Nerve Pain: Diabetic neuropathy

Overview

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerves throughout your body. Diabetic neuropathy most often damages nerves in your legs and feet.

Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in your legs and feet to problems with your digestive system, urinary tract, blood vessels, and heart. Some people have mild symptoms. But for others, diabetic neuropathy can be quite painful and disabling.

Diabetic neuropathy is a common and serious complication of diabetes. But you can often prevent diabetic neuropathy or slow its progress with tight blood sugar control and a healthy lifestyle.

Symptoms

There are four main types of diabetic neuropathy. You can have one or more than one type of neuropathy. Your symptoms will depend on the type you have and which nerves are affected. Usually, symptoms develop gradually. You may not notice anything wrong until considerable nerve damage has occurred.

Peripheral neuropathy

Peripheral neuropathy is the most common type of diabetic neuropathy. It affects the feet and legs first, followed by the hands and arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include:

• Numbness or reduced ability to feel pain or temperature changes
• Tingling or burning sensation
• Sharp pains or cramps
• Increased sensitivity to touch — for some people, even the weight of a bedsheet can be painful
• Muscle weakness
• Loss of reflexes, especially in the ankle
• Loss of balance and coordination
• Serious foot problems, such as ulcers, infections, and bone and joint pain

Autonomic neuropathy

The autonomic nervous system controls your heart, bladder, stomach, intestines, sex organs and eyes. Diabetes can affect nerves in any of these areas, possibly causing:

• A lack of awareness that blood sugar levels are low (hypoglycemia unawareness)
• Bladder problems, including urinary tract infections or urinary retention or incontinence
• Constipation, uncontrolled diarrhea or both
• Slow stomach emptying (gastroparesis), causing nausea, vomiting, bloating and loss of appetite
• Difficulty swallowing
• Increased or decreased sweating
• Problems controlling body temperature
• Changes in the way your eyes adjust from light to dark
• Increased heart rate at rest
• Sharp drops in blood pressure after sitting or standing that may cause you to faint or feel lightheaded
• Erectile dysfunction
• Vaginal dryness
• Decreased sexual response

Radiculoplexus neuropathy (diabetic amyotrophy)

Radiculoplexus neuropathy affects nerves in the thighs, hips, buttocks or legs. It’s more common in people with type 2 diabetes and older adults. Other names for this type are diabetic amyotrophy, femoral neuropathy or proximal neuropathy.

Symptoms are usually on one side of the body but sometimes may spread to the other side. You may have:

• Severe pain in a hip and thigh or buttock that occurs in a day or more
• Eventual weak and shrinking thigh muscles
• Difficulty rising from a sitting position
• Abdominal swelling, if the abdomen is affected
• Weight loss

Most people improve at least partially over time, though symptoms may worsen before they get better.

Mononeuropathy

Mononeuropathy, or focal neuropathy, is damage to a specific nerve in the face, middle of the body (torso) or leg. It’s most common in older adults. Mononeuropathy often strikes suddenly and can cause severe pain. However, it usually doesn’t cause any long-term problems.

Symptoms usually go away without treatment over a few weeks or months. Your specific signs and symptoms depend on which nerve is involved. You may have pain in the:

• Shin or foot
• Lower back or pelvis
• Front of thigh
• Chest or abdomen

Mononeuropathy may also cause nerve problems in the eyes and face, leading to:

• Difficulty focusing
• Double vision
• Aching behind one eye
• Paralysis on one side of your face.

When to see a doctor

Call your doctor for an appointment if you have:

• A cut or sore on your foot that is infected or won’t heal
• Burning, tingling, weakness or pain in your hands or feet that interferes with daily activities or sleep
• Changes in digestion, urination or sexual function
• Dizziness

These signs and symptoms don’t always mean you have nerve damage. But they can be a sign of another condition that requires medical care. Early diagnosis and treatment of any health condition give you the best chance for controlling your diabetes and preventing future problems.

Causes

The exact cause likely differs for each type of neuropathy. Researchers think that over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals, leading to diabetic neuropathy. High blood sugar also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.

However, a combination of factors may lead to nerve damage, including:

• Inflammation in the nerves caused by an autoimmune response. The immune system mistakes nerves as foreign and attacks them.
• Genetic factors unrelated to diabetes may make some people more likely to develop nerve damage.
• Smoking and alcohol abuse damage both nerves and blood vessels and significantly increase the risk of infection.

Risk factors

Anyone who has diabetes can develop neuropathy, but these risk factors make you more likely to get nerve damage:

• Poor blood sugar control. Uncontrolled blood sugar puts you at risk of every diabetes complication, including nerve damage.
• Diabetes history. Your risk of diabetic neuropathy increases the longer you have diabetes, especially if your blood sugar isn’t well-controlled.
• Kidney disease. Diabetes can damage the kidneys. Kidney damage sends toxins into the blood, which can lead to nerve damage.
• Being overweight. Having a body mass index (BMI) greater than 24 may increase your risk of diabetic neuropathy.
• Smoking. Smoking narrows and hardens your arteries, reducing blood flow to your legs and feet. This makes it more difficult for wounds to heal and damages the peripheral nerves.

Complications

Diabetic neuropathy can cause a number of serious complications, including:

• Loss of a toe, foot or leg. Nerve damage can make you lose feeling in your feet. Foot sores and cuts may silently become severely infected or turn into ulcers. Even minor foot sores that don’t heal can turn into ulcers. In severe cases, an infection can spread to the bone, and ulcers can lead to tissue death (gangrene). Removal (amputation) of a toe, foot or even the lower leg may be necessary.
• Joint damage. Nerve damage can cause a joint to deteriorate, causing a condition called Charcot joint. This usually occurs in the small joints in the feet. Symptoms include loss of sensation and joint swelling, instability and sometimes joint deformity. Prompt treatment can help you heal and prevent further joint damage.
• Urinary tract infections and urinary incontinence. If the nerves that control your bladder are damaged, you may be unable to fully empty your bladder. Bacteria can build up in the bladder and kidneys, causing urinary tract infections. Nerve damage can also affect your ability to feel when you need to urinate or to control the muscles that release urine, leading to leakage (incontinence).
• Hypoglycemia unawareness. Low blood sugar (below 70 milligrams per deciliter, or mg/dL) normally causes shakiness, sweating and a fast heartbeat. But if you have autonomic neuropathy, you may not notice these warning signs.
• Sharp drops in blood pressure. Damage to the nerves that control blood flow can affect your body’s ability to adjust blood pressure. This can cause a sharp drop in pressure when you stand after sitting (orthostatic hypotension), which may lead to dizziness and fainting.
• Digestive problems. If nerve damage strikes your digestive tract, you can have constipation or diarrhea, or bouts of both. Diabetes-related nerve damage can lead to gastroparesis, a condition in which the stomach empties too slowly or not at all. This can interfere with digestion and severely affect blood sugar levels and nutrition. Signs and symptoms include nausea, vomiting and bloating.
• Sexual dysfunction. Autonomic neuropathy often damages the nerves that affect the sex organs. Men may experience erectile dysfunction. Women may have difficulty with lubrication and arousal.
• Increased or decreased sweating. Nerve damage can disrupt how your sweat glands work and make it difficult for your body to control its temperature properly. Some people with autonomic neuropathy have excessive sweating, particularly at night or while eating. Too little or no sweating at all (anhidrosis) can be life-threatening.

Prevention

You can prevent or delay diabetic neuropathy and its complications by keeping tight control of your blood sugar and taking good care of your feet.

Blood sugar control

Use an at-home blood sugar monitor to check your blood sugar and make sure it consistently stays within the target range. It’s important to do this on schedule. Shifts in blood sugar levels can accelerate nerve damage.

The American Diabetes Association recommends that people with diabetes have the A1C test at least twice a year. This blood test indicates your average blood sugar level for the past two to three months. If your blood sugar isn’t well-controlled or you change medications, you may need to get tested more often.

Foot care

Follow your doctor’s recommendations for good foot care.

Foot problems, including sores that don’t heal, ulcers and even amputation, are a common complication of diabetic neuropathy. But you can prevent many of these problems by having a comprehensive foot exam at least once a year, having your doctor check your feet at each office visit and taking good care of your feet at home.

To protect the health of your feet:

• Check your feet every day. Look for blisters, cuts, bruises, cracked and peeling skin, redness, and swelling. Use a mirror or ask a friend or family member to help examine parts of your feet that are hard to see.
• Keep your feet clean and dry. Wash your feet every day with lukewarm water and mild soap. Avoid soaking your feet. Dry your feet and between your toes carefully by blotting or patting with a soft towel. Moisturize your feet thoroughly to prevent cracking. Avoid getting lotion between your toes, however, as this can encourage fungal growth.
• Trim your toenails carefully. Cut your toenails straight across, and file the edges carefully so there are no sharp edges.
• Wear clean, dry socks. Look for socks made of cotton or moisture-wicking fibers that don’t have tight bands or thick seams.
• Wear cushioned shoes that fit well. Always wear shoes or slippers to protect your feet from injury. Make sure that your shoes fit properly and allow your toes to move. A podiatrist (foot doctor) can teach you how to buy properly fitted shoes and to prevent problems such as corns and calluses. If problems do occur, your doctor can help treat them to prevent more serious conditions. Even small sores can quickly turn into severe infections if left untreated. If you qualify for Medicare, your plan may cover the cost of at least one pair of shoes each year. Talk to your doctor or diabetes educator for more information.