Among the many health problems that patients with diabetes face, nerve damage can be a huge issue. Also known as diabetic neuropathy, nerve damage can occur when a person has high blood sugar levels for a prolonged period of time. The most common area where nerve damage/ neuropathy related to diabetes occurs is the feet and toes of a person. Symptoms generally involve numbness, tingling or pain. Calluses or corns can be a sign of neuropathy as well. If you wish to learn about our online diabetes doctors and our telehealth diabetes care center, contact us after you finish reading the article and remember to share with other people who may benefit from the information.
Once nerve damage/neuropathy due to diabetes occurs, you might need to get immediate medical attention. If left unchecked, it can worsen and become more widespread. In a short while, the nerve damage can lead to problems with muscles, joints, and even the bones in the feet and legs. It can also affect other parts of the body.
In such instances, opting for diabetes specialist care options like the ones offered by SugarMDs is a good idea. Additionally, understanding nerve damage can also help you deal with the condition better. So, we’re taking some time to take a closer look at nerve damage that is caused by diabetes.
Table of Contents
- The Types of Nerve Damage (Neuropathy)
- 1. Polyneuropathy or Peripheral Neuropathy
- 2. Autonomic Neuropathy due to type 2 diabetes
- 3. Charcot’s Joint
- 4. Cranial Neuropathy
- 5. Compression Mononeuropathy
- 6. Femoral Diabetic Neuropathy
- 7. Focal Diabetic Neuropathy
- 8. Thoracic/Lumbar Radiculopathy
- 9. Unilateral Foot Drop due to Neuropathy due to Diabetes
- How to Detect and Diagnose Diabetic Neuropathy
- Physical Exam
- Nerve Conduction Studies and Electromyography – EMG
- Can You Prevent Diabetic Neuropathy?
- Here are some tips for foot care with diabetes
The Types of Nerve Damage (Neuropathy)
Nerve damage can be of different types based on the areas and the kinds of nerves it affects in the body. Due to this reason, neuropathy is usually divided into different types. A person can experience the following kinds of neuropathy:
1. Polyneuropathy or Peripheral Neuropathy
This is considered to be the most common type of nerve damage. It causes damage to the nerves in the feet, hands, legs, and the arms of a person. It usually starts from the feet but if left unchecked, it will progress to other areas. The most significant sign of peripheral neuropathy is that it affects both feet at the same time. Other common symptoms are:
- Tingling in feet, even during the night
- Extreme sensitivity or pain in feet
- Numbness and loss of feeling, even when injured
- Weak muscles and difficulty in walking
If you have these problems, please remember to mention to your diabetic doctor asap.
2. Autonomic Neuropathy due to type 2 diabetes
This type of nerve damage/ diabetic neuropathy affects the nerves of your autonomic system in the body. This includes your digestive system, sex organs, urinary tract, your sweat glands, cardiovascular system, and your eyes. Some of the most common signs of autonomic neuropathy are:
- Bladder paralysis – nerve damage in the bladder which causes urine to be retained in the bladder and cause urinary tract infections UTI
- ED – Erectile dysfunction– nerve damage/diabetic neuropathy to the pudental nerve.
- Diarrhea or constipation – caused by nerve damage, diabetic neuropathy in the intestines
- Digestive issues – Bloating, vomiting and poor or fast absorption of food such as gastroparesis which is another form of diabetic neuropathy.
3. Charcot’s Joint
Also known as diabetic neuropathic arthropathy, this condition occurs due to nerve damage/diabetic neuropathy around the joint. It can lead to the breakdown of the joint. It largely affects the foot and it can cause complete loss of sensation. It also means a person cannot sense their joint position. Leg muscles can start to weaken which means that the joint is not properly supported. Other common symptoms include:
- Swelling and redness
- Loss of sensitivity in the foot
- Inflammation and heat
4. Cranial Neuropathy
This diabetic neuropathy affects all 12 nerves which control eye movement, hearing, sight and taste. It can be dangerous as it can cause paralysis in the eye muscles. Additionally, the eye muscles are the first areas that are affected by cranial neuropathy. Other symptoms include:
- Pain around the affected eye – usually on one side of your face
- Double vision
5. Compression Mononeuropathy
This condition occurs when only 1 nerve is damaged and is considered a common form of nerve damage. There are two scenarios where it commonly occurs – When damage happens to a blood vessel due to diabetes which restricts the blood flow – OR – When nerves are damaged in areas where they must pass over bone or a tunnel such as the fingers. Common symptoms for this condition are:
- Numbness in fingers
- Swelling of fingers
- Prickling feeling in the fingers
- Pain or difficulty in tasks such as knitting or driving
6. Femoral Diabetic Neuropathy
This type of diabetic neuropathy commonly occurs in individuals who have Type 2 diabetes. A person can experience pain on one thigh. This is usually followed with muscle weakness and eventually the muscle wastes away. Another form of femoral neuropathy is diabetic amyotrophy. This causes weakness on both sides but there is generally no pain. The type of nerve damage is considered to be a form of disease of the blood vessels.
7. Focal Diabetic Neuropathy
This nerve damage/diabetic neuropathy is similar to cranial neuropathy because it can cause eye damage. However, it usually affects a number of different nerves, causing pain and weakness throughout the body. Common symptoms for focal neuropathy include:
- Double vision
- Bell’s Palsy – Paralysis of one side of the face
- Pain in the thigh
- Pain in other parts of the body
8. Thoracic/Lumbar Radiculopathy
Similar to femoral diabetic neuropathy, thoracic or lumbar radiculopathy is a form of mononeuropathy and occurs commonly. Unlike femoral neuropathy though, it doesn’t affect the thighs but the torso of a person. It affects the abdominal wall muscles or the chest muscles on one or both sides of a person. It is also said to occur more commonly in patients of Type 2 diabetes.
9. Unilateral Foot Drop due to Neuropathy due to Diabetes
This type of nerve damage affects the foot and makes it impossible for a person to walk or stand. Their foot cannot be picked up or won’t respond to stimuli. It is said to be caused by damage occurring to the peroneal nerve in the leg, either by compression or due to a blood vessel disease.
These are the different types of nerve damage (neuropathy) that you can experience. The good news is that early detection can help work out effective treatment options. You can talk with the professionals at SugarMDs to learn more.
How to Detect and Diagnose Diabetic Neuropathy
The good news is that if you pay attention to the early symptoms of nerve damage it can make it easier to work out a treatment plan. Your endocrinologist will opt for the following options to understand the nerve damage you are experiencing:
A thorough examination of the feet is necessary since nerve damage usually starts here. You should check your feet daily. Your endocrinologist may not see you frequently enough to catch an infection or ulcer.
Nerve Conduction Studies and Electromyography – EMG
If there is a suspicion of nerve damage, you will have to undergo EMG tests. These are designed to read the response from your nerves and check on how they are working with your muscles. This test also checks the speed with which your muscles and nerves respond to properly diagnose any nerve damage.
Remember that based on your condition, your tests might be different. In some cases, the nerve damage might be so pronounced that a physical exam might be enough to determine it.
Can You Prevent Diabetic Neuropathy?
Prevention of nerve damage is usually encouraged because treatment can be long, lengthy and often painful. There are certain forms of nerve damage that often go away on their own. In such cases, pain medication is the only thing prescribed. Yet the best way to prevent diabetic neuropathy remains diabetes control via keeping your A1c down.
Therefore, it is important to focus on the prevention of nerve damage. The following are some of the ways that you can prevent nerve damage:
1. Maintain Healthy Glucose Levels
It is necessary to monitor your glucose levels because nerve damage occurs due to high blood sugar levels. Most endocrinologists recommend that you use a CGM (continuous glucose monitor) such as Dexcom G6 or libre or a meter for blood glucose tracking. SugarMDs can monitor your glucose levels remotely and coach you to get you to goal healthy glucose levels. Additionally, you should take an A1C test at least twice a year to understand your average blood sugar level rate. In some instances, more frequent A1c testing is justified.
2. Be Attentive To Your Feet
Always be attentive towards your feet and pay attention to any numbness, sensitivity, tingling or even any sores, lesions or signs of infections. Always get your feet properly cleaned and disinfected to control the infections. If left unchecked, you can end up getting an amputation as nerve damage will make it difficult for the infection to heal.
Here are some tips for foot care with diabetes
Look at both feet (top, bottom, and sides) and between the toes daily. This can be done when putting on or taking off socks and shoes.
Look for cuts, calluses, blisters, thick or ingrown toenails, and signs of infection such as redness, swelling, or pus. Seek prompt medical attention for any problems.
Wash and dry feet thoroughly, especially between the toes. avoid routine foot soaks. to avoid hot water burns, test the temperature of bath and shower water with an elbow before stepping in.
Moisturize dry skin (except between the toes) with an emollient such as lanolin or a hand or body lotion. avoid using lotions that contain alcohol, as this can dry the skin. talcum powder may be used between the toes, if desired.
Cut toenails straight across and file the sharp corners to match the contour of the toe (this is best done after a bath or shower).
Do not use chemicals on or cut corns and calluses.
Inspect shoes daily by feeling the insides for torn linings, cracks, pebbles, nails, or other irregularities that may irritate the skin. Get in the habit of shaking out shoes before putting them on. Changing shoes during the day can limit repetitive local pressure.
Avoid going barefoot or sock- footed. Wear footwear at the pool or beach and apply sunscreen to avoid burns.
Avoid using hot water bottles or heating pads if your feet are cold.
Wear lightly padded clean socks and shoes that fit well.
3. Exercise and Dietary Changes
Exercising and meal control are a necessities but you should be careful when you are exercising. If you get injured, it can be difficult to heal. B12 is an important supplement in the diet. Food high in glycemic indexes should also be avoided.
Diabetic neuropathy is common yet preventable. Treatment is also available. You do not have to suffer from the pain due to diabetic neuropathy. For more information about nerve damage caused by diabetes/diabetic neuropathy, consult our endocrinologists at SugarMDs. We offer the best services, including remote monitoring services and medical advice for your condition. Get in touch with us now!
Author: Ahmet Ergin, MD, FACE, CDCES, ECNU
About the author: Dr. Ergin operates a large diabetes practice mostly in Jupiter, FL and yet can see diabetic patients across the entire state of Florida via a unique telehealth platform which also allows him and his team to track patient progress and be available at all times.