Diabetic Neuropathy

What Is Diabetic Neuropathy?

Diabetic neuropathy is nerve damage caused by long-term elevated blood glucose levels in diabetes. Diabetic neuropathy is one of the most common consequences of diabetes. Nearly half of all diabetic patients over the age of 60 have neuropathy. Patients with type 1 and type 2 diabetes are equally affected.

The disease affects the nerves of the peripheral nervous system. The peripheral nervous system includes all the nerves in the body that are outside the central nervous system. For example, the brain and spinal cord form the central nervous system.

Since nerves of different regions of the body can be damaged, other clinical pictures can develop.

A distinction is made between sensorimotor polyneuropathy and autonomic neuropathy.

In sensorimotor polyneuropathy, nerves responsible for sensation and touch are damaged, which causes disturbances in the sensation of touch, pain, and temperature.

In autonomic neuropathy, nerves of the autonomic nervous system are affected. These nerves control organ functions. Damage to the nerves can affect the cardiovascular system or the gastrointestinal tract, for example.

In addition, there are less common atypical forms of neuropathy in which specific nerve roots or individual nerves are damaged.

Causes: Why Does Neuropathy Occur in Diabetes Patients?

Several factors play a role in the development of nerve damage. However, the main cause is elevated blood glucose levels over a long period. Many years of diabetes and high blood glucose levels, therefore, favor neuropathy. In type 2 diabetes, a disorder of lipid metabolism is also involved.

Other risk factors for diabetic neuropathy are high blood pressure, vascular disease, diabetic retinopathy, diabetic nephropathy, elevated blood lipids, alcohol, nicotine, overweight, little exercise, and an unhealthy diet.

Symptoms: How Does Diabetic Neuropathy Manifest?

Most often, diabetic neuropathy manifests as a sensory disturbance in the extremities. Usually, the feet are affected, but symptoms can also occur in the hands, lower legs, and forearms. Typical symptoms include pain, tingling, burning, or numbness in the extremities.

Some patients react extremely sensitive to touch. Even light touch - for example, with the bedspread or socks - feels unbearable. Often, the paresthesia is worse during the night than during the day. Pain also occurs mainly at night and is described as lightning-like and stabbing.

In addition to pain, numbness may also occur. The loss of sensation feels to patients as if the feet do not belong to them or are packed in absorbent cotton. The sensation of temperature and pain is also impaired.

If the nerves of the organs are damaged, many different symptoms can develop, depending on which nerves and organ systems are affected.

When nerves of the gastrointestinal tract are damaged, patients may experience difficulty swallowing, nausea, constipation, or diarrhea.

Typical signs of nerve damage to the cardiovascular system include low blood pressure, rapid heartbeat at rest, and arrhythmias. As a result, these patients are at increased risk for cardiac arrest.

If the urinary or reproductive system is affected, patients may have difficulty emptying the bladder, bladder weakness, or erectile dysfunction.

Other symptoms include extreme sweating or sweating of the face and neck when eating.

Symptoms of atypical forms of diabetic neuropathy may include pain on one side, for example, in the chest area, weight loss, or weakness.

Diagnosis: How Is Diabetic Neuropathy Diagnosed?

Patients with diabetes should be examined regularly for signs of diabetic neuropathy. Screening examinations are available for this purpose and should be performed once a year from diagnosis in type 2 diabetics and no later than five years after the onset of diabetes in type 1 diabetics.

During these examinations, the physician inquiries about complaints and examines the hands and feet. He tests whether patients feel very light touches or vibrations and checks muscle reflexes. If they do not feel these touches or vibrations, or if the muscle reflexes are weaker, this indicates the onset of diabetic neuropathy.

If there are abnormalities in these tests, the doctor also checks the sensation of pain and cold. He assesses the gait and examines the feet for injuries.

The doctor also asks about symptoms of autonomic neuropathy. For example, many of these complaints, gastrointestinal complaints or cardiovascular problems, can also have another cause. To exclude other diseases or in the case of atypical symptoms, further examinations are sometimes necessary, such as a laboratory test or echocardiography (ECG).

What Is the Course of Diabetic Neuropathy?

The course of diabetic neuropathy varies.

In subclinical diabetic neuropathy, patients have no symptoms, but nerve damage is already present and can be seen in neurological tests.

A common form of diabetic neuropathy is chronic painful neuropathy with pain and numbness. After months or years, when pain-conducting nerve fibers die, the pain may decrease.

Acute painful neuropathy with symmetrical pain in the feet and legs is relatively rare.

Painless neuropathy without discomfort or with numbness and paresthesia is also common. Loss of sensation and lack of muscle reflexes make it difficult for patients to walk. Injuries and pressure points on the feet are often not noticed or noticed too late.

In addition, people with diabetic neuropathy are prone to infection and ulcers on the feet. Damage to bones and joints also occurs. In the worst case, this can lead to the foot having to be amputated.

Therapy: What Helps Patients with Diabetic Neuropathy?

Reasonable blood glucose control can slow the progression of the disease in type 1 diabetes. However, in patients with type 2 diabetes, good blood glucose levels alone are less effective in stopping diabetic neuropathy. Here, blood lipids, blood pressure, and body weight also play a role. Therefore, in type 2 diabetes, a healthy diet and lifestyle are important to counteract the progression of the disease.

Patients can take medication for pain. However, common painkillers such as aspirin or ibuprofen do not work well for diabetic neuropathy. Instead, medications commonly used to treat depression and epilepsy, such as pregabalin or duloxetine, are used for pain management. These also change the perception of pain: they inhibit the transmission of pain stimuli to the brain and help better against the pain of diabetic neuropathy.

In addition, alpha-lipoic acid and benfotiamine, a precursor of vitamin B12, have a beneficial effect on the nerves.

In addition to drug-based pain therapy, there are alternative treatment approaches, for example, transcutaneous electrical nerve stimulation (TENS) or acupuncture. So far, however, studies have not been able to prove their effectiveness in diabetic neuropathy.

Another important aspect of treatment is the prevention of foot complications. People with diabetic neuropathy often have cracked and dry skin, and minor injuries often go unnoticed. Therefore, they should examine their feet daily to notice injuries, ulcers, and skin infections in time.

What Is the Prognosis for Diabetic Neuropathy?

Diabetic neuropathy is not curable because the nerve damage usually cannot be reversed, but it is possible to influence the course of the disease. Above all, the disease can be stopped by reasonable blood sugar control and a healthy lifestyle.

Once neuropathy has manifested, pain can be relieved with treatment, but the loss of sensation remains. Therefore, patients with advanced neuropathy need to learn how to cope with physical limitations and remain independent in the daily routine - for example, through occupational therapy and physiotherapy.

Can Diabetic Neuropathy Be Prevented?

In type 1 diabetes, diabetic neuropathy can be prevented primarily by keeping blood glucose levels well controlled.

In type 2 diabetes, a healthy lifestyle is the best preventive measure. This includes a healthy diet, plenty of exercises, weight reduction if overweight, and abstaining from alcohol and nicotine.

Which Doctors and Clinics Are Specialized in Diabetic Neuropathy?

Every patient who needs a doctor wants the best medical care. Therefore, the patient is wondering where to find the best clinic. As this question cannot be answered objectively and a reliable doctor would never claim to be the best, we can only rely on the doctor's experience.

We will help you find an expert for your condition. All listed doctors and clinics have been reviewed by us for their outstanding specialization in diabetic neuropathy and are awaiting your inquiry or treatment request.

Sources:

• Helmholtz Zentrum München, Deutsches Zentrum für Diabetesforschung, Deutsches Diabetes-Zentrum. Diabinfo – Das Diabetesinformationsportal. www.diabinfo.de. Aufgerufen am 27.04.2021
• Hien, Böhm, Claudi-Böhm, Krämer, Kohlhas. Diabetes- Handbuch, 7.Auflage, 2013
• Nationale VersorgungsLeitlinie Neuropathie bei Diabetes im Erwachsenenalter. Langfassung 1. Auflage, 2011 Version 5 AWMF-Register-Nr.: nvl-001e