Diabetic Neuropathy

The Problem

Diabetic neuropathy is the name given to a group of nerve disorders that are caused by high blood glucose levels from diabetes.  Exposure to high blood glucose likely causes nerve damage in several ways.  Approximately 50% of patients with diabetes will develop nerve damage. 

The most common type of nerve injury is peripheral neuropathy.  This can cause pain or numbness in the legs and feet and arms or hands.  Patients with diabetic peripheral neuropathy may experience hypersensitivity in the extremities or a loss of balance.

Another type of injury, proximal neuropathy, can lead to pain in the buttocks, hips and thighs and weakness in the upper legs.

Diabetic neuropathy can take other forms, including autonomic neuropathy, which can affect such things as blood pressure, digestion or sexual function.  This cannot be diagnosed through nerve function testing testing and will not be discussed in further detail.

Diagnosis

The diagnosis of diabetic neuropathy begins with history and physical examination. This often reveals decreased sensation in the lower legs and feet, or wrists and hands.  Decreased temperature sensation or vibration sensation can also be noted, along with the loss of reflexes in the ankles.

Nerve conduction studies (NCS) and electromyography (EMG) are useful in showing the extent of nerve injury and its severity.

Treatment

The most important method of slowing the progression of diabetic neuropathy is to achieve tight, stable control of blood sugar levels.  This is typically done with the assistance of your primary care provider or endocrinologist.

Treatment is otherwise symptomatic and geared towards control of nerve pain.  A number of medications, including pregabalin, gabapentin have been shown to be effective in relieving the pain of diabetic neuropathy.  Other medications, such as tramadol should also be considered.  When the problem is fairly limited in distribution or if there are reasons why oral medications should be avoided, lidocaine patches or capsaicin cream can be considered.

B vitamins are often prescribed to help reduce tingling or burning pain, though experimental evidence to support such therapy is not firmly established.  Research into additional treatments for diabetic neuropathy is ongoing.