Diabetic Neuropathy: Symptoms, Causes & Treatment

Diabetic neuropathy is a common complication of diabetes that causes progressive nerve damage and affects up to 50% of people with diabetes. Diabetic neuropathy symptoms in the feet commonly include pain, tingling, burning, numbness, or loss of sensation.

Diabetic neuropathy usually develops slowly and may go unnoticed at first. Without proper treatment, it can increase the risk of foot injuries, ulcers, and other complications, although managing blood sugar levels can help slow its progression.

Treatment for diabetic neuropathy focuses on controlling blood sugar levels, relieving symptoms, and preventing complications. Diagnosis is based on symptoms, a physical examination, and, in some cases, specialized nerve tests to identify the type and extent of nerve damage.

Common symptoms

The main symptoms of diabetic neuropathy include:

• Tingling, burning, stabbing pain, numbness, or a feeling of heaviness, especially in the hands or feet

• Extreme sensitivity or pain from light touch, or loss of sensation

• Muscle weakness

• Feeling unsteady while walking

• Constipation

• Difficulty digesting food or swallowing

• Increased or decreased sweating

Diabetic neuropathy symptoms in the feet may be worse at night and can make walking or maintaining balance more difficult. Loss of sensation can also allow cuts, blisters, ulcers, or other injuries to go unnoticed and lead to diabetic foot complications.

People with diabetic neuropathy may also experience erectile dysfunction, vaginal dryness, a drop in blood pressure when standing, double vision, or bladder problems, such as frequent urination or a sudden urge to urinate.

Symptoms can affect different parts of the body depending on the type of neuropathy and may go unnoticed for a long time.

Confirming a diagnosis

Diabetic neuropathy is diagnosed by an endocrinologist or neurologist based on a person's symptoms, medical history, and physical examination.

To help confirm the diagnosis, the doctor may order other tests. These can include a nerve conduction study to check how quickly signals travel through the nerves, an electromyography test (EMG) to measure muscle activity, and autonomic function testing to see how blood pressure changes when a person changes position.

Different types

Depending on the symptoms and the nerves affected, diabetic neuropathy may be classified as:

• Focal or multifocal neuropathy: Symptoms occur when a specific nerve in the hands, feet, legs, trunk, or head is damaged.

• Diabetic polyneuropathy: Symptoms mainly affect the hands and feet and may gradually progress toward the trunk.

• Proximal motor neuropathy: Symptoms mainly affect the thighs, hips, buttocks, abdomen, and chest. They usually begin on one side of the body but may spread to the other side.

• Autonomic neuropathy: This type affects the nerves that control organs such as the heart, bladder, stomach, intestines, and reproductive organs.

A doctor usually determines the type of neuropathy based on the symptoms and findings from a physical examination. In some cases, additional tests, such as electromyography and nerve conduction studies, may be needed.

Main causes

Diabetic neuropathy is a complication of diabetes that mainly affects people whose blood sugar levels are not adequately controlled. According to the American Diabetes Association (ADA), persistently high blood sugar levels can progressively damage the nerves over time.

Treatment options

Treatment for diabetic neuropathy should be supervised by an endocrinologist or neurologist. The first step is to keep blood sugar levels within the target range, which can help slow further nerve damage and reduce the risk of complications.

Treatment may include:

• Blood sugar management with insulin, oral diabetes medications, regular glucose monitoring, a balanced diet, and physical activity

• Anticonvulsants, such as pregabalin or gabapentin, to relieve nerve pain

• Antidepressants, such as amitriptyline, imipramine, duloxetine, or venlafaxine, to relieve mild to moderate pain

• Oral opioid pain relievers, such as tramadol, morphine, oxycodone, or methadone, or opioid patches containing fentanyl or buprenorphine

Treatment may also be needed for complications affecting other parts of the body. A urologist may treat bladder problems or erectile dysfunction, while a cardiologist may help manage blood pressure changes or heart-related complications.

Can diabetic neuropathy be cured?

Diabetic neuropathy cannot be cured. However, controlling diabetes and treating symptoms with medications such as antidepressants and pain relievers may help slow its progression.

Following a healthy diet and exercising regularly may also help support the recovery of normal sensation.

How to prevent

Measures that can help prevent diabetic neuropathy include:

• Attend regular medical appointments.

• Monitor blood sugar levels at home with a blood glucose meter, as directed by a healthcare provider.

• Take medications or inject insulin exactly as prescribed.

• Exercise regularly with activities such as light walking, swimming, or water aerobics.

It is also important to follow a balanced diet that includes fiber, protein, and healthy fats. According to the American Diabetes Association (ADA), maintaining healthy eating habits along with good blood sugar control can help reduce the risk of developing or worsening diabetic neuropathy.