Diabetic nerve damage is also called diabetic neuropathy. Persistently high blood sugar levels can damage your nerves. This often causes pain, tingling, or numbness in your extremities.
Closely monitoring your blood glucose levels can greatly reduce your risk.
Diabetic nerve damage can occur anywhere in the body. There are four main types of nerve damage.
This is the most common type of diabetic nerve damage. It affects the:
Peripheral nerve damage may cause tingling, pain, or numbness.
This condition damages your autonomic nervous system. The autonomic nervous system is the part of the peripheral nervous system that acts independently of conscious control (involuntarily). It controls:
- blood pressure
Autonomic nerve damage also makes you less aware of low blood glucose levels. This is known as hypoglycemia unawareness.
This condition causes pain in your thighs, hips, and buttocks. It leads to leg weakness.
This type of damage causes one nerve, or a group of nerves, to suddenly become weak. It can occur in any nerve in the body.
High blood glucose levels cause nerve damage.
Over time, high levels of glucose can damage the blood vessels, which supply and maintain your nerves in working order.
The risk of nerve damage is highest for people who have had diabetes for more than 10 to 20 years.
Anyone with type 1 or type 2 diabetes can develop nerve damage. About half of people with diabetes will develop nerve damage. Your risk increases with:
- longer time as a person with diabetes
- trouble controlling blood sugar
- excess weight
Symptoms often develop slowly over many years. They vary depending on the nerves that are affected.
Common symptoms include:
- tingling in the arms and feet, especially the toes and fingertips
- pain that is often first felt in your toes and feet
- feeling full or vomiting after a small meal
- bloating or heartburn
- nausea, constipation, or diarrhea
- trouble swallowing
- feeling light-headed when you stand up
- fast heart rate
- sexual problems, including erectile dysfunction and vaginal dryness
- bladder problems, including not being able to tell when your bladder is full or leaking urine
- excessive sweating
Nerve damage can make managing your blood sugar levels difficult, as it may be hard to tell when your blood sugar is low.
Nerve damage can also hide the symptoms of chest pain, so you may miss the warning signs of a heart attack or heart disease.
Your doctor will perform a physical exam. Tests may also be ordered to confirm nerve damage.
Keep track of your symptoms and bring a list to your appointment. This can help identify nerve damage.
Your doctor will check:
- your reflexes
- any changes in skin color or texture
- if your blood pressure changes when you stand up or sit down
People with diabetes should have a comprehensive foot exam every year to check for nerve damage. This includes the skin, muscle, and bone health of your feet. Your doctor will also poke your feet to check for sensation.
Other tests for diabetic nerve damage include:
- electromyogram (EMG): checks the electrical currents in your nerves. It also checks for electrical activity in the muscles
- nerve conduction velocity test (NCV): records how quickly signals travel through your nerves
- ultrasound: uses sound waves to look at your organs and check their function. It is often used to examine the bladder or urinary system.
Treatment involves taking steps to keep your blood glucose in the normal range. This includes:
- meal planning
- frequent glucose monitoring
- engaging in regular physical activity
- managing diabetes medications and insulin dosing
You may need to check your blood sugar a few times throughout the day. Work with your doctor to develop a plan to keep your blood sugar in a healthy range.
To relieve the pain caused by nerve damage you may be prescribed oral medications, such as:
- antidepressants: believed to relieve pain by interfering with the chemical processes in the brain and spinal cord that mediate pain
- anticonvulsants: used to treat siezures; change the way the body senses pain
- opioids: commonly used narcotic pain medication
- duloxetine: acts on the main neurotransmitters that are mediators in the pain pathways of the brain and spinal cord
- pregabalin: a type of anticonvulsant; acts by decreasing the number of pain signals that are sent out by damaged nerves in the body
You may also be given treatments to apply on your skin, such as creams or lidocaine patches. Studies have recently found that alpha-lipolic acid and evening primrose oil can decrease symptoms and may improve nerve function (NDIC, 2009).
Other alternative treatment options include:
- physical therapy
- bed cradle (to prevent blankets from touching or irritating sensitive feet)
Digestive Symptom Relief
You may relieve digestive symptoms by:
- eating small, frequent meals
- avoiding fats
- eating less fiber
You may be prescribed medications to reduce stomach acid or speed digestion.
Dizziness and Weakness
Always stand or sit down slowly to relieve these symptoms. You may also benefit from lowering the level of salt in your diet or taking high blood pressure medications.
Physical therapy is helpful if you have muscle weakness or problems with coordination.
Urinary and Sexual Problems
To relieve urinary problems, you can:
- take antibiotics for infection
- drink plenty of water to avoid infection
- urinate regularly to prevent bladder leakage
If you are experiencing sexual problems, your doctor may recommend:
- erectile dysfunction medication
- vacuum devices
- penile implants / inserts
- vaginal lubricants)
- follow-up with a urologist or gynecologist
It is important to take proper care of your feet. They are very susceptible to damage from diabetic neuropathy.
The following are helpful foot care tips:
- Clean your feet every day using mild soap and warm water. Do not soak your feet. Use a soft towel to dry them.
- Examine your feet and toes every day for cuts, blisters, swelling, and other problems. You may not feel these injuries. It is important to look for changes in the appearance of the skin.
- Use lotion to moisturize your feet.
- File corns and calluses with a pumice stone after a bath or shower.
- Check your toenails every week. Cut them back or file them with an emery board.
- Always wear shoes that fit and allow your toes to move. When you get new shoes, break them in slowly. Wear them only an hour at a time.
- Get a foot exam every six to 12 months.
- Talk to your doctor about any concerns or changes in your feet.
You may want to follow up with a podiatrist to help monitor and care for your feet.
Maintaining control of your blood sugar can help prevent nerve damage. You should monitor your blood sugar at home using a blood sugar meter. It is also important to get a hemoglobin A1C test twice a year. This test monitors your long-term blood sugar control.
Exercise can protect the nerves in your feet and legs. However, you should also be careful not to damage or injure them. Your doctor can help you find activities that work for you.
Regular foot checks can prevent small infections or problems from getting worse. Complete and regular physical examinations and foot examinations will help you control your symptoms and prevent further nerve damage. Talk to your doctor right away if you notice symptoms of diabetic neuropathy.
Nerve damage often worsens over time. However, proper treatment and monitoring can control symptoms and slow disease progression.
Written by: Cindie Slightham
Medically reviewed by Romilla Anwar, MD