A common condition caused by high blood glucose level is nerve damage know as diabetic neuropathy. Nerves are found throughout our body. They are responsible for everything we feel, from warmth and cold to pain. They also play a vital role in controlling our heart rate, digestive system, bladder control and sexual function. High blood glucose level can, over time, cause damage to nerves through out the body causing symptoms in every organ system. In diabetics the damage most commonly involves the longest nerves first (those in the feet and toes) resulting in loss of sensation and numbness. If left untreated, it can lead to complete loss of feeling and spread to legs and hands.

Diabetic neuropathy can occur in both Type 1 and Type 2 diabetics due to prolonged high blood glucose level. It occurs in nearly half the diabetics but not everyone with nerve damage develops symptoms. In those who do develop symptoms, they can range from mild to severe. Diabetics can develop nerve damage anytime, but the risk increases with long duration of diabetes or poorly controlled blood sugar. It is especially common among those who have had diabetes for at least 20-25 years.

Diabetic Neuropathy is the most common complication of diabetes. But you can prevent or slow its progression by healthy lifestyle and strict blood glucose control.

Diabetic Neuropathy is caused by interaction among a number of factors. It is most commonly caused by prolonged levels of high blood glucose. However, research has shown that tight blood glucose control, although decreases the risk of developing neuropathy, does not eliminate it completely.  This suggests other factor such as genetic and environmental factors may also be involved.

High Blood Glucose Damages Nerves and Blood Vessels:

• Nerves carry messages back and forth between the brain and other parts of the body. Small blood vessels provide nerves with nutrients and oxygen required to survive and function. Your nerves are extremely sensitive to any change in nutrients and oxygen supply. High blood glucose damages these small blood vessels that feed the nerves. When the vessels are damaged, a sufficient supply of nutrients and oxygen no longer reaches the nerve, causing the nerve to become damaged and eventually die.
• High blood glucose also damages the outer protective layer of nerves, affecting their ability to transmit signals. This results in incorrect signals being sent to the brain causing chronic pain.

Other Factors Contributing to Nerve Damage Include:

• Genetic Factors
  Some people are more susceptible to nerve damage indicating a possible role of genetics.
• Autoimmune factors
  in which the immune system mistakenly attacks your own nerves as if they are foreign. This results in nerve inflammation resulting in interference with transmission of signals.
• Mechanical injury to nerves

• Age >40 years
• Long duration of diabetes – especially if you’ve diabetes for >20 years
• Periods of poor glucose control – this is the greatest risk factor for all diabetic complications.
• Smoking – narrows and hardens the arteries, reducing blood flow and causing nerve damage.
• Kidney disease – Diabetics with kidney problems are more likely to develop neuropathy
• Eye disease
• Excessive alcohol consumption
• High blood pressure
• High blood cholesterol
• Ischemic heart disease

Diabetic neuropathy can be divided into four types depending on the location and type of nerves involved. Please select the tab to display more information about the Type and Symptoms below:

• Your healthcare provider will usually establish the diagnosis of diabetic neuropathy based on your symptoms and foot exam findings. Special tests are sometimes done to confirm this diagnosis. (See article- exams and tests for diabetic feet).
• In additions to these, your healthcare provider will perform a full assessment of diabetes and blood pressure control.
• Other conditions such as thyroid problems, vitamin B12 deficiency may also cause neuropathy. Therefore it is essential to exclude these first, before establishing a diagnosis of diabetic neuropathy. Your healthcare provider will perform blood tests to exclude these.

There is currently no well established treatment for reversing diabetic neuropathy. Management mainly focuses on four important aspects of the condition. These include:

1.0 Keeping your blood glucose level in target range:

• The first step in management of diabetic neuropathy is to keep your blood glucose level in target range throughout the day.
• Once the nerves are damaged, they cannot be repaired. Keeping your blood glucose level in target range will slow the progression of diabetic neuropathy and even cause some improvement in symptoms you already have.

2.0 Pain Management:

Pain is the most distressing symptom of diabetic neuropathy. Medications that are used to manage pain of diabetic neuropathy are used in other conditions as well such as epilepsy and depression.  Your healthcare provider will decide which medication is best for you as these don’t work for everyone and have side effects.

• Most commonly used medications are anti-seizure meds, anti depressant, topical lidocaine patch and opioids.
• Talk with your healthcare provider about options for treating your pain.
• Other measures for pain- Using a device called bed foot cradle which keeps sheets from touching feet can be helpful.
• Physical therapy may be helpful in relieving pain in some diabetics.
• Alternative Medicine- Includes topical capsaicin, alpha-lipoic acid, acupuncture, biofeedback and transcutaneous electrical nerve stimulation (TENS).
• Capsaicin cream can reduce pain of neuropathy in some people. May cause skin burning and irritation.
• Alpha-lipoic acid- An anti-oxidant that has been found to be effective in relieving diabetic neuropathy pain.
• TENS- small electrical impulses are applied to specific nerves to prevent pain signal reaching the brain. May not be suitable for everyone.

3.0 Managing complications:

• Digestive Problems
  Mild symptoms of gastroparesis can be managed with small frequent meals, eating less fat and fiber. For severe symptoms, your healthcare provider will prescribe a medication. Diarrhea and constipation are managed with medications and dietary changes.
• Bladder Problems
  For urinary tract infection, your healthcare provider will prescribe an antibiotic. Also drink plenty of fluids. For incontinence, timed urination at 2-3 hour interval is helpful. Pessaries and rings can be inserted in vagina to prevent urine leakage.
• Sexual Problems
  For vaginal dryness, lubrication can be used. For erectile dysfunction associated with neuropathy, your healthcare provider may prescribe a medication such as sildenafil etc. These medications are not safe for everyone, so consult with your healthcare provider before using these.
• Orthostatic Hypotension
  Lifestyle measures such as raising head of the bed, standing slowly, drinking plenty of water may help. You may benefit from wearing elastic stockings. Your healthcare provider may also prescribe a medication.

• Keep your blood glucose in target range
• Keep your blood pressure and blood cholesterol in check
• Follow a healthy dietary plan- Include beans and nuts, fish (salmon, tuna), fruits and veggies in your diet.
• Exercise regularly- participate in non-weight bearing activities
• Maintain a healthy weight for your height
• Follow a diabetic foot care routine and see your podiatrist regularly.
• Stop smoking
• Avoid excessive alcohol- Recommended amount: No more than one drink per day for women and two drinks per day for men.

In conclusion, as a diabetic it is very important for you to learn as much as possible about routine diabetic foot care as it plays the biggest role in preventing foot ulcers.

Diabetes and Foot Care … read more:

• How diabetes effects my Feet?
• How to take care of my feet?
• Daily Foot Exam Checklist
• Prevention is better than cure! Do’s and Don’ts
• When to see your doctor?
• At the Doctor’s office 
• Diabetic Foot Infections
  
• Diabetic Foot Ulcers
• Diabetic Foot Deformities 
• Exams and Tests for Diabetic Feet
  
• What is Diabetic Neuropathy? 
• Diabetic Shoes
  
• Diabetes and Alcohol Consumption  – Latest Release