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Diabetic Neuropathy, Some Things You May Not Know

Diabetic neuropathy

The most common complication of type 1 diabetes and type 2 diabetes is diabetic neuropathy. Despite the fact that approximately half of the people with diabetes develop and suffer with this nerve damaging condition, surprisingly few understand what diabetic neuropathy is and what can be done about it.

If you have diabetes, it’s important for you to keep up to date on information about the disease and its management as well as seek support to help with your efforts. Therefore, let’s look at some key features of diabetic neuropathy and some things you may not know that could help you prevent or better live with this diabetes complication.

It’s about more than your feet. Some people mistakenly believe that diabetic neuropathy only affects the feet and legs. In fact, there are four different types of diabetic neuropathy, and each one is characterized by the types and location of the affected nerves. The four different types of diabetic neuropathy are:

  • Peripheral, which includes nerve damage to the feet and legs
  • Proximal, which involves nerves in the thighs, buttocks, or hips
  • Focal, which can affect any specific nerve or site in the body
  • Autonomic, which impacts the autonomic nervous system. Therefore, you may have nerve damage to your urinary, gastrointestinal, vascular, or genital systems and experience symptoms such as diarrhea, constipation, sexual dysfunction (e.g., erectile dysfunction), and urinary incontinence. Diabetic autonomic neuropathy also is associated with an increased risk of cardiovascular death.

Diabetic autonomic neuropathy may be missed. One reason is that the signs and symptoms of diabetic autonomic neuropathy are similar to those of numerous other diseases and conditions. However, it’s been noted that “diabetic autonomic neuropathy (DAN) is among the least recognized and understood complications of diabetes despite its significant negative impact on survival and quality of life in people with diabetes.”

If you have diabetes and are experiencing any of the following, report to your healthcare provider. Those signs and symptoms can include nausea, vomiting, diarrhea, constipation, fainting, dizziness, urinary incontinence, erectile dysfunction, feeling full after eating only a small amount, vaginal dryness, inability to completely empty the bladder, swallowing difficulties, and bloating.

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It can be prevented. Diabetic neuropathy is believed to be caused by the presence of excessive levels of glucose in the blood stream. The sugar can damage the walls of blood vessels that transport nutrients to the nerves. In turn, the signals associated with pain, sensation, temperature, muscle movement, and other bodily systems are jeopardized.

The best way to help prevent development of diabetic neuropathy—or at least delay its onset—is to maintain control over your blood sugar levels. Consistently high blood sugar levels or poor blood glucose management is a sure recipe for diabetic neuropathy.

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It can be painful. When nerves are damaged, the result can be a loss of sensation or feeling as well as sensations of pain, tingling, and burning, which can range from mild to severe. Painful diabetic neuropathy is a challenge to treat. In fact, a new report in Diabetes explains that “treating painful diabetic neuropathy therefore remains a march through a list of potential treatments in search of an acceptable balance between pain relief and side effects.” (See “It can be treated” below.)

Painful neuropathy can be treated. Thus far, there are only three drugs approved by the Food and Drug Administration (FDA) for painful diabetic neuropathy: pregabalin (an anticonvulsant), duloxetine (an antidepressant in the serotonin-norepinephrine reuptake inhibitor [SNRI] category), and tapentadol (an opioid/SNRI combination).

None of these options especially effective and all of them have significant side effects, including but not limited to nausea, vomiting, dizziness, fatigue, problems with concentration and memory, tremors, loss of balance, and headache. Topical agents including capsaicin and lidocaine can be helpful for some people.

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Alternative treatments are available. Nondrug approaches to relieving diabetic neuropathy (in addition to using diet and exercise to maintain healthy glucose levels) include TENS (transcutaneous electric nerve stimulation), taking warm baths (be sure to check the water temperature with your hands and not your feet), vitamin B supplements (B vitamins support nerve health), alpha-lipoic acid, and evening primrose oil supplements.

Diabetic neuropathy is a serious complication of diabetes and one that can have a significantly detrimental effect on quality of life. Be sure to talk to your healthcare provider about diabetic neuropathy and stay tuned to Emaxhealth for upcoming articles on this topic and others relating to type 1 and type 2 diabetes.

Calcutt NA. Location, location, location? Is the pain of diabetic neuropathy generated by hyperactive sensory neurons? Diabetes 2013 Nov; 62(11): 3658-60
Khalil H. Painful diabetic neuropathy management. International Journal of Evidence Based Healthcare 2013 Mar; 11(1): 77-79
Pappachan JM et al. Diabetic cardiomyopathy: pathophysiology, diagnostic evaluation and management. World Journal of Diabetes 2013 Oct 15; 4(5): 177-89
Vinik AL et al. Diabetic autonomic neuropathy. Diabetes Care 2003 May; 26(5): 1553-79

Image: Image: Martin Pettitt/Flickr



Has anyone looked into topical pain management for their neuropathy pain? My fiance was diagnosed with type 1 diabetes as a child and quickly began to experience the pain of neuropathy at an early age. Over a decade of pain later, after a little research, she talked to her doctor about topical pain relief. He decided to give it a shot and now he writes her prescriptions for topical pain gels, as needed, through A&R Pharmacy in Liberty, Missouri, to help combat her pain. She has been using them for about 7 months now, and she is the best off I've seen her in years. No pills. No side effects. Just good 'ole pain relief at a price we can afford, both monetarily and physically. I highly suggest looking into them if you are looking for something that works. I hope this helps!
Thank you for your comments. Good to hear that your fiance is doing well with topical treatment. I made only a brief mention of topical treatment in my article (capsaicin and lidocaine), and the former is available over the counter and can be quite helpful for many patients. Thanks again!