Diabetic Neuropathy

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Diabetic Neuropathy
What is it?

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Diabetic neuropathy is damage to the nerves caused by diabetes. The two most common types are peripheral and autonomic neuropathy.

Peripheral nerves go from the brain and spinal cord to the muscles and skin of the arms and legs. Peripheral neuropathy is the gradual deterioration of these long nerves, resulting in pain and sensory impairment. The end result of peripheral neuropathy is numbness in the lower legs and feet, which, combined with circulation problems experienced by some people with diabetes, accounts for the high prevalence of foot problems in diabetes.
Autonomic nerves regulate functions that we do not control consciously: blood pressure, the digestion of food, emptying the bladder, the flow of blood to the brain, the flow of blood to the penis required to achieve and maintain an erection. Autonomic neuropathies impair these functions. One of the most common results of autonomic neuropathy is impotence, a frequent problem in men with diabetes.
Symptoms

The first symptoms of peripheral neuropathy are usually pain and tingling in the toes. These sensations may be accompanied by some numbness. Over months and years, these symptoms gradually progress up the leg. The symptoms vary in intensity from one person to another and may include diminished or absent reflexes, numbness, pain, burning or stinging sensations, aching, weak muscles or supersensitivity, as to the feel of bed sheets on the leg. Most of the time, symptoms are in both legs. Over time, the pain is replaced with numbness.

Symptoms of autonomic neuropathy vary depending on the nerves that are affected. The most common is male impotence; by age 43, 46 percent of men with type 1 diabetes experienced impotence (erectile dysfunction), according to some studies. Some women also report diminished sexual responsiveness, probably due to decreased sensation. When autonomic neuropathy affects the digestive system, the symptoms may be diarrhea or constipation, difficulty swallowing, or a bloated feeling with nausea. Poor bladder emptying is another symptom of autonomic neuropathy. Dizziness when you stand up, caused by a sudden drop in blood pressure called orthostasisis is another symptom.

What your doctor looks for

To identify peripheral neuropathy, the doctor looks for decreased sensation in the feet and legs. The doctor will ask about symptoms that can result from the different systems that can be affected by autonomic neuropathies and will check your sitting and standing blood pressure.

Diagnosis

Peripheral neuropathy is diagnosed with a tuning fork or monofilament, to determine if someone feels vibrations, a light touch or a pinprick. Autonomic neuropathies are diagnosed based on symptoms after other causes have been ruled out.

Expected duration

Neuropathies develop slowly and usually cannot be reversed.

Prevention

Neuropathies can be prevented, first and foremost, with good blood glucose control. Smoking also contributes to neuropathies, so smokers should quit. Maintaining normal blood pressure may also be protective. Beyond that, not much can be done to prevent neuropathies. However, much can be done to prevent the damage from peripheral neuropathies.

Meticulous foot care is a very important aspect of personal hygiene and self-monitoring for people with diabetes. This means being attentive to the fit of your shoes and checking daily for any breaks in the skin. Going barefoot is a bad idea because you might not be able to feel small cuts or abrasions or the burn of walking on a hot surface. Treat any infection quickly and aggressively.

Treatment

Amitriptyline and desipramine, antidepressant medications, can often reduce the pain and discomfort of peripheral neuropathies. The anticonvulsant drug gabapentin (Neurontin) may also control the pain. To minimize side effects of all these medications, an initial small dose may be increased gradually if necessary. Some people get relief using capsaicin, a topical cream or ointment containing the ingredient that gives chili peppers their heat.

To treat the diarrhea or constipation caused by autonomic neuropathies, over-the-counter antidiarrheal medications or laxatives are helpful. Other medications help the stomach work more normally. Tight stockings can keep blood from pooling in the legs, and people who experience orthostasis are advised to stand up slowly. Finally, the drugs Viagra, Levitra and Cialis are helpful for some men with diabetes-related erectile dysfunction, though they do not work for impotence due to diabetic neuropathy.

When to call your doctor

Call your doctor at the onset of any symptoms of neuropathies that interfere with normal life. See your doctor for calluses, sores or signs of infection on your feet.

Prognosis

The most dire outcome of peripheral neuropathy is an uncontrolled foot infection, which may lead to gangrene and necessitate amputation, one of the biggest fears of people with diabetes. The prognosis is much brighter today, however, with better preventive care, prompt treatment and new effective treatments for wounds. The prognosis also continues to improve for people with autonomic neuropathies, particularly erectile dysfunction.

Additional information

For more information about peripheral neuropathy, you may contact:

American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
1-800-DIABETES ( 1-800-342-2383 )
http://www.diabetes.org

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