Diabetes-Related Neuropathy

What is diabetes-related neuropathy?

Diabetes-related neuropathy happens when you experience nerve damage due to high blood sugar (hyperglycemia) that lasts a long time. It can affect people with long-term diabetes, like Type 1 diabetes and Type 2 diabetes. But not everyone with diabetes develops it.

Neuropathy can develop from other causes, too, like pinched nerves, inflammation, nutrient deficiencies and injuries affecting your nerves. Healthcare providers diagnose neuropathy as diabetes-related if you have diabetes and they can’t find another cause for it.

Types of diabetes-related neuropathy

Diabetes-related neuropathy can damage different nerves throughout your body. Types of diabetes-related neuropathy include:

• Peripheral neuropathy: This is the most common type of neuropathy. “Peripheral” refers to any of the nerves outside of your spinal cord. It often affects your feet and legs and sometimes your hands.
• Autonomic neuropathy: This type of neuropathy happens when you have damage to autonomic nerves, which control your involuntary body processes. They control things like your bladder, intestinal tract, blood pressure, heart and sex organs. Another name for autonomic neuropathy is dysautonomia.
• Proximal neuropathy: This is a rare type of neuropathy that affects nerves in your hip, thigh or buttock. It typically only affects one side of your body.

How common is diabetes-related neuropathy?

Overall, diabetes-related neuropathy is fairly common. Studies show that up to 50% of people with diabetes have peripheral neuropathy. More than 30% of people with diabetes have autonomic neuropathy.

What are the symptoms of diabetes-related neuropathy?

Your symptoms will depend on which type of diabetes-related neuropathy you have.

Symptoms of diabetes-related peripheral neuropathy

Diabetes-related peripheral neuropathy commonly affects your feet. Symptoms include:

• Numbness, tingling and/or pins and needles sensations (paresthesia).
• Pain, which may be burning, stabbing or shooting.
• Unusual touch-based sensations (dysesthesia).
• Muscle weakness.
• Slow-healing leg or foot sores (ulcers).
• Total loss of sensation in your feet, like not feeling pain from foot injuries.

Nerve damage that causes peripheral neuropathy typically develops over many years. You may not notice symptoms of mild nerve damage for a long time.

Symptoms of diabetes-related autonomic neuropathy

Autonomic neuropathy can have many different symptoms because it can affect several body systems. Examples include:

• Digestive system: Indigestion, heartburn, nausea and vomiting, gas, diarrhea and constipation. Gastroparesis is a type of digestive system neuropathy.
• Urinary system: Urinary incontinence, urinary retention and frequent UTIs.
• Sex organs: Sexual dysfunction, erectile dysfunction, retrograde ejaculation, vaginal dryness and anorgasmia.
• Cardiovascular system: Low blood pressure, irregular heart rate, dizziness and fainting.
• Sweat glands: Excessive sweating or a lack of sweat.
• Eyes: Difficult for your pupils to adjust to changes in light.

Autonomic neuropathy can also cause hypoglycemia unawareness. This means you don’t experience the typical warning signs of low blood sugar, like shakiness, confusion and intense hunger.

Symptoms of diabetes-related proximal neuropathy

Symptoms of proximal neuropathy include:

• Sudden and severe pain in your hip, buttock or thigh.
• Weakness in your leg that makes it difficult to stand up.
• Loss of reflexes, like the knee-jerk reflex.
• Loss of muscle tissue (atrophy) in the affected area.
• Unexplained weight loss.

What causes diabetes-related neuropathy?

Perpetually high blood sugar levels can damage small blood vessels that provide oxygen and nutrients to your nerves. Without enough oxygen and nutrients, nerve cells can die, affecting the function of your nerve. This causes neuropathy.

Each person is different, so it’s almost impossible to predict how high blood sugar levels have to be — and for how long — to cause neuropathy. One study of people with Type 2 diabetes shows that having an A1C over 7% for at least three years increases your risk of diabetes-related neuropathy. An A1C of 7% means your blood sugar is 154 mg/dL on average.

What are the risk factors for diabetes-related neuropathy?

If you have diabetes, your chance of developing diabetes-related neuropathy increases the older you get and the longer you’ve had diabetes.

Studies show that peripheral neuropathy affects at least 20% of people with Type 1 diabetes who’ve had diabetes for at least 20 years. It affects 15% to 50% of people with Type 2 diabetes who’ve had diabetes for at least 10 years.

You’re also more likely to develop neuropathy if you have diabetes along with:

• High blood pressure (hypertension).
• High body mass index (BMI).
• High cholesterol.
• Kidney disease.
• Alcohol use disorder.
• Smoking.

Studies show that genetics may also increase your risk of diabetes-related neuropathy.

How is diabetes-related neuropathy diagnosed?

To start, a healthcare provider will ask detailed questions about your medical history and diabetes management. They’ll ask about your symptoms and do a physical exam. Tests that help confirm a diabetes-related neuropathy diagnosis include:

• Diabetes foot exam: Your provider will visually assess your feet for any injuries or issues. They’ll then touch your toes and feet with various tools to check if you have numbness. This exam helps diagnose peripheral neuropathy.
• NCS (nerve conduction studies): This test checks how fast electrical signals move through your peripheral nerves in different parts of your body. It helps diagnose peripheral and proximal neuropathies.
• EMG (electromyography): This test evaluates the health and function of your skeletal muscles and the nerves that control them. It helps diagnose peripheral and proximal neuropathies.

Tests to diagnose autonomic neuropathy vary depending on which body system is affected. For example, an ultrasound can show how well your bladder empties when you pee. Tests like gastric emptying scintigraphy (GES) can help diagnose digestive system issues.

It may take more time to get an autonomic neuropathy diagnosis, as many other conditions can cause the same symptoms.

What is the treatment for diabetes-related neuropathy?

Diabetes-related neuropathy treatment involves carefully managing your blood sugar. This is the most important step to prevent nerve damage from getting worse. Your healthcare provider and other diabetes specialists — like a CDCES (Certified Diabetes Care and Education Specialist) — will work with you to achieve realistic blood sugar goals.

Treatment for the symptoms of neuropathy varies depending on the type you have. The following medications can help treat painful symptoms that disturb your sleep or daily activities:

• Pregabalin.
• Gabapentin.
• Capsaicin patches.
• Antidepressants.

Therapies are also helpful, including:

• Physical therapy: This therapy helps improve how you do physical movements. It’s essential if you have peripheral neuropathy, especially if you have muscle pain and weakness.
• Occupational therapy: This therapy helps improve your ability to perform daily tasks.
• Speech therapy: If you have nerve damage that affects your ability to swallow (dysphagia), speech therapy can help.
• Acupuncture: This therapy uses thin needles to stimulate specific points in your body
• Nutrition consult: This can help you learn how to plan, shop for and prepare healthy meals.

Treatments for autonomic neuropathy vary based on the specific issue. Your provider will work with you to find the best option for you.

Can diabetes-related neuropathy be reversed?

With improved blood sugar management, symptoms of diabetes-related neuropathy like numbness and other abnormal sensations may fade within one year. The more severe neuropathy is, the less likely it is that it’ll be reversible.

How can I prevent diabetes-related neuropathy?

You can decrease your risk of diabetes-related neuropathy by:

• Maintaining an A1C under 7%.
• Keeping your blood pressure below 140/90 mmHg or within the target your provider sets.
• Following a healthy meal and exercise plan.
• Maintaining a healthy weight.
• Avoiding or limiting alcohol.
• Avoiding or quitting smoking.
• Visiting your healthcare provider for a checkup and foot exam at least once per year.

It’s also important to do self-examinations of your feet every day to look for blisters, wounds or broken skin. This can help you catch signs of neuropathy — or complications from it — quickly.

What is the prognosis for someone with diabetes-related neuropathy?

If you have diabetes-related neuropathy, your prognosis (outlook) depends on several factors, like:

• The type of neuropathy.
• The severity of neuropathy.
• Your age and overall health.

Your healthcare provider will be able to give you a better idea of what to expect.

Without proper treatment, peripheral neuropathy can affect your quality of life. This is why it’s essential to seek medical help as soon as you notice signs of it.

Autonomic neuropathy can be serious because it involves your body’s vital functions. When those don’t work correctly, it can have very severe — and sometimes, life-threatening — effects.

What are the complications of diabetes-related neuropathy?

Possible complications of peripheral neuropathy include:

• Skin breakdown.
• Infection.
• Ulceration.
• Charcot foot.
• Difficulty with mobility.
• Increased risk of falls and bone fractures.
• Amputation.

Complications of autonomic neuropathy vary depending on the affected body system(s).

How do I take care of myself if I have diabetes-related neuropathy?

Reversing nerve damage is difficult, so diabetes-related neuropathy may affect your day-to-day life. Besides working with your healthcare provider to carefully manage diabetes and getting treatment for neuropathy, you can make the following adjustments to take care of yourself:

• Use a cane or other mobility device to help you move more easily.
• Wear special shoes to protect your feet from injuries.
• Self-check and identify foot and leg wounds early. Get help from a wound clinic when you find them — don’t wait!
• Removing throw rugs and other tripping hazards in your home to prevent falls.
• Seek help from a psychologist or therapist if living with neuropathy is affecting your mental health.
• Educate loved ones about neuropathy and what they can do to help you.
• Join a support group to relate to others going through similar experiences.

When should I see my healthcare provider if I have diabetes-related neuropathy?

You’ll need to see your healthcare provider regularly if you have diabetes-related neuropathy. This is so they can monitor your symptoms and see if they’re getting worse or better. You’ll also need to see your diabetes provider (like an endocrinologist) regularly to make adjustments to your diabetes management plan.

What questions should I ask my doctor?

If you have diabetes-related neuropathy or are at risk for developing it, it may be helpful to ask your healthcare provider the following questions:

• What are the warning signs of diabetes-related neuropathy?
• Can I reverse neuropathy?
• How can I keep neuropathy from getting worse?
• How can I better manage my blood sugar levels?
• Which treatments do you recommend?
• Should I see specialists for neuropathy?
• How will neuropathy affect my day-to-day life?