Too often I see patients, and based on the symptoms they are experiencing, it is clear that it is diabetic neuropathy. However, in many cases they have never heard of the condition, which is damage to nerves, that occurs as a result of diabetes. Diabetes is thought to damage nerves due to prolonged elevated levels of blood glucose.

The three main types of neuropathy include sensory, autonomic and motor:

• Sensory neuropathy (or peripheral neuropathy, usually just called neuropathy), affects the nerves that carry information to the brain, about sensations from various parts of the body. For example, how hot or cold something is; what the texture of something feels like; the pain caused by a sharp object or heat; etc. This is the most common form of diabetic neuropathy.
• Autonomic neuropathy affects the nerves that control involuntary activities of the body, such as the action of the stomach, intestine, bladder and even the heart.
• Motor neuropathy affects the nerves that carry signals to muscles, to allow motions like walking and moving fingers. This form of neuropathy is very rare in diabetes.

Sensory neuropathy can lead to pain, numbness or tingling in the extremities; and ultimately, an inability to feel heat, cold, pain or any other sensation in affected areas. Autonomic neuropathy can lead to impotence in men; bladder neuropathy (which means the bladder is unable to empty completely); diabetic diarrhoea; or bloated stomach. Motor neuropathy can lead to muscle weakness.

If you are diagnosed with neuropathy, your physician or podiatrist may use terms to describe the type that you have based on whether only one side of your body is affected (asymmetric), or both sides (symmetric). If only one kind of nerve is affected, your doctor may say you have mononeuropathy. If several nerves are affected, the term polyneuropathy may be used.

Peripheral neuropathy most commonly causes:

• pain
• burning
• tingling
• numbness of the feet and lower legs.

Autonomic neuropathy causes symptoms related to dysfunction of an organ system, such as:

• urinary incontinence
• diarrhoea or constipation
• sexual dysfunction.

There is no cure for diabetic neuropathy, but treatments are available to manage the symptoms. Diabetic nerve pain may be controlled by medications. Keeping tight control of blood sugar levels is the best way to prevent diabetic neuropathy and other complications of diabetes.

While diabetes is a frequent cause of neuropathy, it is not the only cause. Nutritional deficiencies (B-12 and folate), chemical exposures, pressure on nerves, or medications (such as some of those used for chemotherapy or to treat AIDS), can also cause neuropathy.

What are the signs and symptoms of diabetic neuropathy? 

The symptoms and signs of diabetic neuropathy depend upon the type of neuropathy that is present. Signs and symptoms can also vary in severity among affected people, they include:

• Numbness or tingling of the feet and lower legs
• Pain or burning sensations
• Loss of sensation in the feet or lower legs

Sometimes, but less commonly, these symptoms can occur in the hands or arms too.

How is diabetic neuropathy diagnosed?

Diabetic neuropathy is usually presumptively diagnosed clinically by the patient’s symptoms, medical history, and physical exam. However, there are other tests that can definitively diagnose the condition by actually measuring the loss of nerve function. Nerve conduction studies measure the speed of nerve signals in the arms and legs. Other tests of nervous system function may be done on some patients. About 45% to 50% of all patients with diabetes are eventually diagnosed with some form of neuropathy.

 How is it treated?

Unfortunately, there are no miracle cures or treatments for neuropathy. There is no way to heal or replace nerves that have been damaged. There are treatments available, however, to help manage some of the symptoms.

The most important thing someone who has neuropathy can do is keep their blood glucose levels as close to the target goal as possible; exercise regularly; and make sure his or her weight is as close to what it should ideally be. This will help keep blood glucose closer to normal, and limit the damage high blood glucose can cause to nerves. Exercise will have the added benefit of keeping muscles that may be weakened by decreasing nerve activity,  remain strong and toned.

Some patients have experienced success with some forms of pain management, such as acupuncture or electrical therapy. Don’t discourage a person from trying any safe, non-drug approach to pain relief. What may not work for one person, may work really well for someone else.

The pain of diabetic neuropathy can sometimes be managed with certain medications. Certain prescription antidepressants, and antiseizure medications, have been shown to be effective in relieving pain that originates in the nerves. To assist your efforts, have annual checks done, which your podiatrist can facilitate.

Your feet mirror your general health . . . cherish them!