Diabetic Neuropathy
Multimedia
Definition
Diabetic neuropathy is damage to nerves in the body that occurs due to high blood sugar levels from diabetes.
Alternative Names
Nerve damage - diabetic
Causes, incidence, and risk factors
Nerve injuries are caused by decreased blood flow and high blood sugar levels. They are more likely to develop if blood sugar levels are not well controlled.
About half of people with diabetes will develop nerve damage. Most of the time symptoms do not begin until 10 to 20 years after diabetes has been diagnosed.
Nerve injuries may affect:
Nerves in the skull (cranial nerves)
Nerves from the spinal column and their branches
Nerves that help your body manage vital organs, such as the heart, bladder, stomach, and intestines (called autonomic neuropathy)
References
Eisenbarth GS, Polonsky KS, Buse JB. Type 1 diabetes mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 31.
Wong MC, Chung JW, Wong TK. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ. 2007;335:87.
American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care. 2011 Jan;34 Suppl 1:S11-61.
Review Date: 6/28/2011
Reviewed By: Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Nerve damage - diabetic
Symptoms
Symptoms often develop slowly over several years. They can vary depending on the nerves that are affected.
People with diabetes may have trouble digesting food. These problems can make your diabetes harder to control. Symptoms of this problem are:
Feeling full after eating only a small amount of food
Nausea, constipation, or diarrhea
Throwing up food you have eaten a few hours after a meal
Tingling or burning in the arms and legs may be an early sign of nerve damage. These feelings often start in your toes and feet. You may have deep pain, often in the feet and legs.
Nerve damage may cause you to lose feeling in your arms and legs. Because of this you may:
Not notice when you step on something sharp
Not know that you have a blister or small cut
Not notice when you touch something that is too hot or cold
Damage to nervves in your heart and blood vessels may cause you to:
Other symptoms of nerve damage are:
Sexual problems. Men may have problems with erections. Women may have trouble with vaginal dryness or orgasm.
Not being able to tell when your blood sugar gets too low
Bladder problems. You may leak urine and may not be able to tell when your bladder is full. Some people are not able to empty their bladder.
Sweating too much -- when the temperature is cool, when you are at rest, or at other unusual times
Signs and tests
A physical exam may show:
A lack of reflexes in the ankle
A loss of feeling in the feet (your health care provider will check this with a brush-like instrument called a monofilament)
Changes in the skin
Drop in blood pressure when you stand up after sitting or lying down
Tests that may be done include:
References
Eisenbarth GS, Polonsky KS, Buse JB. Type 1 diabetes mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 31.
Wong MC, Chung JW, Wong TK. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ. 2007;335:87.
American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care. 2011 Jan;34 Suppl 1:S11-61.
Review Date: 6/28/2011
Reviewed By: Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Nerve damage - diabetic
Treatment
It is very important to keep your blood sugar in a healthy range. You should learn the basic steps for managing your diabetes, avoiding its complications, and staying as healthy as possible. These steps will include diet, exercise, and sometimes medicines.
You may need to check your blood sugar daily, or more often. Your doctor will help you by taking blood tests and other tests.
See also:
The following medications may be used to reduce symptoms in the feet, legs, and arms:
Certain drugs that are also used to treat depression, such as amitriptyline (Elavil), doxepin (Sinequan), or duloxetine (Cymbalta)
Certain drugs that are also used to treat seizures, such as gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol), and valproate (Depakote)
Pain medicines
Treatments for nausea and vomiting may include:
Taking medicines that help food move more quickly through your stomach and intestines
Sleeping with your head raised
Eating smaller, more frequent meals
Diarrhea, constipation, bladder problems, and other symptoms are treated as needed.
See also:
Drugs such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) may be used for treating impotence. Discuss these medicines with your doctor before taking them.
To keep your feet healthy, you should:
Check and care for your feet EVERY DAY
Get a foot exam by your doctor at least once every 6 to 12 months, and learn whether you have nerve damage.
Make sure you wear the right kind of shoes.
See also: Diabetes foot care
Expectations (prognosis)
Treatment relieves pain and can control some symptoms, but the disease generally continues to get worse.
Complications
Bladder and kidney infections
Injury to the feet due to loss of feeling
Muscle damage
Poor blood sugar control due to nausea and vomiting
Skin and soft tissue damage and risk of amputation
Neuropathy may also hide angina, the warning chest pain for heart disease and heart attack.
Calling your health care provider
Call your health care provider if you develop symptoms of diabetic neuropathy.
References
Eisenbarth GS, Polonsky KS, Buse JB. Type 1 diabetes mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 31.
Wong MC, Chung JW, Wong TK. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ. 2007;335:87.
American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care. 2011 Jan;34 Suppl 1:S11-61.
Review Date: 6/28/2011
Reviewed By: Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Alternative Names
Nerve damage - diabetic
Prevention
Tight control of blood sugar levels may prevent neuropathy in many people with type 1 diabetes, and may reduce the severity of symptoms.
In addition, regular foot care can prevent a small infection from getting worse. This is why no appointment for diabetes care is complete without a thorough foot examination.
References
Eisenbarth GS, Polonsky KS, Buse JB. Type 1 diabetes mellitus. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 31.
Wong MC, Chung JW, Wong TK. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ. 2007;335:87.
American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care. 2011 Jan;34 Suppl 1:S11-61.
Review Date: 6/28/2011
Reviewed By: Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
Review Date: 6/28/2011
Reviewed By: Ari S. Eckman, MD, Chief, Division of Endocrinology, Diabetes and Metabolism, Trinitas Regional Medical Center, Elizabeth, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2004 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.