Diabetic Neuropathy

Overview

Diabetic neuropathy is a type of nerve damage that can occur in people with diabetes due to

Understanding the disease

Symptoms

Symptoms of diabetic neuropathy can vary depending on the type and nerves affected. The most common type is peripheral neuropathy, which affects the feet and legs first, followed by the hands and arms. Symptoms of peripheral neuropathy can include pain and numbness in the legs, feet, and hands, as well as problems with the digestive system, urinary tract, blood vessels, and heart. Symptoms often worsen at night. Other types of diabetic neuropathy can affect different parts of the body and cause additional symptoms, such as issues with balance, coordination, and blood pressure regulation.

Risk Factors

Risk factors for developing diabetic neuropathy include having diabetes, uncontrolled high blood sugar, poor blood sugar control, a history of diabetes with poorly controlled blood sugar, kidney disease, being overweight, smoking, and having a family history of diabetes and kidney disease.

Assessment and Diagnosis

Triage

If you suspect diabetic neuropathy, you should see a doctor for an accurate diagnosis and appropriate treatment. It is important to consult a healthcare professional if you experience any of the following symptoms:

1. Burning, tingling, weakness, or pain in your hands or feet that interferes with daily activities or sleep
2. Changes in digestion, urination, or sexual function
3. Dizziness or fainting These symptoms may indicate nerve damage, and a doctor can help determine the cause and provide guidance on managing the condition. Early intervention and proper care can help prevent further complications.

Diagnosis

To diagnose diabetic neuropathy, your healthcare provider will typically perform a physical exam and carefully review your symptoms and medical history. The exam may include checking your overall muscle strength and tone, tendon reflexes, sensitivity to touch, pain, temperature, and vibration. Specific tests may also be performed, such as filament testing, sensory testing, nerve conduction testing, electromyography, and autonomic testing.

Management and Treatment

Complications

The potential complications of diabetic neuropathy include:

1. Hypoglycemia unawareness: People with autonomic neuropathy may not experience warning signs of low blood sugar levels.
2. Loss of a toe, foot, or leg: Nerve damage can lead to a lack of feeling in the feet, which can result in unnoticed cuts or sores that can become infected, potentially requiring amputation.
3. Burning, tingling, weakness, or pain in hands or feet: These symptoms can interfere with daily activities or sleep.
4. Changes in digestion, urination, or sexual function: Diabetic neuropathy can affect various organ systems.
5. Dizziness and fainting: Nerve damage can impair blood flow to the brain, leading to these symptoms. Remember, the complications of diabetic neuropathy can develop gradually over time and may include other issues like fluid retention, heart and blood vessel disease, bone and mineral disorders, and foot sores. It's important to manage diabetes effectively to reduce the risk of complications.

Prevention

Diabetic neuropathy can be prevented or delayed by effectively managing your blood sugar and taking good care of your feet. Closely monitor your blood sugar levels and aim for an A1C of less than 7.0% as recommended by the American Diabetes Association (ADA). Regularly have your feet examined, follow your healthcare provider's recommendations for foot care, and check for any potential issues. The exact cause of neuropathy is unknown, but high blood sugar over time can damage nerves and interfere with their function. Risk factors include diabetes, uncontrolled high blood sugar, and a lack of appropriate management.

Treatment

To treat diabetic neuropathy, the goals of treatment are to slow its progression, relieve pain, manage complications, and restore function. Consistently keeping your blood sugar within the target range recommended by your healthcare provider is key to preventing or delaying nerve damage. Blood sugar management may even improve some current symptoms. Treatment may also involve lifestyle changes, pain management, and medication. Some prescription medications available for diabetes-related nerve pain include anti-seizure drugs like pregabalin (Lyrica) and gabapentin (Gralise, Neurontin). It's important to discuss the benefits and possible side effects with your healthcare provider to find the best treatment for your individual needs.

Preparing for medical consultation

To prepare for an appointment for diabetic neuropathy, you should:

1. Be aware of any pre-appointment restrictions: When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
2. Make a list of your symptoms: Include any symptoms you're experiencing, even if they seem unrelated to diabetic neuropathy.
3. Make a list of key personal information: Note any major stresses or recent life changes that may be relevant to your health.
4. Create a list of all medications, vitamins, herbs, and supplements you're taking: Include the doses and any changes you've made recently.
5. Bring a record of your recent blood sugar levels: If you check them at home, bring a record to share with your healthcare provider.
6. Bring a family member or friend: Having someone accompany you to the appointment can help you remember important details.
7. Prepare a list of questions to ask your healthcare provider: Some basic questions to ask may include, "Is diabetic neuropathy the most likely cause of my symptoms?" or "What treatments are available, and which do you recommend?" Remember to communicate openly with your healthcare provider about your symptoms and concerns, and don't hesitate to ask for clarification or additional information if needed.