What is Diabetic Neuropathy?

Have you ever noticed sudden tingling, pain, or numbness in your hands, arms, and feet?

If you have poorly controlled or untreated type 2 diabetes, these symptoms may indicate diabetic neuropathy and cannot be ignored.

While it starts with the limbs, untreated diabetic neuropathy can also affect your digestive system, bladder control, and heart. However, high blood sugar is not the only factor in diabetic neuropathy.

This complication of type 2 diabetes is also affected by high levels of fat or triglycerides in your body. Let’s understand this condition better.

What is Diabetic Neuropathy?

High blood sugar levels can damage the various nerves and lead to pain. This condition is known as diabetic neuropathy. This is a progressive condition, which means that, over time, the symptoms may worsen.

Types of diabetic neuropathy and symptoms 

There are mainly four types of diabetic neuropathy:

1. Peripheral symmetric neuropathy

• Also called diabetic peripheral neuropathy or distal symmetric peripheral neuropathy
• The most common form of diabetic neuropathy.
• Mainly affects the nerves in the hands and feet. 

Symptoms

• Numbness 
• Tingling sensation or pain 
• Burning sensation in the toes and fingers that move up to the arms and legs
• Unable to feet heat or cold sensation
• Unable to feel any physical injury
• Problems with balance
• Depleting muscle tone in the limbs
• Breaking down of joints due to nerve damage, usually in the feet (also known as Charcot’s joint)

2. Autonomic neuropathy

• Mainly affects the nerves that control involuntary functions of the body and the internal organs.
• Can affect body functions such as digestion, heart rate, and urination

Symptoms

• Difficulty in swallowing or speaking 
• Bloating or heartburn 
• Regular vomiting usually occurs several hours after eating
• Diarrhoea, constipation, nausea
• Heart rate faster than normal
• Feeling full even after eating less
• Sweating excessively, even in cool temperatures or without exertion
• Hypoglycaemic unawareness, in which the person does not feel any signs and symptoms associated with low levels of sugar
• Orthostatic hypotension, in which the person feels dizzy or light-headed when standing up from a sitting or lying down position
• Weakness and contractions in the muscles
• Sexual dysfunction
• Difficulty urinating
• Bladder issues, such as urinary incontinence 
• Noticeable drooping in the eyelids or face

3. Focal Neuropathy

• Can affect any individual nerve in the body.
• Usually affects a single nerve closer to the skin and a bone and typically affects a hand, leg, or torso.

Symptoms

• Loss of feeling in the affected area
• Pain or burning sensation
• Weakness where damage has set in
• Tingling or pin-prick sensation in the affected area

4. Proximal Neuropathy

• A rare and disabling form of nerve damage that affects the hips, buttocks or thigh.
• Typically affects one side of the body and rarely spreads to the other.
• Often causes severe pain and may lead to significant weight loss.

Symptoms

• Symptoms of thoracic and lumbar root neuropathy are often clubbed together and referred to as radiculopathy.
• These affect the cervical (neck area), lumbar (lower spine), and thoracic area (upper back).
• Cervical radiculopathy – shoulder pain, weakness in the shoulder muscles, numbness that moves from the arm to the hand.
• Lumbar – sciatica pain, constant discomfort, and pain in the lower back.
• Thoracic – pain, tingling, or numbness from the back to the front of the body.

What are the Causes of Diabetic Neuropathy?

Several factors could lead to diabetic neuropathy:

1. High blood sugar levels

• Over a period of time, high levels of blood sugar can cause chemical changes in various nerves and disrupt their ability to emit signals.
• It can also damage the blood vessels that help carry nutrients and oxygen to the nerves.

2. Heredity

• Certain genetic traits can make some people more prone to diabetic neuropathy.
• These people are more susceptible to nerve damage as compared to others.

3. Metabolic factors:

• High levels of cholesterol and triglycerides can also increase the risk of diabetic neuropathy.
• Being overweight or obese increases the risk of developing diabetic neuropathy.

Treatment and Management of Diabetic Neuropathy 

Diabetic neuropathy does not have any known cure. Most treatment plans aim to slow down the progression of the condition and keep symptoms under control. A few management strategies used in diabetic neuropathy include:

1. Slowing down progression

• Monitoring and keeping your blood sugar levels within the target range can slow down the progression and prevent nerve damage.
• Regular physical activity is recommended to keep nerves functioning normally.
• A healthy diet that is high in fibre and protein is essential.
• You must keep your weight within the normal range as suggested by the doctor.
• Effective stress and sleep management can help manage blood sugar levels and keep diabetic neuropathy at bay.
• Diabetes medicines and insulin for those with severe diabetes.

2. Reducing pain

• While there are various prescription drugs to help relieve pain resulting from nerve damage, not all may work for everyone.
• Your doctor will most likely prescribe medicines that help relieve nerve pain.
• Certain antidepressants are also known to relieve pain caused due to nerve damage.

3. Managing complications

• Having smaller and more frequent portions may help people with digestive issues.
• Speak to your doctor about any changes in diet or medication you may need to make.
• Urinating regularly while ensuring the entire bladder is empty may help with bladder issues. In severe cases, catheterisation is recommended.
• Oral medications or injections can help with sexual dysfunction issues. Your doctor will advise on the same.
• Those with orthostatic hypotension can get relief with small lifestyle changes like quitting alcohol and smoking, having more water, and slowly moving from lying/sitting to standing.
• Physical therapy can improve problems such as numbness, tingling, pain, or discomfort.

Long term effects of diabetic neuropathy

If not diagnosed and treated in time, diabetic neuropathy can cause complications and long-term effects. Some of these include:

• Sores
• Ulcers
• Increased risk of infections
• Risk of falls and fractures due to lack of sensation in the feet, poor balance or coordination

Other more severe long-term effects and complications of untreated diabetic neuropathy are:

• Changes in heart rate
• Stroke or heart attack
• Visual impairment
• Permanent loss of sensation in the feet
• Permanent damage to feet, hands, nerves, eyes, and kidney
• Damage to the structure of the foot, such as clawed toes
• Amputation in severe cases

Preventing Diabetic Neuropathy

You can delay the onset of diabetic neuropathy or prevent the condition from worsening by regularly monitoring your blood glucose levels using a continuous glucose monitor (CGM) or a smart glucometer.

Here are some factors that you can take care of to prevent diabetic neuropathy:

1. Stress

Chronic stress and neuropathy both affect the nervous system, causing damage. When there is nerve damage, it can result in pain, numbness, tingling and other associated symptoms. Several studies have shown that chronic stress can lead to diabetes, worsening diabetes and causing diabetic neuropathy.

This may be attributed partly to people’s behaviour as a stressed individual is more likely to grab an unhealthy snack or a high sugar-containing food which is easily available.

2. Diet

You must consume the right amount of nutrients for your nerves and the nervous system to function normally. At the same time, eating unhealthy foods expose your nervous system to toxins. For this reason, you must ensure you eat a clean, safe, healthy diet to prevent diabetic neuropathy from developing or aggravating.

3. Obesity

While obesity is a known risk factor for a wide range of diseases, including diabetes, not many are aware that it can cause peripheral neuropathy. Scientists have identified several mechanisms by which obesity can cause neuropathy in people with normal blood glucose levels and diabetes.

4. Sleep

The relationship between sleep and diabetic neuropathy is bi-directional. Poor sleep over a long period of time increases the risk of diabetes and its associated complications like peripheral neuropathy.

Diabetes disrupts not just your blood sugar levels but also affects your sleep. People with diabetic neuropathy often complain of aggravating body pain, especially at night, which prevents them from getting a good night’s sleep. 

5. Diabetic foot care

Without proper foot care, nearly 50% of people with diabetes can develop neuropathy. Early diagnosis and treatment of diabetes and diabetic neuropathy can prevent instances of amputations.

Here are some foot care tips that can help prevent neuropathy if you have diabetes:

• Check your feet daily for cuts, cracks, calluses or any other signs of infection like swelling, warmth or discharge.
• Get an annual or bi-annual foot examination by your doctor.
• Always keep your feet clean. Avoid using drying agents like alcohol or hydrogen peroxide on your feet.
• Use lukewarm water to soak your feet as hot water as nerve damage can reduce your sensitivity to temperature.
• Avoid wearing the same shoes daily.
• Use dermatologically-tested and non-lanolin creams between your toes to avoid drying the skin.
• Trim your toenails regularly.
• Opt for customised footwear if you have any foot deformities.
• Visit your podiatrist annually if any deformities or foot-related problems appear.

Keeping your blood sugar levels within the desired range is essential to manage or reverse your diabetes. The best approach is a comprehensive plan focussing on diet, exercise, stress, and sleep. If you have diabetes, you must get your feet checked by a doctor regularly to enable them to spot any early signs of nerve damage. 

Fittertake

Prevention over cure is the best approach to diabetes-related complications like diabetic neuropathy. Regularly testing your blood sugar levels is important to prevent this condition from developing or progressing.

If you have a family history of diabetes or have been diagnosed with prediabetes, you must proactively get your blood sugar levels tested once every few months (based on your doctor’s recommendations.

Once you know a diagnosis, consult your doctor and find a scientific and comprehensive diabetes reversal or management plan.

Fitterfly’s various Diabetes Care Programs have been designed by India’s top diabetologists, nutritionists, fitness experts and psychologists and have helped over 15000+ Indians effectively manage their diabetes.

If you need help with more information on diabetic neuropathy or wish to control your blood sugar levels, speak to us here!