- Lifestyle factors:
- Smoking
- Excessive alcohol consumption
- Obesity
- Duration of diabetes: The longer a person has diabetes, especially if blood sugar is poorly controlled, the higher the risk of developing neuropathy.
- Peripheral Neuropathy (most common, affecting feet and legs, then hands and arms):
- Numbness or reduced ability to feel pain or temperature changes
- Tingling or burning sensation
- Sharp pains or cramps
- Increased sensitivity to touch, even light touch
- Muscle weakness
- Loss of reflexes, especially in the ankle
- Loss of balance and coordination
- Foot problems (ulcers, infections, bone and joint damage)
- Autonomic Neuropathy (affecting nerves that control internal organs):
- Digestive system: Nausea, vomiting, bloating, early fullness, constipation, diarrhea (especially at night), difficulty swallowing.
- Urinary tract: Bladder control problems, difficulty emptying the bladder, increased risk of urinary tract infections.
- Sexual function: Erectile dysfunction in men, vaginal dryness or difficulty with arousal in women.
- Sweat glands: Decreased or increased sweating, especially at night.
- Cardiovascular system: Dizziness or faintness upon standing (orthostatic hypotension), rapid heart rate at rest.
- Eye: Difficulty adjusting from light to dark.
- Proximal Neuropathy (affecting nerves in thighs, hips, buttocks, or legs):
- Severe pain in one side of the body (thigh, hip, buttock).
- Weakness and muscle wasting in the thigh.
- Difficulty rising from a sitting position.
- Focal Neuropathy (affecting a single nerve, often in the head, torso, or leg):
- Sudden pain in a specific area (e.g., chest, stomach, leg, foot).
- Paralysis on one side of the face (Bell's palsy).
- Double vision or difficulty focusing.
- Medical history and physical exam: The doctor will ask about your diabetes management, symptoms, and check your reflexes, sensation (to touch, temperature, vibration), and muscle strength.
- Nerve conduction studies (NCS): Measure how quickly electrical signals travel through your nerves.
- Electromyography (EMG): Measures the electrical activity of muscles in response to nerve stimulation.
- Quantitative sensory testing (QST): Evaluates your ability to feel vibration and temperature.
- Autonomic testing: Specific tests to assess heart rate variability, blood pressure response to position changes, and sweat production.
- Nerve biopsy: Rarely performed, but may be considered in complex cases to rule out other causes of neuropathy.
- Blood Glucose Control:
- Maintaining blood sugar levels within the target range through diet, exercise, and medications (insulin or oral diabetes medications) is the most critical step.
- Pain Management:
- Medications:
- Antidepressants: Tricyclic antidepressants (e.g., amitriptyline) and serotonin-norepinephrine reuptake inhibitors (SNRIs) like duloxetine (Cymbalta) can help relieve nerve pain.
- Anti-seizure medications: Pregabalin (Lyrica) and gabapentin (Neurontin) are often prescribed for neuropathic pain.
- Topical treatments: Capsaicin cream or lidocaine patches can provide localized pain relief.
- Physical therapy: Can help improve muscle strength, balance, and reduce pain.
- Transcutaneous electrical nerve stimulation (TENS): May provide some pain relief for certain individuals.
- Medications:
- Management of Complications:
- Foot care: Daily foot checks, proper footwear, and regular podiatrist visits are essential to prevent and manage foot ulcers and infections.
- Digestive issues: Dietary changes, medications for nausea, vomiting, constipation or diarrhea.
- Urinary problems: Medications, bladder training, or other interventions.
- Sexual dysfunction: Medications or other therapies.
- Orthostatic hypotension: Lifestyle changes (e.g., slow position changes, increased fluid intake) and medications.
- Lifestyle changes:
- Quit smoking.
- Limit alcohol consumption.
- Maintain a healthy weight.
- Regular exercise (as advised by your doctor).