body. These signals:

  • Alert you of sensations.
  • Help you move your body.
  • Control specific bodily functions, such as digestion, sweating and bladder emptying.

When you have nerve damage, you may experience numbness or weakness. Nerve damage may also affect your internal organs or your ability to move.

What are the types of diabetic neuropathy?

Diabetic neuropathy can damage different nerves throughout your body. Types of diabetic neuropathy include:

  • Autonomic neuropathy: Damage to nerves that control your organs.
  • Mononeuropathy: Damage to a single nerve, such as in your hand or leg.
  • Peripheral neuropathy: Most commonly affects your feet and legs and sometimes affects the hands.
  • Proximal neuropathy: Leads to weakness in hips, thighs, buttocks and shoulders.

Who might get diabetic neuropathy?

If you have diabetes, you have a higher risk of nerve damage. Your risk for neuropathy increases if you smoke or drink excessively.

You are also more likely to develop neuropathy if you have diabetes and have:

How common is diabetic neuropathy?

Some types of diabetic neuropathy are more common than others. By some estimates of people with diabetic nerve problems:

  • 1 in 2 people have peripheral neuropathy.
  • 1 in 3 have autonomic neuropathy.
  • 1 in 4 people have carpal tunnel syndrome, a type of mononeuropathy.

Symptoms and Causes

What causes diabetic neuropathy?

Diabetes that is not well-controlled can lead to hyperglycemia (high blood sugar). Over time, elevated blood sugar can damage your nerves. Too much blood sugar can also lead to damage to your blood vessels, which bring oxygen and nutrients to your nerves.

What are the symptoms of diabetic neuropathy?

Your symptoms depend on which type of diabetic neuropathy you have. In general, diabetic neuropathy symptoms may include:

  • Burning or shooting sensations.
  • Increased pain sensitivity.
  • Numbness or weakness.
  • Slow-healing foot or leg sores (ulcers).
  • Tingling.
  • Total loss of sensation in your feet.

Diagnosis and Tests

How is diabetic neuropathy diagnosed?

Diabetic neuropathy diagnosis usually involves a foot exam. Your healthcare provider checks your feet for sores, blisters or injuries. Your provider may also touch your feet with special instruments to check for decreased sensations.

If your provider suspects nerve damage, you may have an electromyogram (EMG). This test measures electrical activity or nerve response. During an EMG:

  1. Your provider connects electrodes to your body.
  2. You contract or move certain muscles, such as lifting your leg or wiggling your toes.
  3. Nerve activity displays on an oscilloscope (monitor that shows electrical signals as a wave).

The size and shape of the oscilloscope wave vary based on your nerve response. Looking at this wave gives your provider information about the extent of nerve damage.

Management and Treatment

How is diabetic neuropathy treated?

Diabetic neuropathy treatment involves carefully managing your blood sugar. Controlling diabetes is the most important step to prevent nerve damage from getting worse. You can control your blood sugar through:

You may manage diabetic neuropathy symptoms with:

  • Pain medicines, including topical creams or patches.
  • Other medications can reduce pain.

You should also check your feet daily for wounds or injuries. Foot wounds can contribute to foot and skin complications of diabetes.

Can diabetic neuropathy be reversed?

Maybe. You can keep diabetic neuropathy from worsening, and you may be able to reverse nerve damage with very good control of blood glucose, but the process is very slow.

Prevention

How can I prevent diabetic neuropathy?

If you have diabetes, it’s important to manage your:

  • Blood glucose (sugar).
  • Blood pressure.
  • Cholesterol.

You can decrease your risk of diabetes complications and diabetic nerve pain by:

  • Following a healthy meal and exercise plan.
  • Limiting your alcohol intake to no more than one to two drinks per day.
  • Quitting smoking.
  • Visiting your healthcare provider for a checkup and foot exam at least once per year.

Outlook / Prognosis

What are the complications of diabetic neuropathy?

Peripheral neuropathy can challenge your balance. Nerve pain may make it hard to walk or even sit still comfortably. Nerve damage may mean you don’t notice foot injury right away.

For people with diabetes, foot and leg wounds need treatment right away. Diabetes can cause or worsen problems such as peripheral artery disease (PAD). Without treatment, PAD can lead to amputations.

What is the outlook for people with diabetic neuropathy?

Although reversing nerve damage is difficult, you can still live a high quality of life. Your healthcare provider may prescribe medications to keep pain at bay.

Lifestyle adjustments can be effective, such as:

  • Using a cane to help you move easier.
  • Wearing special shoes to try to protect feet from injuries and skin breakdown.
  • Getting help from a wound clinic to treat and heal foot and leg wounds.
  • Removing throw rugs and other tripping hazards to prevent falls.

Living With

How can I best learn to cope with neuropathy pain?

People with nerve damage may get depressed or discouraged. Talk with your healthcare provider about your mental health. You may benefit from:

  • Joining a support group to connect with others.
  • Practicing destressing techniques, such as meditation or breathing exercises.
  • Starting therapy.
  • Taking medications such as antidepressants, which can reduce pain.

A note from Cleveland Clinic

Diabetic neuropathy is nerve damage caused by elevated blood sugar. You are more likely to develop diabetic neuropathy if you have diabetes that is not well-managed. Smoking, excessive drinking and high blood pressure are also risk factors. If you have diabetic neuropathy, your healthcare provider may prescribe pain medications. You also need to manage your blood sugar with proper nutrition and exercise. Many people with nerve damage may feel depressed or discouraged. Talk with your healthcare provider about your mental health. You may consider starting therapy or joining a support group for people with diabetic nerve damage.

Last reviewed by a Cleveland Clinic medical professional on 04/29/2021.

References

  • American Association of Neuromuscular and Electrodiagnostic Medicine. Diabetic Neuropathy. (https://www.aanem.org/Patients/Muscle-and-Nerve-Disorders/Diabetic-Neuropathy) Accessed 7/9/2021.
  • American Diabetes Association. Neuropathy. (https://www.diabetes.org/diabetes/complications/neuropathy) Accessed 7/9/2021.
  • National Institute of Diabetes and Digestive and Kidney Diseases. Diabetic Neuropathy. (https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies) Accessed 7/9/2021.

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