Diabetic Neuropathy: What it is, Symptoms and Treatment

Diabetic neuropathy is one of the main complications of diabetes, characterized by the progressive degeneration of the nerves, which can reduce sensitivity or cause pain in various parts of the body, being most common in the extremities such as the hands or feet.

This condition is more common in people who do not comply with diabetes treatment adequately, frequently presenting high blood sugar levels, which cause progressive nerve damage. The development of neuropathy may be slow and symptomless at first, but over time pain, tingling, burning, or loss of sensation in the affected area may occur.

Diabetic neuropathy has no cure, but its progression can be controlled with the use of medications to lower blood sugar levels and relieve neuropathic pain.

Diabetic Neuropathy-Main Types and Symptoms

Diabetic neuropathy develops slowly and may go unnoticed until more serious symptoms emerge. Symptoms vary depending on the type of neuropathy:

1. Peripheral neuropathy

Peripheral neuropathy is characterized by the involvement of the peripheral nerves, being the most common type of diabetic neuropathy. Generally, it starts in the feet and legs, then in the hands and arms. Symptoms are usually worse at night and include:

• Numbness or tingling in the fingers or toes;
• Reduced ability to feel pain or changes in temperature;
• Burning sensation;
• Pain or cramps;
• Loss of touch;
• Muscular weakness;
• Loss of reflexes, mainly in the Achilles heel;
• Loss of balance;
• Loss of motor coordination;
• Joint deformity and pain.

Additionally, peripheral neuropathy can cause serious foot problems, such as diabetic foot characterized by ulcers or infections. Learn better what diabetic foot is and how to treat it.

2. Autonomic Neuropathy

Autonomic neuropathy affects the autonomic nervous system that controls several organs that function independently of will, such as the heart, bladder, stomach, intestines, sexual organs, and eyes.

Symptoms of peripheral neuropathy depend on the area affected and include:

• Absence of symptoms of hypoglycemia, such as confusion, dizziness, hunger, tremor, or decreased motor coordination;
• Constipation or diarrhea;
• Nausea, vomiting, difficulty digestion or swallowing;
• Vaginal dryness;
• Erectile dysfunction;
• Increased or reduced sweat production;
• Decreased blood pressure that may cause dizziness when standing up;
• Feeling of racing heart, even when standing;
• Bladder problems, such as frequent or urgent urination, urinary incontinence, or frequent urinary tract infection.

Additionally, autonomic neuropathy can cause difficulty focusing light in a dark environment.

3. Proximal neuropathy

Proximal neuropathy, also called diabetic amyotrophy or radiculopathy, is more common in the elderly and can affect the nerves of the thigh, hip, buttocks or legs, in addition to the abdomen and chest.

Symptoms usually occur on one side of the body, but can spread to the other side, and include:

• Severe pain in the hip and thigh or buttocks;
• Stomachache;
• Weakness in the thigh muscles;
• Difficulty getting up from sitting;
• Abdominal swelling;
• Weightloss.

People with proximal neuropathy may also present with foot drop or flaccidity, as if they were relaxed, which can cause difficulty walking or falls.

4. Focal neuropathy

Focal neuropathy, also called mononeuropathy, is characterized by the involvement of a specific nerve in the hands, feet, legs, trunk or head.

Symptoms depend on the nerve affected and include:

• Loss of sensation in the affected nerve area;
• Tingling or numbness in the hands or fingers due to compression of the ulnar nerve;
• Weakness in the affected hand that makes it difficult to hold objects;
• Pain on the outside of the leg or weakness in the big toe, due to compression of the perineal nerve;
• Paralysis of one side of the face, called Bell’s palsy;
• Vision problems such as difficulty focusing on an object or double vision;
• Pain behind the eye.

In addition, other symptoms such as pain, numbness, tingling or burning sensation in the thumb, index and middle finger, may occur due to compression of the median nerve, which passes through the wrist and innervates the hands, characterizing carpal tunnel syndrome.

How the diagnosis is confirmed

The diagnosis of diabetic neuropathy is made by the endocrinologist based on the signs and symptoms presented and the history of the disease. In addition, the doctor must perform a physical examination to evaluate muscle strength or tone, assess the tendon reflex, and analyze sensitivity to touch and changes in temperature such as hot or cold.

The doctor may also perform or order specific tests to confirm the diagnosis, such as a nerve conduction test, which measures how quickly the nerves in the arms and legs conduct electrical signals; electromyography, which measures the electrical discharges produced in the muscles or the autonomic test, which can be performed to determine changes in blood pressure in different positions.

How the treatment is performed

Treatment for diabetic neuropathy should be guided by an endocrinologist and is usually performed to relieve symptoms, avoid complications, and slow the progression of the disease.

Treatments for diabetic neuropathy include medications such as:

• Antidiabetics such as insulin injections or taking oral antidiabetics to control blood sugar levels;
• Anticonvulsants such as pregabalin or gabapentin to relieve nerve pain;
• Antidepressants such as amitriptyline, desipramine, imipramine, duloxetine, or venlafaxine that help relieve mild to moderate nerve pain;
• Opioid pain relievers applied in patches, such as transdermal fentanyl or transdermal buprenorphine, or taken by mouth, such as tramadol, morphine, oxycodone, or methadone.

In some cases, the antidepressant may be used along with an anticonvulsant, or those medications may be used with pain relievers to help control pain.

In addition, for the treatment of complications of diabetic neuropathy, care with different specialists may be necessary, such as a urologist to treat urinary tract problems with medications that regulate bladder function or medications for erectile dysfunction, for example, or a cardiologist. to control blood pressure and avoid diabetic cardiomyopathy.

Read Related: 12 symptoms of childhood diabetes (and how to diagnose)

How to avoid neuropathy

Diabetic neuropathy can generally be avoided if blood glucose levels are tightly controlled. For this, some measures include:

• Provide regular medical follow-up ;
• Monitor blood glucose levels at home with the glucometer according to medical guidance;
• Take medications or take insulin as prescribed by your doctor;
• Practice regular physical activities such as light walking, swimming or hydrogymnastics, for example.

You should eat a balanced diet that includes fiber, proteins and good fats, in addition to avoiding foods with a lot of sugar such as cookies, soft drinks or cakes.