Page Updated on Apr 2, 2020 by Dr. Reyfman (Pain Management Specialist) of Pain Physicians NY

What is Diabetic Neuropathy?

Diabetic neuropathy is a long term and very common complication of diabetes. It is a type of nerve damage, mostly in the legs and feet.

What Causes Diabetic Neuropathy?

High levels of blood sugar for a long period of time can damage the nerve fibers, causing eventually diabetic neuropathy. The real cause of diabetic neuropathy is not known, however, it is believed that a combination of factors plays a great role.

High levels of blood sugar damage the delicate nerve fibers, interfering with their ability to transmit signals, as well as the small blood vessels that supply the nerves with oxygen and necessary nutrients.

Other factors thought to have a great role in diabetic neuropathy include:

  • Cigarette smoking
  • Alcohol abuse
  • Genetics
  • Nerve inflammation

Not everyone suffering from diabetes develops diabetic neuropathy. However, people who have poor control of blood sugar, are overweight or have diabetes for a long period of time are at a greater risk of suffering from diabetic neuropathy.

Signs and Symptoms of Diabetic Neuropathy?

The signs and symptoms of diabetic neuropathy vary from the nerves that are affected. However, legs and feet are the most affected. There are four different types of diabetic neuropathy:

  • Peripheral neuropathy – is the most common type of diabetic neuropathy. As mentioned above, legs and feet are the most affected, followed by hands and arms. The signs and symptoms of peripheral neuropathy are usually worse at night and they include sharp pain, cramps in the legs and feet or hands and arms, muscle weakness, loss of balance, loss of coordination, loss of reflexes, a burning sensation, numbness, ulcers, infections, etc.
  • Autonomic neuropathy – is a neuropathy that affects the autonomic nervous system. The autonomic nervous system controls the major vital organs like the heart, lungs, stomach, intestines, bladder, eyes, etc. The signs and symptoms of autonomic neuropathy include problems regulating the body temperature, increased or even decreased sweating, increased heart rate, difficulty swallowing, slow stomach emptying, constipation, diarrhea or an alternation of both of them, erectile dysfunction in men, etc.
  • Diabetic amyotrophy – is a neuropathy that affects the nerves of the legs, buttocks, hips, and thighs. Diabetic amyotrophy is more common among people suffering from type II diabetes and who have been having this disease for a long period of time. Signs and symptoms of this type of neuropathy usually affect only one side of the body. However, sometimes these signs and symptoms can spread to the other side. Characteristic signs and symptoms include sudden pain in the hips, thighs or buttocks, muscle weakness, difficulty rising from a sitting position, weight loss, etc.
  • Mononeuropathy – is diabetic neuropathy that affects specific nerves of the body.

How is Diabetic Neuropathy Diagnosed?

Diabetic neuropathy is a medical condition diagnosed basically due to signs and symptoms, medical history and a physical examination. With physical examination your health care provider will check your muscle strength, muscle tone, tendon reflexes, sensitivity to touch, temperature and vibration.

Some of the necessary tests to diagnose diabetic neuropathy include:

  • Electromyography (EMG)
  • Nerve conduction studies
  • Filament test
  • Autonomic testing
  • Quantitative sensory testing

Diabetic Neuropathy Treatment

There is no cure for diabetic neuropathy. The best cure for diabetic neuropathy is to prevent it by having good control of blood sugar.

The goals of the treatment are to slow the progression of the disease, to relieve the pain once diabetic neuropathy is confirmed and to manage further complications and to restore the functions of the legs and feet as much as possible. Low dose infusions of ketamine have been shown to provide effective relief of neuropathic pain from diabetic peripheral neuropathy.

To help slow the nerve damage as much as you can, it is very important to keep normal body weight, to follow a healthy eating plan, to keep blood pressure under control and to stay active as much as you can. Alcohol, as well as smoking, should be avoided.

Pain killers are recommended for nerve pain relief.