High blood sugar can lead to nerve damage in feet and other areas of the body. Know the signs and how to take steps to prevent this diabetes complication.
Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerves throughout the body. Diabetic neuropathy most often damages nerves in the legs and feet.
Depending on the affected nerves, diabetic neuropathy symptoms include pain and numbness in the legs, feet and hands. It can also cause problems with the digestive system, urinary tract, blood vessels and heart. Some people have mild symptoms. But for others, diabetic neuropathy can be quite painful and disabling.
Diabetic neuropathy is a serious diabetes complication that may affect as many as 50% of people with diabetes. But you can often prevent diabetic neuropathy or slow its progress with consistent blood sugar management and a healthy lifestyle.
There are four main types of diabetic neuropathy. You can have one type or more than one type of neuropathy.
Your symptoms depend on the type you have and which nerves are affected. Usually, symptoms develop gradually. You may not notice anything is wrong until considerable nerve damage has occurred.
This type of neuropathy may also be called distal symmetric peripheral neuropathy. It's the most common type of diabetic neuropathy. It affects the feet and legs first, followed by the hands and arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include:
The autonomic nervous system controls blood pressure, heart rate, sweating, eyes, bladder, digestive system and sex organs. Diabetes can affect nerves in any of these areas, possibly causing signs and symptoms including:
This type of neuropathy often affects nerves in the thighs, hips, buttocks or legs. It can also affect the abdominal and chest area. Symptoms are usually on one side of the body, but may spread to the other side. Proximal neuropathy may include:
Mononeuropathy refers to damage to a single, specific nerve. The nerve may be in the face, torso, arm or leg. Mononeuropathy may lead to:
Call your health care provider for an appointment if you have:
The American Diabetes Association (ADA) recommends that screening for diabetic neuropathy begin immediately after someone is diagnosed with type 2 diabetes or five years after diagnosis with type 1 diabetes. After that, screening is recommended once a year.
The exact cause of each type of neuropathy is unknown. Researchers think that over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals, leading to diabetic neuropathy. High blood sugar also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients.
Anyone who has diabetes can develop neuropathy. But these risk factors make nerve damage more likely:
Diabetic neuropathy can cause a number of serious complications, including:
You can prevent or delay diabetic neuropathy and its complications by closely managing your blood sugar and taking good care of your feet.
The ADA recommends that people living with diabetes have a glycated hemoglobin (A1C) test at least twice a year. This test indicates your average blood sugar level for the past 2 to 3 months.
A1C goals may need to be individualized, but for many adults, the ADA recommends an A1C of less than 7.0%. If your blood sugar levels are higher than your goal, you may need changes in your daily management, such as adding or adjusting your medications or changing your diet or physical activity.
Foot problems, including sores that don't heal, ulcers and even amputation, are common complications of diabetic neuropathy. But you can prevent many of these problems by having a thorough foot exam at least once a year. Also have your health care provider check your feet at each office visit and take good care of your feet at home.
Follow your health care provider's recommendations for good foot care. To protect the health of your feet:
Your health care provider can usually diagnose diabetic neuropathy by performing a physical exam and carefully reviewing your symptoms and medical history.
Your health care provider typically checks your:
Along with the physical exam, your health care provider may perform or order specific tests to help diagnose diabetic neuropathy, such as:
Diabetic neuropathy has no known cure. The goals of treatment are to:
Consistently keeping your blood sugar within your target range is the key to preventing or delaying nerve damage. Good blood sugar management may even improve some of your current symptoms. Your health care provider will figure out the best target range for you based on factors including your age, how long you've had diabetes and your overall health.
Blood sugar levels need to be individualized. But, in general, the American Diabetes Association (ADA) recommends the following target blood sugar levels for most people with diabetes:
The ADA generally recommends an A1C of 7.0% or lower for most people with diabetes.
Mayo Clinic encourages slightly lower blood sugar levels for most younger people with diabetes, and slightly higher levels for older people with other medical conditions and who may be more at risk of low blood sugar complications. Mayo Clinic generally recommends the following target blood sugar levels before meals:
Other important ways to help slow or prevent neuropathy from getting worse include keeping your blood pressure under control, maintaining a healthy weight and getting regular physical activity.
Many prescription medications are available for diabetes-related nerve pain, but they don't work for everyone. When considering any medication, talk to your health care provider about the benefits and possible side effects to find what might work best for you.
Pain-relieving prescription treatments may include:
Antidepressants. Some antidepressants ease nerve pain, even if you aren't depressed. Tricyclic antidepressants may help with mild to moderate nerve pain. Drugs in this class include amitriptyline, nortriptyline (Pamelor) and desipramine (Norpramin). Side effects can be bothersome and include dry mouth, constipation, drowsiness and difficulty concentrating. These medications may also cause dizziness when changing position, such as from lying down to standing (orthostatic hypotension).
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another type of antidepressant that may help with nerve pain and have fewer side effects. The ADA recommends duloxetine (Cymbalta, Drizalma Sprinkle) as a first treatment. Another that may be used is venlafaxine (Effexor XR). Possible side effects include nausea, sleepiness, dizziness, decreased appetite and constipation.
Sometimes, an antidepressant may be combined with an anti-seizure drug. These drugs can also be used with pain-relieving medication, such as medication available without a prescription. For example, you may find relief from acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) or a skin patch with lidocaine (a numbing substance).
To manage complications, you may need care from different specialists. These may include a specialist who treats urinary tract problems (urologist) and a heart specialist (cardiologist) who can help prevent or treat complications.
The treatment you'll need depends on the neuropathy-related complications you have:
Low blood pressure on standing (orthostatic hypotension). Treatment starts with simple lifestyle changes, such as not using alcohol, drinking plenty of water, and changing positions such as from sitting to standing slowly. Sleeping with the head of the bed raised 4 to 6 inches helps prevent high blood pressure overnight.
Your health care provider may also recommend compression support for your abdomen and thighs (abdominal binder and compression shorts or stockings). Several medications, either alone or together, may be used to treat orthostatic hypotension.
These measures can help you feel better overall and reduce your risk of diabetic neuropathy:
Be active every day. Exercise helps lower blood sugar, improves blood flow and keeps your heart healthy. Aim for 150 minutes of moderate or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous exercise. It's also a good idea to take a break from sitting every 30 minutes to get a few quick bursts of activity.
Talk with your health care provider or physical therapist before you start exercising. If you have decreased feeling in your legs, some types of exercise, such as walking, may be safer than others. If you have a foot injury or sore, stick with exercise that doesn't require putting weight on your injured foot.
There are many alternative therapies that may help with pain relief on their own or in combination with medications. But check with your health care provider before using any alternative therapy or dietary supplement to make sure that you don't have any potential interactions.
For diabetic neuropathy, you may want to try:
Living with diabetic neuropathy can sometimes be challenging. Support groups can offer encouragement and advice about living with diabetic neuropathy. Ask your health care provider if there are any in your area, or for a referral to a therapist. The ADA offers online support through its website. If you find yourself feeling depressed, it may help to talk to a counselor or therapist.
If you don't already see a specialist in treating metabolic disorders and diabetes (endocrinologist), you'll likely be referred to one if you start showing signs of diabetes complications. You may also be referred to a specialist in brain and nervous system problems (neurologist).
To prepare for your appointment, you may want to:
Some basic questions to ask may include:
Your health care provider is likely to ask you a number of questions, such as: