Definition

Diabetic neuropathy is a type of nerve damage associated with diabetes. It can result in damage to any nerve in the body. The types of neuropathy include:

• Peripheral neuropathy (most common)—causes pain or loss of feeling in the toes, feet, legs, hands, and arms
• Autonomic neuropathy causes changes in nerves controlling body function, including:
  • Digestion, bowel and bladder function
  • Sexual response
  • Sweating
  • Heart and blood pressure control
  • Breathing
  • Vision
• Proximal neuropathy—causes pain in the thighs, hips, or buttocks and weakness in the legs
• Focal neuropathy—only affects one nerve or a group of nerves

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Causes

Diabetic neuropathy is likely caused by a combination of factors, including:

• Metabolic factors such as elevated blood pressure, high blood glucose, longer duration of diabetes, high cholesterol, and possibly low levels of insulin
• Damage to blood vessels going to nerves
• Autoimmune factors causing inflammation of nerves
• Nerve trauma
• Genetics
• Smoking or alcohol abuse

Risk Factors

This condition is more common in older adults.

Factors that may increase your risk of diabetic neuropathy include:

• Having diabetes for 25 years or more
• Having type 2 diabetes
• High blood pressure
• Obesity
• Lack of exercise
• Peripheral artery disease (PAD)
• High cholesterol

Symptoms

Symptoms of diabetic neuropathy may include:

• Numbness, tingling, or pain in the extremities
• Weakness in the arms and/or legs
• Indigestion
• Nausea or vomiting
• Diarrhea or constipation
• Lightheadedness
• Urination problems
• Erectile dysfunction or vaginal dryness
• Weakness of facial muscles resulting in a drooping eyelid, drooping mouth, facial droop, difficulty swallowing
• Muscle cramps
• A prolonged feeling of fullness after eating, and/or abdominal pain
• Decreased ability to sweat normally
• Blurred or double vision

If you have diabetic neuropathy, you are at increased risk for developing other types of neuropathies, such as carpal tunnel syndrome.

Diabetic neuropathy can lead to serious complications, including foot ulcers, infection, and limb loss.

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. A foot exam will also be done.

Your nerve function may be tested, especially if you have muscle weakness. This can be done with:

• Nerve conduction studies
• Electromyography
• Quantitative sensory testing—the use of stimuli to check for neuropathy
• Quantitative sudomotor axon reflex test—a test to evaluate the nerve supply of sweat glands

Images may be taken of your bodily structures. This can be done with an ultrasound.

Your nerves may need to be tested. This can be done with a biopsy.

Treatment

Treatment may include:

Prevention

The best way to prevent diabetic neuropathy is to regularly monitor and manage your blood glucose levels. Your doctor can instruct you about how often to check your levels and what the numbers mean.