Diabetic Peripheral Neuropathy

Of all of the complications that can come with a diabetes diagnosis, diabetic peripheral neuropathy is arguably one of the most challenging. This condition has no known cure, but with proper diagnosis and treatment, you can halt the progression and relieve symptoms. Here’s what you should know.

What is diabetic peripheral neuropathy?

Neuropathy refers to nerve damage that can cause a variety of symptoms, including pain and numbness. There are four main types of diabetic-related neuropathy, including:

  • Peripheral neuropathy
  • Autonomic neuropathy
  • Radiculoplexus neuropathy
  • Mononeuropathy

Diabetic peripheral neuropathy is a type of nerve pain that involves the peripheral nervous system (PNS). The PNS includes all of the nerves that come from your spinal cord and innervate the rest of your body. The central nervous system, on the other hand, is focused on your brain and spinal cord.

As with all types of neuropathy, people with diabetic peripheral neuropathy may not notice signs or symptoms of the condition until nerves are already damaged. Because of this, it’s important to keep a close eye on potential causes and early symptoms.

What causes diabetic peripheral neuropathy?

Peripheral neuropathy can be caused by many conditions including:

  • Vitamin deficiencies
  • Alcoholism
  • Autoimmune diseases
  • Certain medications
  • Unknown causes
  • Diabete

One of the more common causes of peripheral neuropathy is poor blood sugar control related to diabetes. Excessive and fluctuating amounts of sugar in the blood injure the capillary walls (small blood vessels) that supply your nerves, especially in your hands and feet. This destruction can cause nerve damage that may manifest as pain, numbness, or tingling. These symptoms usually begin in the toes and move towards the head.

Do I have diabetic peripheral neuropathy?

When your peripheral nerves become damaged, they do not function properly and can eventually produce symptoms such as pain, tingling, or numbness.

Other diabetic peripheral neuropathy symptoms to look out for include:

  • Cramps
  • Hypersensitivity to touch
  • Weakness in the extremities, particularly the legs and feet
  • Poor reflexes
  • Poor balance and coordination
  • Increase in foot problems, such as infections or slow-healing wounds

In men with poorly controlled diabetes, erectile dysfunction is also common as these blood vessels are damaged, too.

Another complication from the nerve damage produced by diabetes is neuropathy involving the gastrointestinal system. Damage to these nerves can cause problems with nausea, vomiting, diarrhea, or constipation. Postural hypotension may also ensue due to a progression of your peripheral neuropathy.

All of these symptoms – including pain – are usually located in the lower extremities and are often worse at night.

Diagnosis

Diabetic peripheral neuropathy can be difficult to diagnose. A neurological and physical exam as well as a thorough medical history can help rule out the possibility of other conditions. Certain lab tests may be ordered by your physician in order to rule out other potential causes of peripheral neuropathy, such as a vitamin B12 deficiency.
Other tools for diagnosis include:

  • Nerve conduction studies: Measures how quickly your nerves respond to electrical signals
  • Electromyography (EMG): Measures discharge of electricity from muscles
  • Filament test: Tests the sensitivity of your skin
  • Quantitative sensory testing: Evaluates how your nerves respond to vibration and temperature changes

A proper early diagnosis is crucial, so if you have diabetes and are experiencing any of the symptoms above, talk to your doctor.

Diabetic peripheral neuropathy treatment approaches

Even more difficult than diagnosing diabetic peripheral neuropathy is treating it. There is no cure for this condition. The goal of treatment is to relieve your symptoms and slow or stop progression of nerve damage.

There are no quick fixes for diabetic peripheral neuropathy, so your physician may recommend several different approaches until you find which is most effective for you. Often, you’ll use a variety of treatments to manage your symptoms. Left untreated, diabetic peripheral neuropathy is a serious complication of diabetes that can even result in amputation of the affected limb.

These are the most common diabetic peripheral neuropathy treatment options:

  1. Blood sugar control
  2. Exercise
  3. Foot care
  4. Supplements
  5. Biofeedback
  6. Acupuncture
  7. Over-the-counter pain relievers
  8. Membrane-stabilizing medications
  9. Other prescribed medications
  10. Transcutaneous electrical nerve stimulation (TENS)
  11. Spinal cord stimulation (SCS)
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Exercise is also extremely important in patients with diabetes.

For patients with newly-diagnosed Type 2 diabetes, diet, exercise, and weight loss can help prevent further complications and may even help you avoid the need for further medication. For patients with Type 1 diabetes who still require medication to manage their diabetes, regular exercise uses excess blood sugar for energy and also increases the body’s sensitivity to insulin.

Exercise also helps you maintain a better overall level of physical and mental health.

  • Alpha-lipoic acid
  • Acetyl-L-carnitine
  • Benfotiamine
  • Methylcobalamin
  • Topical capsaicin

References

  1. Smith RG. J J Am Podiatr Med Assoc. 2007 Sep-Oct;97(5):394-401
  2. Ahn AC, Bennani T, Freeman R, Hamdy O, Kaptchuk TJ. Two styles of acupuncture for treating painful diabetic neuropathy–a pilot randomized
control trial Acupunct Med. 2007 Jun;25(1-2):11-7.
  3. Abuaisha BB, Costanzi JB, Boulton AJ. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study.
Diabetes Res Clin Pract. 1998 Feb;39(2):115-21
  4. Haythornthwaite JA, Benrud-Larson LM. Psychological assessment and treatment of patients with neuropathic pain. Curr Pain Headache Rep. 2001 Apr;5(2):124-9.
  5. Head KA Peripheral neuropathy: pathogenic mechanisms and alternative therapies. Altern Med Rev. 2006 Dec;11(4):294-329