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- Diabetic neuropathy, a complication of diabetes, can affect multiple areas of the body, from your face and fingertips to your toes and digestive system.
- No matter which form of the condition you live with, diabetic neuropathy cannot be reversed.
- Much like diabetes itself, managing diabetic neuropathy is largely a matter of practicing healthy lifestyle habits, taking certain preventive steps, and, in some cases, taking medication.
Diabetes is a chronic condition you learn to live with, but that doesn’t have to mean complications of the condition are inevitable. Still, if you do develop certain complications, such as diabetic neuropathy, there’s not necessarily a “cure” for those issues, either. However, there are plenty of ways to manage the pain and gain a better understanding of how to live with diabetic neuropathy.
What Is Diabetic Neuropathy?
In general terms, neuropathy means nerve damage or dysfunction, typically resulting in some form of pain, numbness, tingling, or muscle weakness.
As a complication of diabetes, diabetic neuropathy can cause nerve damage throughout multiple parts of the body, from your eyes and face all the way down to your feet.
According to the Mayo Clinic, the exact cause of different forms of diabetic neuropathy isn’t known. One theory is that “over time, elevated blood sugar can damage the small blood vessels that supply the nerves in your body,” explains One Drop coach, Lindsay Vettleson, a registered dietitian/nutritionist (RDN), certified diabetes care and education specialist (CDCES), and certified personal trainer (CPT). “This stops all nutrients from reaching the nerves. As a result, the nerves can become damaged, which is what leads to diabetic neuropathy.” But unmanaged blood sugar may also affect the nerves’ ability to send signals to other parts of the body, resulting in diabetic neuropathy.
People living with either type 1 or type 2 diabetes can develop diabetic neuropathy, but according to the 2022 American Diabetes Association (ADA)’s Clinical Compendia Series’ “Diagnosis and Treatment of Painful Diabetic Peripheral Neuropathy,” prevalence rates in those with type 1 diabetes are only around 11% to 13% compared to more than 50% among people with type 2 diabetes.
Why the huge disparity? One Drop coach, Lisa Goldoor, CDCES and registered nurse (RN), says it may be due to the fact that type 2 diabetes, in general, often goes undetected for a much longer time than type 1 diabetes, which has a more acute onset of initial symptoms, meaning complications of the condition may follow a similar trajectory.
“Risk factors that are known to be strongly associated with diabetic neuropathy include poor glycemic control, long duration of diabetes, older age (>70 years old), tall stature, hypertension, obesity, and metabolic syndrome,” says Vettleson.
Regardless of what precipitates the condition, diabetic neuropathy can manifest in several different ways, depending on which part of the body is experiencing nerve damage. Per the ADA, here’s a breakdown of some of the most common forms of diabetic neuropathy.
The most common type of diabetic neuropathy, peripheral neuropathy affects your peripheral nervous system—in other words, the nerves that help your central nervous system (a.k.a. your brain and spinal cord) communicate with other parts of your body, including your hands, feet, legs, and arms.
Peripheral neuropathy typically begins in the hands and feet and has the potential to work itself up the legs and arms, explains Goldoor. “Symptoms can include burning sensations, pain, sensitivity to touch, and numbness,” she adds. If left untreated, “these symptoms can lead to foot ulcers, infections, gait disturbances, and injuries.”
The ADA recommends having a foot exam at least once a year (either with your primary care provider and/or a podiatrist, depending on your circumstances), including a check of the skin on your feet, your foot muscles and bones, and your blood flow. Your doctor can also check for numbness in your feet by using a monofilament, a tool that looks like a stiff piece of fishing line, to poke different areas of each foot to see if you can feel each sensation.
If your doctor suspects that you have peripheral neuropathy, they may also recommend tests that can tell you how well the nerves in your arms and legs are working. Nerve conduction studies, for example, can check the speed at which your nerves send messages to other parts of your body, while electromyography (EMG) checks how your nerves and muscles work together.
The autonomic nervous system is part of the peripheral nervous system, but rather than assisting the control of nerves in your limbs, your autonomic nerves serve more “automatic” functions, such as your heart rate, blood pressure, bladder control, sexual arousal, digestion, and vision. So, symptoms of autonomic neuropathy can be related to one (or multiple) of those organs: vision changes, erectile dysfunction, indigestion, diarrhea, constipation, bloating, nausea, vomiting, and bladder dysfunction, to name a few.
According to the ADA, a physical exam and certain tests (think: ultrasounds to check on your bladder or X-rays to look at your stomach) can help you figure out if you’re diagnosed with autonomic neuropathy.
Other Types of Diabetic Neuropathy
Peripheral and autonomic neuropathy tend to be the most common forms of diabetic neuropathy, but there are other types of nerve damage that can be associated with diabetes as well.
- Proximal neuropathy, for example, affects the nerves in your thighs, hips, buttocks, and legs, explains Goldoor, causing pain and weakness in these areas.
- Cranial neuropathy, on the other hand, affects the nerves that control your eye and face muscles, resulting in pain near the affected eye(s), double vision, or, in some cases, Bell’s palsy (paralysis on one side of the face).
- Compression mononeuropathy is a condition in which only a single nerve is damaged. For instance, carpal tunnel syndrome (one of the most common forms of compression mononeuropathy) happens when the median nerve of the forearm is compressed at the wrist, causing symptoms like numbness, swelling, or prickling sensations in the fingers, according to the ADA.
- Thoracic/lumbar radiculopathy, another type of mononeuropathy, refers to a compressed nerve root in either the thoracic (upper back) or lumbar (lower back) area of your spine, causing weakness, numbness, or tingling in the affected area.
- Femoral neuropathy affects the femoral nerve—which begins at the pelvis and goes down the leg—typically causing pain in the front of one thigh, followed by muscle weakness.
- Focal neuropathy, similar to compression mononeuropathy, can affect a single nerve, or it can affect a group of nerves, causing sudden weakness or pain that may lead to double vision, Bell’s palsy, or pain in the front of the thigh or other parts of the body.
- Charcot joint, or neuropathic arthropathy, happens when a joint (usually in the foot) deteriorates as a result of nerve damage, oftentimes leading to a loss of most sensations in the area (including pain), according to the ADA.
- Unilateral foot drop is more or less exactly what it sounds like: an inability to pick up your foot, caused by damage to the peroneal nerve of the leg by compression, or a blood vessel-related condition.
Treating and Managing Diabetic Neuropathy
Much like diabetes itself, diabetic neuropathy cannot be reversed. That means treating diabetic neuropathy is mostly a matter of pain management and prevention.
Medication for Diabetic Neuropathy
While medication won’t necessarily work for everyone, many prescription medications can be used to manage the pain that comes with diabetic neuropathy.
Of course, the type of medication you’re prescribed will depend on several factors, including the part(s) of your body affected by diabetic neuropathy.
For instance, according to Vettleson, there are currently four FDA-approved pharmacological treatments for the pain associated with diabetic peripheral neuropathy: pregabalin (an anticonvulsant that’s also used to treat seizures, but can help reduce nerve pain by controlling certain brain chemicals that send signals to the nerves), duloxetine (a type of antidepressant that similarly affects the way certain brain chemicals interact with the nerve cells), tapentadol (a type of opioid), and, most recently approved, a topical capsaicin patch (a synthetic version of a naturally occurring compound in chili peppers that can be used to manage neuropathic pain).
“Other pharmacological therapies used to treat diabetic peripheral neuropathy include amitriptyline (another antidepressant commonly used for nerve pain), gabapentin (another anticonvulsant medication), and other types of opioids,” adds Vettleson. However, Goldoor notes that, while opioids may still be routinely prescribed in this context, they’re not included in the ADA’s 2022 Clinical Update of medication classes for pain management of diabetic neuropathy.
Lifestyle Changes and Preventive Practices for Diabetic Neuropathy
Outside of medication, managing or preventing diabetic neuropathy is largely a matter of keeping your blood sugar levels in your target range through healthy eating, physical activity, and a generally well-balanced lifestyle, says Vettleson.
“You can also lower your risk of having other diabetes-related complications by self-examining and taking care of your feet every day,” notes One Drop coach, Sandra Gonzalez, RDN, CDCES. She recommends following these tips from the Centers for Disease Control and Prevention (CDC):
- Self-inspect your feet every day. Look for cuts, sores, red spots, swelling, blisters, ingrown nails, corns, calluses, and any other significant changes to the skin or nails. Be sure to use a mirror or ask for help if you have trouble inspecting the bottom of your feet.
- Wash your feet every day with warm, not hot, water. Warm water will ensure you’re not damaging the skin. Additionally, remember to dry your feet completely and apply lotion to the top and bottom of your feet (but not between the toes, which could cause infection).
- Ask for help when removing corns or calluses. No matter what over-the-counter products you might find, have your doctor help you remove corns or calluses so you don’t burn yourself or otherwise damage your skin.
- Trim your toenails straight across. Doing so will help you avoid ingrown nails. Remember to use a nail file to buff out any sharp edges.
Prevention, however, is your “strongest tool” against diabetic neuropathy, notes Goldoor.
“Knowing that factors such as excess weight, high blood sugar, high cholesterol, and elevated triglycerides can all be factors for developing diabetic neuropathy, staying on top of your health and keeping track of your data is important,” she explains. “As of 2022, the ADA’s updated guidelines call for screening all people for diabetes starting at age 35 (down from age 40 in previous guidelines). The sooner you know you have high blood sugar, the sooner you can take steps to manage those levels (either through lifestyle changes, medications, or both) and therefore decrease your risk of complications, including diabetic neuropathy. Knowledge is power!”
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This article has been clinically reviewed by Jamillah Hoy-Rosas, MPH, RDN, CDCES, and VP of clinical operations and program design at One Drop, and Lisa Goldoor, RN, BSN, CDCES, and clinical health coach at One Drop.