FAQs on Diabetic Neuropathy
Diabetes is a common condition that affects millions of adults. One serious condition that is caused by diabetes is diabetic neuropathy. With this condition, the sensory of and motor nerves of the lower limbs are affected. Diabetes neuropathy can affect just one nerve (mononeuropathy), or it can affect many nerves (polyneuropathy).
What symptoms are associated with diabetic neuropathy?
The symptoms of diabetic neuropathy depend on the type. With polyneuropathy, patients report unusual sensations of the hands and feet, as well as pain and numbness. In addition, many patients report feelings of weakness in the hands and feet. With mononeuropathy, the pain is localized to the chest wall, face, a hand, or one leg. When the patient has diabetic autonomic neuropathy, symptoms include diarrhea, constipation, nausea, vomiting, incontinence, sweating, and/or sexual dysfunction.
What causes diabetic neuropathy?
Most patients develop neuropathy because of poorly controlled diabetes. The high levels of circulating glucose damage blood vessels and nerves. Risk factors for the condition include:
- Having diabetes for 25 years or longer
- Genetic predisposition
- Having type 2 diabetes
- Lack of exercise
- High blood pressure
- Peripheral artery disease
How is diabetic neuropathy diagnosed?
Diabetic neuropathy diagnosis is based on medical history, clinical examination, and laboratory values. The doctor will use electromyography and nerve conduction studies to assess nerve damage. To confirm the diagnoses, the doctor may do skin biopsies (to assess cutaneous nerve innervation), as well as nerve and muscle biopsies. To test the nerve supply of sweat glands, quantitative sudomotor axon reflex testing may be ordered.
What are the medications are used for diabetic neuropathy?
Treatment of diabetic neuropathy involves tight blood glucose control, weight loss to reduce insulin resistance, and symptomatic control of paresthesias. Medication options for treatment include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) – These medications include ibuprofen, naproxen, and meloxicam. These agents treat mild neuropathic pain.
- Opioids – For severe pain, the pain management specialist may prescribe opioids or narcotic analgesics. These drugs work by blocking pain signals. They come in pill form, topical patch, or injectable versions.
- Antidepressants – Tricyclic antidepressants (amitriptyline and nortriptyline) change the way the body and brain perceives pain. In addition, they regulate sleep and decrease anxiety.
- Anticonvulsants – Used to control seizures, these drugs are effective for managing painful conditions. Examples include gabapentin and pregabalin.
- Topical agents – Aspercreme (trolamine salicylate) and capsaicin interferes with pain sensations and perception of pain.
What interventional methods are used to treat diabetic nerve pain?
When medications alone are not enough, the pain specialist may recommend other treatments. These include:
- Celiac plexus block – When the diabetic neuropathy causes abdominal pain, the doctor may perform a celiac plexus block. A neurolytic agent or long-acting anesthetic is injected onto the celiac plexus nerves, which blocks pain signals to the brain.
- Sympathetic nerve block – When the pain to the lower extremities occurs, the doctor will inject the targeted nerves with an anesthetic agent.
- Intrathecal pump implant – For severe pain, a small device is implanted into the lower abdomen. The device has a small catheter that runs to the spine to deliver medications.
How common is diabetic neuropathy?
In a recent study, the prevalence rate of diabetic neuropathy was 26%, according to a study involving type 2 diabetes. However, some reports found the rate to be as high as 40-50%. According to the Centers for Disease Control and Prevention, persons diagnosed with diabetes have quadrupled from 1980 to 2014. Currently, 21.9 million Americans aged 18 and older have diabetes mellitus.
Davies M, Brophy S, & Williams R (2012). The Prevalence, Severity, and Impact of Painful Diabetic Peripheral Neuropathy in Type 2 Diabetes. Diabetes Care, 29(7), 1518-1526.