Diabetic neuropathy is a common neuropathic disorder associated with diabetes mellitus.
Presentation is dependent on the type of neuropathy being dealt with .
- Numbness or reduced ability to feel pain or changes in temperature, especially in the feet and toes
- A tingling or burning sensation
- Sharp, jabbing pain that often worsens at night
- Pain when walking
- Extreme sensitivity to the lightest touch
- Muscle weakness and difficulty walking
- Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain
- A lack of awareness that blood sugar levels are low (hypoglycemia unawareness)
- Bladder problems, including frequent urinary tract infections or urinary incontinence
- Constipation, uncontrolled diarrhea or a combination of the two
- Slow stomach emptying (gastroparesis), leading to nausea, vomiting and loss of appetite
- Difficulty swallowing
- Erectile dysfunction in men
- Vaginal dryness and other sexual difficulties in women
- Increased or decreased sweating
- Inability of the body to adjust blood pressure and heart rate, leading to sharp drops in blood pressure following rise from sitting or lying down (orthostatic hypotension). This may cause the feeling of lightheaded and even fainting in some cases.
- Problems regulating body temperature
- Changes in the way eyes adjust from light to dark
- Increased heart rate when at rest
- Sudden, severe pain in hip and thigh or buttock
- Eventual weak and atrophied thigh muscles
- Difficulty rising from a sitting position
- Abdominal swelling, if the abdomen is affected
- Weight loss
Entire Body System
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. [web.archive.org]
Consider gastric emptying studiesif the individual has persistent nausea/vomiting. [nhshighland.scot.nhs.uk]
In blood vessels: Symptoms include: Blacking out when you stand up quickly Faster heartbeat Dizziness Low blood pressure Nausea Vomiting Feeling full sooner than normal If you have it: Avoid standing up too quickly. [webmd.com]
Symptoms of autonomic neuropathy include: Bladder problems (loss of bladder control, not being able to fully empty the bladder, frequent urinary tract infections) Digestive system problems (bloating, nausea, vomiting, diarrhea, constipation) Erectile [hormone.org]
In clinical trials, only a few adverse effects have been reported - transient mild headache, flushing, dyspepsia, and some altered color vision. [health.am]
Symptoms such as anorexia, nausea, vomiting, and dyspepsia are nonspecific and resemble many other conditions ( 186 ) and may just be associated with the presence of diabetes ( 181 ). [doi.org]
- Abdominal Distension
Abdominal distension. Dysphagia. Diarrhoea. Gustatory sweating, anhidrosis. Tends to be associated with peripheral neuropathy. People with both types 1 and 2 are affected. [patient.info]
- Abdominal Bloating
People with diabetes may present with early satiety; feeling of fullness; abdominal bloating or upper abdominal pain and discomfort. Consider gastroscopy if possibility of alternative cause for obstructive symptoms. [nhshighland.scot.nhs.uk]
- Abdominal Mass
In patients with diabetes who have a painful abdominal mass, the potential presence of a diabetic truncal neuropathy should be considered. [ncbi.nlm.nih.gov]
- Orthostatic Hypotension
He was diagnosed with postural orthostatic tachycardia syndrome (POTS), and orthostatic intolerance disappeared after β-blocker treatment. Scintigraphy using 123I-metaiodobenzylguanidine showed decreased cardiac uptake. [ncbi.nlm.nih.gov]
It may present with: Cardiac autonomic neuropathy, which has been linked to [ 5 ] : Resting tachycardia, postural hypotension, orthostatic bradycardia and orthostatic tachycardia. Exercise intolerance. Decreased hypoxia-induced respiratory drive. [patient.info]
It can also strike your autonomic nervous system—the nerves that control heart rate, digestion and other essential functions—and lead to significant resting tachycardia (a heart rate that is higher than normal when you are at rest), slowing of the digestive [footsmart.com]
- Left Ventricular Dysfunction
ventricular dysfunction, silent or asymptomatic myocardial infarction, and exercise intolerance. [1,13,14,15] There is evidence that the disease process may begin early in the course of diabetes but remain asymptomatic until later stages. [1,13,15] Gastroparesis [medscape.com]
The patient with cranial nerve involvement usually has diplopia and single third, fourth, or sixth nerve weakness on examination but the pupil is spared. A full recovery of function occurs in 6-12 weeks. [health.am]
The onset of a diabetic third nerve palsy is usually abrupt, beginning with frontal or periorbital pain and then diplopia. [en.wikipedia.org]
Cranial nerve III involvement results in ophthalmoplegia, ptosis, and diplopia with sparing of pupillary function. The median, radial, and lateral popliteal nerves are the most common sites of peripheral nerve involvement. [aafp.org]
Hypotension (symptomatic in up to 12%) Resting tachycardia or loss of sinus arrythmia (up to 20%) Dysphagia with delayed gastric emptying, nausea/vomiting Constipation/diarrhoea Urinary retention/overflow incontinence Neuropathic oedema Gustatory sweating Anhidrosis [nhshighland.scot.nhs.uk]
Gustatory sweating, anhidrosis. Tends to be associated with peripheral neuropathy. People with both types 1 and 2 are affected. High mortality rate (50% within three years) mainly due to chronic kidney disease but there is often no obvious cause. [patient.info]
[…] and fainting sexual dysfunction, erectile dysfunction in men, and problems with vaginal lubrication and arousal in women changes in perspiration, heavy night sweating, the inability to regulate internal temperature or complete lack of perspiration ( anhidrosis [draxe.com]
[…] abnormalities: Heart rate response to deep breathing; Expiratory to inspiratory ratio; Valsalva ratio Sympathetic: Orthostatic hypotension Gastrointestinal: Nausea; Diarrhea; Appetite change Genitourinary: Frequency; Anuria; Erectile dysfunction Sudomotor: Anhidrosis [neuromuscular.wustl.edu]
- Vaginal Dryness
If you have vaginal dryness, your doctor may suggest a lubricant. If you have erectile dysfunction, they may prescribe medication that can help. [healthline.com]
dryness or orgasm problems in women. [nlm.nih.gov]
Sexual problems, such as erection problems in men and vaginal dryness in women. Heart and blood vessel problems, leading to poor circulation or low blood pressure. [cigna.com]
- Sexual Dysfunction
In diabetic autonomic neuropathy, the patients may experience persistent nausea, vomiting, diarrhea, constipation, incontinence, sweating abnormalities or sexual dysfunction. [hopkinsmedicine.org]
Symptoms of autonomic nerve dysfunction include:> erectile or sexual dysfunction loss of bladder or bowel control abnormal sweating with inability to tolerate changes in temperature abnormal blood pressure control, causing lightheadedness when standing [healthcentral.com]
It may also help alleviate: burning and tingling sensations in the legs and feet muscle cramps muscle weakness sexual dysfunction Electrical nerve stimulation is a painless type of physical therapy that might help to reduce feelings of stiffness and enhance [medicalnewstoday.com]
- Urinary Incontinence
For example, antispasmodic or anticholinergic drugs can help prevent urinary incontinence. [medicinenet.com]
[…] tract infections or urinary incontinence Constipation, uncontrolled diarrhea or a combination of the two Slow stomach emptying (gastroparesis), leading to nausea, vomiting and loss of appetite Difficulty swallowing Erectile dysfunction in men Vaginal [symptoma.com]
The urinary tract may also be affected, and at the worst stages this can cause urinary incontinence. Also, neuropathy can decrease sexual response in both men and women. [diabetes.co.uk]
The condition is diagnosed based on symptoms presented, a physical exam and a medical history . During the exam, the muscle strength and tone is checked, tendon reflexes as well as sensitivity to touch, temperature and vibration are also checked. Other tests that may be conducted include the following:
- Filament test
- Nerve conduction studies
- Electromyography (EMG)
- Quantitative sensory testing
- Autonomic testing
Diabetic neuropathy has no known cure  . Treatment and management is mostly focused on slowing of the progression of the disease, relieving of pain, management of complications and restoration of functions.
Prognosis of diabetic neuropathy is an uphill task as it remains silent for several years after the onset of diabetes. [ncbi.nlm.nih.gov]
Prognosis of Diabetic Neuropathy The prognosis for diabetic neuropathy depends largely on how well the underlying condition of diabetes is handled. Treating diabetes may halt progression and improve symptoms of the neuropathy, but recovery is slow. [sydneynorthneurology.com.au]
Expectations (prognosis) Treatment relieves pain and can control some symptoms, but the disease generally continues to get worse. [web.archive.org]
More than 100 types of peripheral neuropathy have been identified, each with its own symptoms and prognosis, according to the National Institute of Neurological Disorders and Stroke. [practicalpainmanagement.com]
There are certain risk factors associated with more severe cases of diabetic neuropathy. They include the following :
- Poor glycemic control
- Advanced age
- Long duration of diabetes mellitus
- Heavy alcohol intake
- HLA-DR3/4 phenotype
- Tall height
Development of symptoms is however, dependent on a variety of factors such as the total hyperglycemic exposure as well as other risk factors like elevated lipds, blood pressure, smoking, increased height as well as excessive exposure to some other neurotoxic agents like ethanol. Genetic factors have also be considered to have a role.
In the United States, 47% of patients with diabetes show some peripheral neuropathy . Neuropathy is believed to be seen in 7.5% of patients at the time of diagnosis of diabetes with more than half of the cases demonstrating distal symmetric polyneuropathy. Internationally, figures are far lower.
Diabetes mellitus affects men and women with the same frequency. However, male patients with type 2 diabetes may develop polyneuropathy much earlier than their female counterparts. Diabetic neuropathy can be seen at any age but it is most common with increasing age, severity and duration of the diabetes.
The major factors responsible for the development of diabetic neuropathy remains incompletely understood . However, multiple hypotheses have been brought forward. It is generally believed that the condition is a multifactorial process.
Development of symptoms is dependent on several factors such as total hyperglycemic exposure and other risk factors like elevated lipids, blood pressure, smoking, increased height, as well as high exposure to other potentially neurotoxic agents like ethanol. Genetic factors can also play a role.
Important contributing biochemical mechanisms in the development of the more commonly known symmetrical forms of diabetic polyneuropathy may include the following: polyol pathway, advanced glycation end products as well as oxidative stress.
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. [web.archive.org]
SETTING: This study was part of a longitudinal cohort study of a nurse-led health promotion programme for preventing foot ulceration in Chiayi County, Taiwan. [ncbi.nlm.nih.gov]
Prevention The patient plays a vital role in minimizing the risk of developing diabetic peripheral neuropathy and in preventing its possible consequences. Some important preventive measures include: Keep blood sugar levels under control. [acfas.org]
Diabetic neuropathies refer to any of the neuropathic disorders that are commonly associated with diabetes mellitus . These conditions are believed to arise mostly from diabetic microvascular injuries which often involve the small blood vessels responsible for supplying nerves as well as macrovascular conditions that may end up in diabetic neuropathy. There are 4 major types of neuropathy: Peripheral neuropathy, autonomic neuropathy, radiculoplexus neuropathy or diabetic amyotrophy and mononeuropathy.
Diabetic neuropath refers to a type of nerve damage which can occur in people with diabetes. High blood sugar may bring about injury to the nerve fibres around the body but diabetic neuropathy is focused on the legs and feet.
Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain, to numbness in the extremities as well as problems in the urinary tract, digestive tract, blood vessels and the heart. For some people, these symptoms are often mild while for others, diabetic neuropathy can be fatal, painful or disabling.
Diabetic neuropathy is common but serious complication of diabetes that can only be controlled by sticking to prescribed blood sugar controls and living a healthy lifestyle.