Diabetic Neuropathy Overview
What Is Diabetic Nerve Pain?
Diabetes can damage nerves throughout your body. In fact diabetic neuropathy (neuro- means nerves; -pathy means disease or suffering) is the most common, chronic complication of diabetes according to the American Diabetes Association.1 It affects 60-70% of people with type 1 and type 2 diabetes, according to the National Institute of Diabetes and Digestive and Kidney Disease. 2
Diabetic neuropathy can be extremely painful. It can also pave the way for health-threatening and even life-threatening problems including foot ulcers, amputations, heart attacks, digestion problems and difficulty recognizing low blood sugar episodes. While it cannot be cured, smart lifestyle steps may prevent diabetic neuropathy for some people and slow its progression for others. Medications and other approaches can treat symptoms, such as pain. And awareness—through steps like good foot care, regular foot exams and telling your doctor about other symptoms—can help prevent this blood-sugar-related nerve damage from spiraling into even more serious health issues.
The best-known type of diabetic neuropathy is called diabetic peripheral neuropathy. It can cause burning, stabbing or electric-shock-type pain or tingling in your feet, legs, hands or arms. The pain may be worse at night; treatment options range from over-the-counter patches to prescription drugs.
But there’s growing evidence that diabetes causes deeper nerve damage that affects more people with high blood sugar than experts once understood. Other types of diabetic neuropathy include:
- “Silent” diabetic peripheral neuropathy. Up to 50% of people with peripheral neuropathy have no pain3 and may not realize their feet are numb. 4 This boosts the risk for foot ulcers (if you don’t notice cuts or blisters, for example) 5 and increases the risk for amputations 2.5-fold. 6
- Diabetic autonomic neuropathy (DAN). High blood sugar can also harm the nerves that control your heart, digestive system, sweat glands, bladder and sexual organs.7 This can lead to heart attacks, stroke, digestion problems like constipation or diarrhea, sexual difficulties, trouble exercising and can even make noticing low blood sugar episodes difficult – a dangerous condition called hypoglycemic unawareness. Once considered rare, researchers now say DAN is more common than once understood; up to 90% of people with type 1 diabetes and 70% with type 2 may have some form of it. 8
- Proximal neuropathy. A special concern for some people with type 2 diabetes, this nerve damage can lead to weakness in the legs and pain in the thighs, hips, and buttocks. Medication can ease symptoms during recovery.
- Mononeuropathies. Also called focal neuropathies, these are more common in people with diabetes and involve damage to a single nerve. 9 It may affect the shoulder, hand, leg, feet or face and may be caused by pressure on a nerve. This can cause weakness, pain, numbness or even paralysis. Unlike diabetic neuropathies, which cannot be cured, mononeuropathy usually resolves with treatment.10
The precise cause of diabetic neuropathy isn’t fully understood. Researchers believe that it’s related to high blood glucose (blood sugar). Inflammation, high cholesterol, and immune-system changes may also play important roles. You’ll learn more about blood glucose and other causes of neuropathy in the article on diabetic neuropathy causes.
Diabetes-related nerve damage worsens with age and with advancing diabetes. About one in three people with type 1 diabetes had signs of diabetic neuropathy 25 years after their diabetes was first diagnosed in one large study from Manchester Royal Infirmary in the UK, published in the journal Diabetologia. 11 Half of those with type 2 diabetes have neuropathy ten years after their diagnosis, 12 according to a 2014 University of Michigan review in the journal Current Diabetes Reports.
But diabetic neuropathy also affects children, teens and young adults with diabetes. And there’s growing evidence that nerve damage can begin early in diabetes. According to the American Diabetes Association, 10-20% of people with prediabetes have signs of diabetic neuropathy, too.
Staying Ahead of Diabetic Neuropathy
A few helpful tips to keep you on top of and in tune with your foot health:
- Have a comprehensive foot exam every year, or more often, performed by a healthcare practitioner. This is a good way to check for peripheral neuropathy. Your doctor may perform additional tests to look for signs of neuropathy. Regular doctor’s-office foot exams, recommended to catch nerve damage and related problems early, only happen at 12 to 30% of medical appointments for people with diabetes, say members of an American Diabetes Association task force on foot health. 15 It’s also important to share any symptoms you’re having with your doctor, such as pain, numbness, constipation, diarrhea, sexual dysfunction or becoming easily tired when you exercise. In a 2015 the University of Arkansas for Medical Sciences nearly 40% did not get treatments to help ease the pain.16
- Keep blood sugar in a healthy range slow development of diabetic neuropathy.
- Follow a heart-healthy lifestyle. Studies show that this may reduce the risks associated with autonomic nerve damage of the heart for people with type 1 and type 2 diabetes.13 Too often, this condition is not recognized or managed. 14