Neuropathy Diabetes

Answer 1

Definition

Diabetic neuropathy is a common complication of diabetes, in which nerves are damaged as a result of high blood sugar levels (hyperglycemia).

Alternative Names

Nerve damage - diabetic

Causes, incidence, and risk factors

People with Diabetes commonly develop temporary or permanent damage to nerve tissue. Nerve injuries are caused by decreased blood flow and high blood sugar levels, and are more likely to develop if blood sugar levels are not well controlled.

Some people with diabetes will not develop nerve damage, while others may develop this condition early. On average, symptoms begin 10 to 20 years after the diabetes diagnosis. Approximately 50% of people with diabetes will eventually develop nerve damage.

Peripheral nerve injuries may affect nerves in the skull (cranial nerves) or nerves from the spinal column and their branches. This type of nerve injury (neuropathy) tends to develop in stages.

Autonomic neuropathies affect the nerves that regulate vital functions, including the heart muscle and smooth muscles.

Symptoms

Digestive tract:

• Constipation
• Diarrhea
• Nausea and vomiting
• Swallowing difficulty

Legs and arms:

• Deep pain, most commonly in the feet and legs
• Loss of the sense of warm or cold
• Muscle cramps
• Numbness (if the nerves are severely damaged, you may be unaware that a blister or minor wound has become infected)
• Tingling or burning sensation in the extremities, particularly the feet
• Weakness

Other symptoms:

• Dizziness
• Drooping eyelid
• Drooping face
• Drooping mouth
• Impotence
• Light-headedness when standing up (orthostatic hypotension)
• Loss of bladder control
• Rapid heart rate
• Speech impairment
• Vision changes

Note: Symptoms vary depending on the nerves affected, and may include symptoms other than those listed. Symptoms usually develop gradually over years.

Signs and tests

Physical examination, including nervous system (neurological) and sensory tests, may diagnose neuropathies. A common early finding is the absence of ankle reflexes.

Health care providers often test for loss of sensation in the feet with a brush-like instrument called a monofilament.

Electrodiagnostic testing may be done.

Treatment

The goals of treating diabetic neuropathy are to prevent the disease from getting worse and to reduce the symptoms of the disease.

Tight control of blood sugar (glucose) is important to prevent symptoms and problems from getting worse.

Medications may be used to reduce the symptoms in the feet, legs, and arms. These medications include:

• Antidepressant drugs, such as amitriptyline (Elavil), doxepin (Sinequan), or duloxetine (Cymbalta)
• Antiseizure medications, such as gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol), and valproate (Depakote)
• Drugs that block bladder contractions may be used to help with urinary control problems.
• Erythromycin, domperidone (Motilium), or metoclopramide (Reglan) may help with nausea and vomiting.
• Pain medications (analgesics) may work for some patients on a short-term basis, but in most cases they do not provide much benefit.
• Phosphodiesterase type 5 (PDE-5) drugs, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are safe and effective for treating impotence in patients with diabetes.
• Capsaicin can be used topically to reduce pain.

Regular foot exams are important to identify small infections and prevent foot injuries from getting worse. If foot injuries go unnoticed for too long, amputation may be required.

Expectations (prognosis)

Treatment relieves pain and can control some symptoms, but the disease generally continues to get worse.

Complications

• Injury to the feet due to loss of feeling
• Muscle breakdown and imbalance
• Poor blood sugar control due to nausea and vomiting
• Skin and soft tissue breakdown (ulceration) that may require amputation

In addition, neuropathy may mask 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.

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

Vinik AI. Diabetic neuropathies. Med Clin North Am. 2004;88(4):947-999.

Vardi M, Nini A. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus. Cochrane Database Syst Rev. 2007;(1):CD002187.

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--2010. Diabetes Care. 2010 Jan;33 Suppl 1:S11-61.

Answer 2

Diabetic neuropathy is nerve damage caused by prolonged high blood glucose levels. It is manifested by numbness, tingling, and pain. It is most commonly found in the extremities of the body, especially in the feet. Diabetics can prevent this by managing blood glucose levels and having regular exams to check for signs of neuropathy.

Answer 3

If you suffer from neuropathy diabetes, you most likely experience a great deal of pain and numbness in your feet. It is imperative that you wear the right type of shoes to protect your feet from injury.

Answer 4

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)

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
• Heartburn and bloating
• Nausea, constipation, or diarrhea
• Swallowing problems
• 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:

• Feel light-headed when you stand up (orthostatic hypotension)
• Have a fast heart rate
• Not notice angina, the chest pain that warns of heart disease and heart attack

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:

• Electromyogram(EMG) -- a recording of electrical activity in muscles
• Nerve conduction velocity tests (NCV) -- a recording of the speed at which signals travel along nerves

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:

• Type 1 diabetes
• Type 2 diabetes

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:

• Bowel retraining
• Neurogenic bladder

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.

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.

Reviewed By

Review Date: 06/28/2011

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.

Answer 5

One of the most concerning complications that comes with diabetes is diabetic neuropathy. It often presents as a tingling in the feet and can lead to complete loss of sensation in the feet.