Diabetic neuropathy is a complication of diabetes, characterized by the progressive degeneration of nerves, which can reduce sensitivity or cause pain in various parts of the body, being more common in the extremities, such as the hands or feet.
The development of diabetic neuropathy is usually slow and can cause symptoms such as pain, tingling, burning sensations or loss of sensation. Even though there is no cure, it is possible to control neuropathy through adequate diabetes treatment and the use of medications such as painkillers and antidepressants. Find out more about how neuropathic pain is treated.
If diabetic neuropathy is suspected, it is important to consult an endocrinologist or neurologist so that a detailed assessment can be carried out so that appropriate treatment can be initiated.
Types of diabetic neuropathy
Diabetic neuropathy can be classified according to the symptoms present and their location. The main types of neuropathy include:
- Neuropatia focal ou multifocal: Symptoms indicate that a specific nerve in the hands, feet, legs, trunk or head is compromised.
- Diabetic polyneuropathy: It is characterized by symptoms that mainly affect the hands and feet and tend to progress towards the trunk.
- Proximal motor neuropathy: is characterized by symptoms that mainly involve the thighs, hips, buttocks, abdomen and chest, usually on just one side of the body, but may spread to the other side;
- Autonomic neuropathy: affects the control of body organs such as the heart, bladder, stomach, intestines and sexual organs.
Generally, the classification is made by the doctor, who takes into account the symptoms present and the information obtained from the physical examination. However, in some cases it may be necessary to perform other tests such as electroneuromyography and nerve conduction studies.
Main symptoms
The main symptoms of diabetic neuropathy include:
- Sensation of tingling, burning, electricity, stabbing, pain, numbness or heaviness in parts of the body, especially in the hands or feet;
- Pain when touched or loss of sensitivity;
- Weakness in making efforts;
- Easy fatigue;
- Feeling of insecurity when walking;
- Difficulty getting up from a sitting position;
- Muscle tremor;
- Absence of symptoms of hypoglycemia, such as confusion, dizziness, hunger, tremor or decreased motor coordination;
- Constipation;
- Difficulty digesting or difficulty swallowing;
- Vaginal dryness;
- Erectile dysfunction;
- Increase or decrease in sweat production;
- Drop in blood pressure;
- Bladder problems such as needing to urinate frequently or having an urgency to urinate;
- Difficulty seeing.
Symptoms can affect different parts of the body depending on the type of neuropathy and can go unnoticed for a long time. However, the pain, when present, tends to be worse at night or during rest and may improve when walking. Furthermore, when there is loss of sensitivity there is a greater risk of injuries and ulcers on the feet, causing the so-called diabetic foot. Understand better what diabetic foot is and how to treat it.
If diabetic neuropathy is suspected, it is important to consult an endocrinologist or neurologist for a detailed evaluation.
Cause of diabetic neuropathy
Diabetic neuropathy is a complication of diabetes and mainly affects people who do not receive adequate treatment, often presenting high blood sugar levels, which cause progressive nerve damage.
How to confirm the diagnosis
The diagnosis of diabetic neuropathy is made by an endocrinologist or neurologist and is based on the signs and symptoms presented and the history of the disease. In addition, the doctor must perform a physical examination to check muscle strength and tone, test the tendon reflex and analyze sensitivity to touch and temperature changes, such as cold and heat.
The doctor may also perform or request specific tests to confirm the diagnosis, such as a nerve conduction test, which measures how quickly the nerves in the arms and legs conduct electrical signals, electroneuromyography, which measures the electrical discharges produced in the muscles, or autonomic testing, which can be done to determine changes in blood pressure in different positions.
Treatment for diabetic neuropathy
Treatment for diabetic neuropathy must be guided by an endocrinologist or neurologist and is normally done to alleviate symptoms, avoid complications and slow the progression of the disease.
Treatment for diabetic neuropathy may include medications such as:
- Antidiabeticssuch as insulin injections or taking oral antidiabetics, to control blood sugar levels;
- Anticonvulsantssuch as pregabalin or gabapentin to relieve pain;
- Antidepressantssuch as amitriptyline, imipramine, duloxetine or venlafaxine that help relieve mild to moderate pain;
- Opioid analgesics taken orally, such as tramadol, morphine, oxycodone, or methadone, or a patch, such as transdermal fentanyl or transdermal buprenorphine.
Furthermore, to treat complications of diabetic neuropathy, care may be required from different specialists, such as a urologist to treat urinary tract problems, with medications that regulate bladder function or medications for erectile dysfunction, for example, or a cardiologist to control blood pressure and avoid diabetic cardiomyopathy. Find out what diabetic cardiomyopathy is and how to treat it.
Is diabetic neuropathy curable?
Diabetic neuropathy has no cure, however, it is possible to reduce the progression of neuropathy through adequate control of diabetes and treatment of symptoms caused by the use of medications such as antidepressants and analgesics.
Furthermore, it is possible that adopting a healthy diet and practicing regular physical activity may have some benefit in recovering normal sensitivity.
How to avoid neuropathy
Diabetic neuropathy can usually be prevented if blood glucose levels are tightly controlled. To achieve this, some measures include:
- Undergo regular medical follow-up;
- Monitor blood glucose levels at home with glucometers, as advised by your doctor;
- Take medications or inject insulin as prescribed by your doctor;
- Practice physical activities regularly, such as light walking, swimming or water aerobics, for example.
You should also eat a balanced diet that includes fiber, proteins and good fats, and avoid foods with a lot of sugar such as cookies, soft drinks or cakes. Check out how to follow a diabetes diet.
Bibliography
- VINIK, Aaron I. et al. Diabetic neuropathy. Endocrinol Metab Clin North Am. Vol.42, n.4. 747-787, 2013
- ZAKIN, Elina; ABRAMS, Rory; SIMPSON, David M. Diabetic Neuropathy. Semin Neurol. Vol.39, n.5. 560-569, 2019
- BERNAL, D. Samper; et al. Etiology and management of painful diabetic neuropathy. Magazine of the Spanish Pain Society. 17. 6; 286-296, 2010
- FELDMAN, Eva L.; et al. Diabetic neuropathy. Nat Rev Dis Primers. 2019 Jun 13; 5(1): 42.. 5. 1; 1-40, 2019
- BOULTON, Andrew J. M. Diabetic neuropathy and foot complications. Handbook of Clinical Neurology. 126. 97-107, 2014
- VINIK, Aaron I.; et al. Diabetic Neuropathy. Endocrinology and Metabolism Clinics of North America. 42. 747–787, 2013
