Diabetes is responsible for a host of nerve related disorders, commonly referred to as diabetic neuropathies. The problem is very wide spread and can affect every organ system. Approximately 60% -70% of all people with diabetes develop some form of nerve damage.
The risk of developing a nerve disorder increases with time and age, with the highest rate being people who have had diabetes for over 25 years. No cause is known, but the usual diabetes suspects rear their heads, including but not limited to:
- Metabolic Issues (high blood glucose, length of diabetes, low insulin)
- Genetic Issues (inherited susceptibility to nerve disease)
- Lifestyle Issues (smoking and alcohol use)
Types of Nerve Damage
There are four classifications of diabetic neuropathy – peripheral, autonomic, proximal and focal.
Peripheral neuropathy is the most common type and affects the legs, feet, toes, hands and arms. This type of neuropathy is also known as distal symmetric neuropathy and sensorimotor neuropathy. Usually, peripheral damage strikes the lower extremities first. Symptoms are often nonexistent or slight, but can include:
- Sharp pains or cramps
- Sharp sensitivity to touch
- Balance and Coordination Problems
- Numbness or insensitivity to pain or temperature
- Burning, tingling, or prickly sensations
The symptoms can also be worse at night. Other symptoms can include loss of reflexes, foot deformities, blisters and sores on numb areas. Feet injuries are especially problematic for diabetics. Sores that become infected can spread to the bone, ultimately leading to amputations. The NIH estimates that up to 50% of all diabetic amputations could be avoided if prompt treatment was given.
Autonomic neuropathy affects a wide range of important bodily functions including: the heart, blood pressure, blood glucose levels, digestion, respiration, vision, sweat glands, urination, and sexual response.
Proximal neuropathy is often referred to as lumbosacral plexus neuropathy, femoral neuropathy and diabetic amyotrophy. The disorder causes pain in the thighs, hips, and buttocks. Ultimately, the disorder progresses to the point where the legs are weakened making independent sitting or standing difficult without assistance. Proximal neuropathy is more common in older diabetics and those with type 2 diabetes.
Focal neuropathy can affect any nerve in the body, most commonly in the leg, torso, and head. The condition usually comes on suddenly, causing pain and weakness in the areas affected. Typical signs of focal neuropathy in diabetics are:
- Eye Issues (inability to focus, double vision, aching behind one eye)
- Bell’s Palsy (face paralysis on one side)
- Pain (chest, stomach, side, lower back, pelvis, outside of shin, front of thigh, inside of feet)
- Chest pain (often confused with heart attacks).
As you can see, the bad news is that focal neuropathy can be painful and unpredictable. The good news is that usually improves over time (weeks or months) and does no long term damage.
Prevention and Diagnosis of Diabetic Neuropathies
There is little you can do to prevent neuropathy, other than maintain healthy blood glucose levels. Obviously, if you are experiencing pain, see your doctor for proper diagnosis. Your doctor can conduct a series of observations including, checking blood pressure, pulse, muscle strength, reflexes, sensitivity to touch, etc. Feet are especially susceptible to neuropathy issues, so an annual foot exam is highly recommended. Often neuropathy goes unnoticed in the feet, so it is not wise to wait for symptoms to appear.
Other tests that can be conducted are:
Electromyography (nerve conduction studies). This test essentially checks the electric impulses of nerves in your body. This test is not usually needed for diagnosis.
Heart Rate Variability. This test studies how the heart beat varies during rest and activity, and to changes in blood pressure and posture.
Ultrasound. This test looks at internal organs to see how they look compared to normal healthy organs.
Regulating blood glucose, proper diet and meal planning, along with physical exercise are the main treatments for diabetic neuropathy. Medications may also be helpful to control glucose levels. Certain types of neuropathies require additional assistance.
Oral medications are often used to help people with diabetes manage the pain associated with certain neuropathies. Standard pain relievers, such as ibuprofen and acetaminophen, do not work well with nerve pain and may have harmful side effects, other medications have been developed.
Tricyclic Antidepressants (amitriptyline, imipramine and desipramine (Norpramin, Petrofrane)).
Other Antidepressants (duloxetine (Cymbalta), veniafaxine, bupropion (Wellbutrin), paroextine (Paxil), and citalopram (Celexa)).
Anticonvulsants (pregablin (Lyrica), gabapentin (Gabarone, Neurontin), carbamazepine, and lomatrigine (Lamictal)).
Opiods and Opiad like drugs (oxycodone, tramadol (Ultram).
While many of the above drugs are antidepressants, you do not have to be depressed to use them. They work quiet well to relieve nerve pain. Moreover, the above list is not exhaustive. No medication is right for everyone, so please consult your physician for guidance.
Skin issues, such as the feet, often benefit from capsaicin cream, lidocaine (Lidoderm, Lidopain) and even primrose oil. A bed cradle, a devise used to elevate bedding above the skin, is also useful to relieve feet and leg pain.
National Institute of Health, Publication No. 08-3185, Diabetic Neuropathies: The Nerve Damage of Diabetes, February 2009 (Accessed May 2013).
By Erich Schultz – Last Reviewed May 2013.