Diabetic neuropathy is nerve damage that can occur as a result of long-term and poorly controlled diabetes. This is caused by prolonged exposure to high blood sugar, which can damage nerve fibers, most often in the legs and feet, due to an inability to transmit signals. High blood sugar also weakens the walls of the small blood vessels that supply oxygen and nutrients to the nerve. Other factors that may contribute to diabetic neuropathy include inflammation caused by an autoimmune response, genetic factors unrelated to diabetes, smoking and alcohol abuse, kidney disease, and being overweight.
Signs and symptoms can range widely, and most cases develop gradually, but the most common symptoms are pain, tingling, or numbness in the toes and feet—or less commonly in the arms and legs. Some other symptoms include digestive and/or urinary issues, sexual dysfunction in men and women, issues with body temperature regulation, increased heart rate, and vision problems. The symptoms can range from painful to disabling, with severe cases becoming fatal.
Patients can prevent or slow the progression of diabetic neuropathy by regulating blood sugar and adopting a healthier lifestyle. Foot care is also an important component of disease management, and a yearly comprehensive foot exam is recommended.
During an exam, your physician may assess blood pressure, heart rate, muscle strength, reflexes, and sensitivity to position changes, vibration, temperature, or light touch to make a diagnosis. A foot exam should also be included to assess the skin, muscles, bones, circulation, and sensation. Your doctor may use electromyography to determine the type and extent of nerve damage. By transmitting an electrical current through a nerve, the test shows how muscles respond.
Duloxetine and pregabalin have been approved by the U.S. Food and Drug Administration to treat pain related to diabetic neuropathy, and other medications that may be prescribed include tricyclic antidepressants, anticonvulsants, alpha-lipoic acid, and opioids. Treatment can also involve electrical stimulation to improve blood flow, help heal the damaged nerves, and stimulate circulation.