Types of Peripheral Neuropathy - Pre-diabetic/Diabetic

Idiopathic | Pre-diabetic/Diabetic | Hereditary | Toxic/Secondary to Drugs | Inflammatory | Systemic/Metabolic |
Compression | Other Types of PN

Diabetic neuropathy, or nerve damage caused by diabetes, is one of the most common known causes of neuropathy. It is one of many complications associated with diabetes, with nearly 60 percent of diabetics having some form of nerve damage. It is a progressive disease that can involve loss of sensation, as well as pain and weakness, in the feet and sometimes in the hands. Peripheral neuropathy may be more prevalent in people who have difficulty managing their blood sugar levels, have high blood pressure, are overweight, and are over 40 years old. A clinical examination may identify early signs of neuropathy in diabetics without symptoms.

The first sign of diabetic neuropathy is usually numbness, tingling or pain in the feet, legs or hands. Over a period of several years, the neuropathy may lead to muscle weakness in the feet and a loss of reflexes, especially around the ankle. As the nerve damage increases, the loss of sensation in the feet can reduce a person's ability to detect temperature or to notice pain. Because the person can no longer notice when his/her feet become injured, people with diabetic neuropathy are more likely to develop foot problems such as skin lesions and ulcers that may become infected.

Diabetic neuropathy may suddenly flare up and affect a specific nerve or group of nerves. When this occurs, the result may be weakness and muscle atrophy in various parts of the body, such as involvement of the eye muscles or eyelid (e.g., causing double vision or a drooping eyelid) or thigh muscles. Alternatively, neuropathy caused by diabetes may slowly progress over time. It also can interfere with the normal functioning of the digestive system and sexual organs.

SYMPTOMS AND SIGNS

(Not all symptoms and signs may be present.)

• Numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
• Indigestion, nausea, or vomiting
• Diarrhea or constipation
• Dizziness or faintness due to a drop in blood pressure especially when rising to a standing position
• Problems with urination
• Erectile dysfunction (impotence) or vaginal dryness

EVALUATION AND TESTS

(Not all evaluation and tests may be necessary.)

• Comprehensive foot exam
• Physical examination
• Neurological evaluation
• Electromyography
• Nerve conduction velocity tests
• Quantitative sensory testing (QST)
• Nerve or skin biopsy
• Blood studies to verify diabetes (e.g., HbA1C) and to rule out other potential causes

Is there any treatment?

The goal of treatment for diabetic neuropathy is to relieve discomfort and to prevent further tissue damage. The first step is to bring blood sugar levels under control by diet and medication. Another important part of treatment involves taking special care of the feet.

TREATMENT AND THERAPY

(Not all treatments and therapies may be indicated.)

• Over-the-counter pain medication for mild pain
• For severe pain, take over-the-counter pain medication or prescription drugs used for peripheral neuropathy, on a regular basis—rather than waiting until nighttime when symptoms can become more severe
• Keep blood sugar levels in normal range
• Get regular exercise
• Maintain a healthy weight
• Antidepressants (for pain relief)
• Foot care: inspect your feet daily for injuries
• Special therapeutic shoes (which may be covered by Medicare and other insurance)
• Take safety measures to compensate for loss of sensation