Neuropathy

Neuropathy, which refers to nerve damage, is a common complication of diabetes. About half of those with diabetes will develop some type of neuropathy.¹

Why does neuropathy occur in type 2 diabetes?

High blood sugar (hyperglycemia) that occurs in diabetes can lead to nerve damage. Sugar crystals in the blood are sharp and can damage the vessels and nerves inside the body over time.^1,2

Types of diabetic neuropathy

There are several different types of neuropathy that affect people with diabetes. These neuropathies are named according to which part of the nervous system is affected and how it is affected.²

Peripheral

Peripheral neuropathy is the most common type of nerve damage in diabetes. It is sometimes called distal symmetric peripheral neuropathy. This type of nerve damage affects the feet and legs first, then the hands and arms. The signs and symptoms of peripheral neuropathy include:^2,3

• Numbness
• Tingling and burning sensation
• Extreme sensitivity to touch
• Inability to feel light touch or determine the position of the foot
• Decreased ability to sense pain and temperature
• Foot complications, including ulcers, infections, and bone pain

Autonomic

The autonomic nervous system is the system of nerves that is responsible for the function of muscles and organs that work “automatically,” including your:^2,3

• Heart
• Bladder
• Stomach
• Eyes

Diabetes can affect the nerves of these areas. Possible complications may include:^2,3

• Bladder or bowel problems
• Slow stomach emptying (gastroparesis)
• Exercise intolerance, due to your heart rate not changing with activity
• Problems with your eyes adjusting from light to dark
• Dizziness and fainting

Proximal (diabetic polyradiculopathy)

Proximal neuropathy affects the nerves of the thighs, hips, buttocks, or legs. This condition is more common in older adults with type 2 diabetes.^2,3

This type of nerve damage usually starts on 1 side of the body. Sometimes the symptoms spread to the other side of the body. Other symptoms of this condition include:^2,3

• Sudden, severe pain
• Weakness and shrinking (atrophy) of the thigh
• Difficulty standing up from a seated position

Mononeuropathy

This type of neuropathy is damage to a single nerve. This can be painful but usually does not cause long term damage, and symptoms come and go over time. Mononeuropathy is sometimes called focal neuropathy. Symptoms depend on where the nerve damage is located and may include:^2,3

• Foot or lower leg pain
• Pain on the front of the thigh
• Belly or chest pain
• Paralysis on one side of the face (known as Bell’s palsy)
• Pain in the back of the eye

Mononeuropathy may result from nerve compression (also called entrapment). The wrist bones and ligaments of your wrist form a tunnel where nerves and tendons run through.The nerve supplies sensation and feeling to the thumb side of your hand. If this nerve becomes compressed within that tunnel, numbness in your thumb and fingers can occur. This nerve compression also leads to wrist pain and hand muscle breakdown. This condition is known as carpal tunnel syndrome.^3,4

Treatment

Prevention of nerve damage is the key to treatment. The overall goals in managing diabetic neuropathy are:⁵

• Slow the damage it is causing
• Manage pain

The best way to treat nerve damage when you have diabetes is to manage your blood sugar levels. Uncontrolled diabetes damages the nerves over time. Additional prevention may include:⁵

• Keeping your blood pressure within normal range
• Maintaining a healthy weight
• Getting regular exercise
• Following a healthy, balanced diet
• Asking your doctor for ways to stop smoking

Your doctor may prescribe drugs to help with the pain. Antidepressants and anti-seizure drugs may be used to help ease the pain from the nerves. Other drugs used may include:⁵

• Over-the-counter (OTC) pain drugs, such as ibuprofen or Tylenol
• Skin-numbing patches, like lidocaine