Nerve damage is called neuropathy. The National Institute of Diabetes and Digestive and Kidney Diseases states neuropathies are a group of nerve problems which often develop in people with diabetes over time. Nerve damage can be without symptoms or people can feel pain, numbness, or tingling in their feet, hands, arms, and legs and this damage can happen in any part of the body because it can affect any organ.
Neuropathy is caused by high blood sugars making blood more acidic. As that acidic blood goes through small blood vessels, it can cause damage over time.
About half of people with diabetes develop nerve damage. It can happen at any time but chances of developing nerve damage go up with age and the longer a person has diabetes. Neuropathy develops more in people who struggle to manage their blood sugars since elevated blood sugar is the root of the nerve damage. It is also more common however, in overweight people with higher levels of cholesterol and blood pressure.
In This Section
- 1 Causes of Neuropathy
- 2 Types of Neuropathy
- 3 How to Lower Risk for Diabetic Neuropathy
- 4 Do I Have Neuropathy?
- 5 Can Nerve Damage be Reversed?
- 6 How is Neuropathy Treated?
Causes of Neuropathy
The National Institute of Health (NIH) also lists different causes or contributors to neuropathy:
- metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin
- neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves
- autoimmune factors that cause inflammation in nerves
- mechanical injury to nerves, such as carpal tunnel syndrome
- inherited traits that increase susceptibility to nerve disease
- lifestyle factors, such as smoking or alcohol use
Types of Neuropathy
This type of neuropathy is the most common type affecting people with diabetes and can be felt as pain, tingling, burning, prickling, numbness and complete loss of feeling in the extremities. This is nerve damage in the arms and legs. Feet will usually be the first place symptoms arise and symptoms will tend to be worse at night.
Since weakness and loss of reflexes can occur over time, people will often change how they walk which can lead to foot deformities.
When areas become numb on the feet, you may not notice blisters or small injuries which can become infected. If an infection isn’t noticed due to loss of feeling, it can spread, eventually leading to amputation. This is why in people with neuropathy in their feet, it is very important to do a daily foot check for injuries and blisters and to never neglect any signs of infection. Taking care of infections in time will help avoid the risk of amputation.
A vitamin B12 deficiency can cause peripheral neuropathy. The very popular diabetes drug metformin has been known to cause low vitamin b12 over time. If you take metformin, have your healthcare provider check you for vitamin B12 deficiency yearly to make sure you don’t experience nerve damage. You may need vitamin B12 supplementation.
This type affects digestion, bowel and bladder function, perspiration, sexual response, nerves that serve the heart and manage blood pressure and nerves that serve the eyes and lungs.
This type of neuropathy is also the one that may cause hypoglycemia unawareness which is when a person with diabetes cannot sense any low blood sugar symptoms.
Heart and Blood Vessels
Autonomic neuropathy affects nerves that serve the heart and can also lead to dizziness upon standing or sitting up due to a sharp decrease in blood pressure.
This can also lead to unregulated blood pressure that rises too high and a heart rate that rises and stays high instead of doing what it should normally do which is to rise but quickly self regulate.
Nerve damage can also affect the digestive system. The most common symptom is constipation.
A condition called gastroparesis can develop which leads the stomach to empty too slowly and can cause ongoing nausea, vomiting, bloating and a loss of appetite. Gastroparesis makes it difficult to manage blood sugars. A person may give insulin for the food they are about to eat but the stomach may empty so slowly that the absorption of glucose (from carbohydrates) is delayed. This can cause an initial low blood sugar that needs to be treated followed by a high blood sugar later when the stomach finally empties and the glucose kicks in.
The nerves of the esophagus can also be affected which can create trouble with swallowing.
Nerve damage to the bowels may cause intermittent constipation coupled with uncontrolled diarrhea.
Any of these problems may lead to weight loss.
The pupils of the eyes can be affected by nerve damage, too. This may cause them to inadequately respond to light changes. This may cause a person to struggle seeing in the dark and may make night driving more challenging.
Damage to the nerves that control sweat glands can cause them to function improperly. A person may sweat very much at night or while eating.
Over time, nerve damage can decrease sexual response in men and women. A man may have difficulty with erections, orgasms, and ejaculation. A woman may struggle with arousal, lubrication, and orgasms.
Bladder and Urinary Tract
Nerve damage may affect the ability of the bladder to empty entirely which can lead to bacteria growth in the bladder and kidneys–leading to infections.
If loss of sensation in those nerves occurs, a person may not be able to sense a full bladder or control the muscles for urination. This is called urinary incontinence.
This type of neuropathy can lead to pain in the thighs, hips, and buttocks. It leads to a loss of strength in the legs.
Proximal neuropathy is more common in people with type 2 diabetes and in older adults with diabetes and can make it difficult for a person to stand up from sitting position.
This type of neuropathy results in the sudden weakness of one nerve or a group of nerves and causes muscle pain and weakness. This can happen to any nerve in the body and typical occurs in older adults with diabetes.
The NIH states that focal neuropathy can cause the following symptoms:
- inability to focus the eye
- double vision
- aching behind one eye
- paralysis on one side of the face, called Bell’s palsy
- severe pain in the lower back or pelvis
- pain in the front of a thigh
- pain in the chest, stomach, or side
- pain on the outside of the shin or inside of the foot
- chest or abdominal pain that is sometimes mistaken for heart disease, a heart attack, or appendicitis
Focal neuropathy can often self-heal with time.
Carpel Tunnel Syndrome
Diabetes raises the risk of nerve compressions which can lead to carpel tunnel syndrome or other other syndromes. Carpel tunnel syndrome may cause nerve pain, weakness, numbness or tingling of the hands. The foot and legs can develop similar issues.
How to Lower Risk for Diabetic Neuropathy
The best way to work to avoid nerve damage is to control blood sugars as well as possible. Nerves are damaged when subject to prolonged elevated blood sugar levels.
Do I Have Neuropathy?
It is wise to visit a healthcare provider on a yearly basis to check for any signs of diabetes complications and discuss your symptoms with a doctor.
A healthcare provider should check your blood pressure, heart rate, reflexes, response to touch and do additional tests according to your symptoms and personal circumstances.
Can Nerve Damage be Reversed?
In some cases, nerve damage may be reversed to some extent. This is why it is important to follow up on early symptoms and get yearly check ups to spot early signs of nerve damage.
The best way to promote any nerve healing is to manage blood sugar levels as close to range as possible and to talk to your healthcare provider about what other issues could be causing nerve damage, such as low vitamin B12 due to the use of metformin or low intake of foods rich in vitamin B12.
How is Neuropathy Treated?
Blood sugar management is crucial to prevent further damage to nerves. Aside from this, treatment for neuropathy varies based on the nerves affected.
People with gastroparesis may need specialized advice on how to change their eating to best cope and perhaps medication to make digestion faster.
There are a number of medications doctors may prescribe for different types of neuropathy to help with pain and functional problems. Be sure to see your healthcare provider yearly with a list of any symptoms you are experiencing.
When the nerves of the feet are damaged, proper foot care becomes essential:
- Check feet daily for signs of injury, cuts, corns and blisters and treat adequately. Use a hand mirror or ask for help to see the bottom of your foot, if needed.
- Keep feet dry.
- Wear comfortable shoes and socks to keep feet from being irritated or injured.
- Cut toenails carefully and to the shape of the toes.
- Moisturize dry feet since cracks can lead to infection.
- See a doctor for any signs of infection like swelling and redness and tackle these issues before they become worse.
- If you smoke, strongly consider quitting. Smoking very much increases the risk of foot damage and amputation.
Remember, the most important thing is to manage blood sugars. It is never to late to improve blood sugar control. Make sure to see a healthcare provider each year to talk about symptoms. Earlier treatment usually leads to improved outcomes.
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