Diabetic Neuropathy: What Can Be Done for Diabetic Nerve Pain?
I’m about to see a patient. As a certified diabetes educator (CDE), they’re coming to see me because they have some form of diabetes. Their physician has sent them to my office because they require education – they may need to start insulin, or they have a new diagnosis, or they may be having a difficult time managing their diabetes.
I review their medical history. “Neuropathy,” I often read.
More often than not, if neuropathy is listed in the medical history of someone with diabetes, they are related.
What Is Diabetic Neuropathy?
Neuropathy is a condition of the nerves – it means that the nerves have been damaged. When diabetes has caused this damage, it is called “diabetic neuropathy.”
According to the National Institute of Diabetes and Digestive and Kidney Diseases, diabetic neuropathy is caused by a multitude of factors – “high blood glucose levels, also called blood sugar, and high levels of fats, such as triglycerides, in the blood from diabetes can damage your nerves.”
Although you may most commonly attribute diabetic neuropathy with a tingling sensation in your feet, there are various types of diabetic neuropathy:
- Peripheral neuropathy is caused by damage to the nerves of the peripheral nervous system. This is the type of neuropathy that you most often attribute with neuropathy, as it affects the hands and the feet. It is estimated that one-third to one-half of people with diabetes have peripheral neuropathy.
- Autonomic neuropathy is caused by damage to the nerves of the internal organs. This leads to issues with the stomach and digestion (gastroparesis), heart rate and blood pressure, the bladder, the sex organs, sweat glands, and the eyes. It can also lead to the inability to detect hypoglycemia, causing a condition known as hypoglycemia unawareness.
- Focal neuropathies affect a single nerve. For example, a single nerve may be damaged in the torso, leg, hand, or arm. An example of a focal neuropathy is carpal tunnel syndrome.
- Proximal neuropathy is a very rare type of neuropathy. It is also very disabling; nerve damage is experienced in the hip, buttock, or thigh on only one side of the body and can take months or years to improve.
What Causes Diabetic Neuropathy?
Sometimes, development of diabetic neuropathy is inevitable. For example, genetic predisposition does play a role in the development of diabetic neuropathy. An autoimmune response can also cause diabetic neuropathy.
However, there are other factors to consider in the development of diabetic neuropathy.
For many people, the development of diabetic neuropathy is related to blood glucose control. Having elevated blood glucose levels for a prolonged period of time can damage the nerves, thus causing diabetic neuropathy. It is thought that this could happen because “High blood sugar interferes with the ability of the nerves to transmit signals. It also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.”
And if you needed another reason to quit smoking, here it is! Smoking damages both the nerves and the blood vessels, as well as increases the risk for infections.
The longer you have diabetes, the higher your risk of developing diabetic neuropathy climbs. This risk is even higher if you have blood glucose levels that are not well controlled, if you are overweight, and if you have kidney disease.
Diabetic Neuropathy Symptoms
If you suspect you have diabetic neuropathy, but you have not been diagnosed, you’ll want to make a note of the following symptoms.
Symptoms of peripheral neuropathy (note that these will be felt in the extremities):
- A tingling sensation.
- Numbness or reduced ability to feel pain and/or temperature changes.
- Muscle weakness.
- Loss of balance and coordination.
- Increased sensitivity to touch.
- Sharp pains.
- Loss of reflexes.
- Serious foot problems; examples include ulcers, bone and joint pain, infections, and deformities.
Symptoms of autonomic neuropathy:
- Hypoglycemia unawareness.
- Difficulty swallowing.
- Bladder problems (such as incontinence, urinary retention, and urinary tract infections).
- Increased heart rate at rest.
- Erectile dysfunction.
- Vaginal dryness.
- The inability of your body to regulate your blood pressure and heart rate, which can lead to sharp drops in blood pressure when standing.
- Problems with regulating body temperature.
Diagnosis of Diabetic Neuropathy
Your physician likely does routine foot exams where she checks for diabetic neuropathy. During the foot exam, she may make a diagnosis of diabetic neuropathy.
In addition to using assessment skills that will check muscle strength and tone, tendon reflexes, and temperature, your physician will also make a diagnosis of diabetic neuropathy using the following tests:
- A monofilament, which is a soft nylon fiber, is placed on various areas of the extremities. Your provider will be detecting sensitivity to touch as well as vibration.
- Nerve conduction studies can be used to diagnose neuropathies such as carpal tunnel syndrome by measuring how quickly your extremities respond to conduct electrical signals.
- Electromyography (EMG) is used with nerve conduction studies to measure the electrical discharges produced by the muscles.
- Autonomic testing is used when your physician suspects autonomic neuropathy. It will assess the ability to sweat and as well as look at your blood pressure in different positions.