Diabetic Neuropathy: Symptoms, Treatment & More

• Diabetic Neuropathy Overview
• Diabetic Peripheral Neuropathy
• Diabetic Autonomic Neuropathy
• Diabetic Proximal Neuropathy
• Diabetic Focal Neuropathy
• Other Nerve Damage Seen With Diabetes
• Prevention of Diabetic Neuropathy

Diabetic Neuropathy Overview

Diabetic neuropathy, a common complication of diabetes, is damage to the nerves that allow you to feel sensations such as pain. There are a number of ways that diabetes damages the nerves, but they all seem related to blood glucose being too high for a long period of time.

Diabetes-related nerve damage can be painful, but it isn't severe pain in most cases.

There are four types of diabetic neuropathy: peripheral, autonomic, proximal and focal.

Diabetic Peripheral Neuropathy

The areas of the body most commonly affected by diabetic peripheral neuropathy are the feet and legs. Nerve damage in the feet can result in a loss of foot sensation, increasing your risk of foot problems. Injuries and sores on the feet may go unrecognized due to lack of sensation. Therefore, you should practice proper skin and foot care. Rarely, other areas of the body such as the arms, abdomen, and back may be affected.

Symptoms of diabetic peripheral neuropathy may include:

• Tingling
   
• Numbness (severe or long-term numbness can become permanent)
   
• Burning (especially in the evening)
   
• Pain

In most cases, early symptoms will become less when blood glucose is under control. Medications can be taken to help control the discomfort if needed.

To prevent peripheral neuropathy:

• Work with your doctor to keep your blood glucose under tight control

To help prevent the complications of peripheral neuropathy:

• Examine your feet and legs daily
   
• Apply lotion if your feet are dry
   
• Care for your nails regularly. (Go to a podiatrist, if necessary)
   
• Wear properly fitting footwear and wear them all the time to prevent foot injury

• Diabetic Autonomic Neuropathy

  Diabetic autonomic neuropathy most often affects the digestive system, especially the stomach, blood vessels, urinary system, and sex organs. To prevent autonomic neuropathy, continuously keep your blood glucose levels well controlled.

  Symptoms of neuropathy of the digestive system may include:

  • Bloating
     
  • Diarrhea
     
  • Constipation
     
  • Heartburn
     
  • Nausea
     
  • Vomiting
     
  • Feeling full after small meals
  Treatments of autonomic neuropathy of the digestive system may include:
  • Eat smaller meals
     
  • Medicines

  Symptoms of autonomic neuropathy of the blood vessels may include:

  • Blacking out when you stand up quickly
     
  • Increased heart rate
     
  • Dizziness
     
  • Low blood pressure
  Treatments of autonomic neuropathy of the blood vessels may include:
  • Avoid standing up too quickly
     
  • Medicines
     
  • Wearing special stockings

  Symptoms of autonomic neuropathy of the male sex organs may include:

  • Unable to have or maintain an erection (erectile dysfunction)*
     
  • "Dry" or reduced ejaculations
  *Note: Impotence needs to be evaluated by your doctor. It may be caused by your medicines or factors other than diabetes.

  Treatments of autonomic neuropathy of the male sex organs include:

  • Counseling
     
  • Penile implant
     
  • Vacuum erection device
     
  • Penile injections
     
  • Medicine

  Symptoms of autonomic neuropathy of the female sex organs may include:

  • Decrease in vaginal lubrication
     
  • Decrease in number of orgasms or lack of orgasm

  Treatments of autonomic neuropathy of the female sex organs include:

  • Counseling
     
  • Vaginal estrogen creams, suppositories and rings
     
  • Lubricants

  Symptoms of autonomic neuropathy of the urinary system may include:

  • Unable to completely empty bladder
     
  • Bloating
     
  • Incontinence (leaking urine)
     
  • Increased urination at night

  Treatments of autonomic neuropathy of the urinary system include:

  • Medicines
     
  • Self-catheterization (inserting a catheter into the bladder to release urine)
     
  • Surgery

  • Diabetic Proximal Neuropathy

    Diabetic proximal neuropathy causes pain (usually on one side) in the thighs, hips, or buttocks. It can also lead to weakness in the legs. Treatment for weakness or pain is usually needed and may include medication and physical therapy. The recovery varies, depending on the type of nerve damage. Prevention consists of keeping blood glucose under tight control.

    Diabetic Focal Neuropathy

    Diabetic neuropathy can also appear suddenly and affect specific nerves, most often in the head, torso, or leg, causing muscle weakness or pain. This is known as focal neuropathy. Symptoms may include:

    • double vision
       
    • eye pain
       
    • paralysis on one side of the face (Bell's palsy)
       
    • severe pain in a certain area, such as the lower back or leg(s)
       
    • chest or abdominal pain that is sometimes mistaken for another condition such as heart attack or appendicitis

    Focal neuropathy is painful and unpredictable, however, it tends to improve by itself over weeks or months and does not tend to cause long-term damage.

    Other Nerve Conditions Seen With Diabetes

    People with diabetes can also develop other nerve-related conditions, such as nerve compressions (entrapment syndromes).

    Carpal tunnel syndrome is a very common type of entrapment syndrome and causes numbness and tingling of the hand and sometimes muscle weakness or pain.

    Prevention of Diabetic Neuropathy

    Keeping tight control of your blood sugar levels will help prevent many of these diabetes-related nerve conditions. Talk to your doctor about optimizing your individual diabetes treatment plan.

    Reviewed by Certified Diabetes Educators in the Department of Patient Education and Health Information and by physicians in the Department of Endocrinology at The Cleveland Clinic.
    
    SOURCES: American Diabetes Association (ADA): “Diabetic Neuropathy (Nerve Damage) and Diabetes.” ADA: “Additional Specific Types of Diabetic Neuropathy.” National Diabetes Education Program: “Prevention and Early Intervention for Diabetes Foot Problems.”
    
    Reviewed by John A. Seibel, MD on July 01, 2007
    Edited by Ephraim K Brenman, DO on March 01, 2007
    
    Portions of this page copyright © The Cleveland Clinic 2000-2005

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