Managing Neuropathy With Diabetes

Nerve damage from diabetes is a common complication. Find out what causes it and what you need to know about preventing or managing neuropathy.

By Chris Iliades, MD

Medically reviewed by Farrokh Sohrabi, MD

Nerve damage (neuropathy) is among the most common potential complications of type 2 diabetes. Diabetic neuropathy refers to nerve damage caused by diabetes, and it can impact quality of life and put you at greater risk of other dangerous diabetes complications. That’s why it’s important to know the symptoms and understand what preventing or managing neuropathy entails.

The risk of neuropathy with diabetes increases with age, poor blood sugar control, and the number of years you’ve been living with diabetes. “Five to 10 percent of people with diabetes have neuropathy at the time of their diagnosis, and about 50 percent will develop neuropathy within 10 to 20 years,” says Ronald Kanner, MD, professor and chair of neurology at Hofstra North Shore-LIJ School of Medicine in New York City.

The highest risk for neuropathy with diabetes is in people who’ve had diabetes for at least 25 years. Other risk factors that contribute to diabetic neuropathy include high cholesterol and obesity. Neuropathy with diabetes can occur anywhere in the body where there are nerves, but the first symptoms usually come from the long nerves that go out to your feet and hands. This is called peripheral neuropathy.

What Causes Nerve Damage From Diabetes

The cause of diabetic neuropathy is not yet fully understood, but may depend on the type of nerves damaged. “Peripheral neuropathy that affects the toes, feet, fingers, and hands may be due to lack of energy. Think of it as an irrigation system: Nerves that run from the spinal cord out to the hands and feet use lots of energy,” Dr. Kanner says. Diabetes may cause nerve cells to run out of energy because diabetes keeps cells from getting energy from glucose in your blood.

“The other common type of nerve damage is called mononeuropathy, which means a single nerve cell gets picked off. This type of isolated nerve damage may be caused by circulation problems with the smallest blood vessels that supply nerves,” Kanner says.

Symptoms of Neuropathy With Diabetes

“The most common symptoms of nerve damage are numbness and tingling. Less frequently, people may also have burning pain,” Kanner says. Symptoms also depend on which nerves are damaged, and may start slowly and go unnoticed for a long time.

In addition to the symptoms of pain, numbness, and tingling, other symptoms may include:

• Loss of muscle in the feet and hands
• Indigestion
• Dizziness (especially when moving from sitting to standing)
• Trouble urinating
• Vaginal dryness in women and erectile dysfunction in men

Preventing Nerve Damage From Diabetes

The most important part of preventing neuropathy is tight diabetes control. “There’s good evidence that blood sugar control can prevent or delay nerve damage from diabetes," says Betul Hatipoglu, MD, an endocrinologist at the Cleveland Clinic in Ohio. "Neuropathy often gets better with improved diabetes management.”

A recent review of existing research on diabetes control and peripheral neuropathy found two studies involving more than 1,000 people with type 1 diabetes and four studies involving almost 7,000 people with type 2 diabetes. The review, published in Cochrane Database Systematic Review, concluded that good blood sugar control significantly prevents neuropathy in type 1 diabetes and reduces neuropathy symptoms in type 2 diabetes.

How to Manage Neuropathy

Once a person with diabetes has neuropathy, medications can help reduce pain. “The two most useful medications are antidepressants and anticonvulsants,” Kanner says. Neuropathy management also includes self-care, especially foot care. The longest nerves in your body are those that go to your feet, so they’re the nerves most commonly damaged by diabetes.

Numbness of the feet can lead to unnoticed injuries, which can lead to infections. And because diabetes causes decreased blood supply to your feet, infections are more dangerous. In fact, diabetes is the cause of more than half of all lower-limb amputations in the United States. Doctors say nearly half of such amputations could be prevented by better foot care.

To prevent problems, follow these principles of good foot hygiene:

• Inspect your feet every day and let your doctor know about any open sores or blisters.
• Clean your feet every day with warm water and mild soap. Avoid soaking your feet, and dry them with a soft towel, including between your toes.
• Take immediate care of toenails, corns, and calluses — see your doctor for guidance.
• Wear shoes that fit well with socks that absorb moisture and provide some padding.

Exercise that doesn’t involve bearing weight is important for people with neuropathy. “This can be done by swimming in a pool or riding a stationary bike. Physical therapy may be helpful for people who have muscle wasting in the feet or hands,” Dr. Hatipoglu says. Eating a healthy diet, controlling your weight, and not smoking are also very important.

Your risk for neuropathy with diabetes increases over time. The best way to prevent nerve damage is to work closely with your doctor to control your blood sugar. If you do develop nerve damage, remember the principles of managing neuropathy — pain medication, safe exercise, healthy weight, and vigilant foot care.