Diabetic neuropathy

What is diabetic neuropathy?

Diabetic neuropathy can occur if you have type 1 or type 2 diabetes. Diabetic neuropathy is a type of nerve damage. It most often affects the nerves in your legs and feet.

It can also affect other nerves in your body known as the autonomic nerves and motor nerves.

• Autonomic nerves carry signals to help with balance, sweating, digestion and many of the things you do without thinking.
• Motor nerves carry signals to help you move.

What are the symptoms of diabetic neuropathy?

The most common symptoms of diabetic neuropathy are numbness, tingling, a burning feeling, aching, cramps and weakness. Symptoms often begin in their feet or hands. These symptoms may later spread to their legs and arms.

Diabetic neuropathy can also cause:

• pain and discomfort in your arms or legs, especially at night
• not being able to feel sores or cuts
• sleep problems
• bloating and indigestion
• heat intolerance
• problems with walking
• diarrhoea
• problems with urinating (passing water)
• low blood pressure on standing
• problems with sexual function
• not being able to recognise when your blood sugar is low (hypoglycaemia)

What causes diabetic neuropathy?

Having high levels of sugar in the blood for a long time increases the risk of damage to the nerves.

High levels of triglycerides, a type of fat found in the blood, can also cause nerve damage.

The longer you have had diabetes, the more likely you are to develop diabetic neuropathy.

Other conditions can play a part, including:

• high blood pressure
• vitamin B deficiency
• alcohol abuse
• smoking
• kidney disease or liver disease
• some medicines, including some drugs used against cancer

When should I see my doctor?

Call your doctor if you have:

• a cut or sore on your foot that is infected and won’t heal
• burning, tingling, weakness or pain in your hands or feet
• changes in digestion, urinating or sexual function

How is diabetic neuropathy diagnosed?

Your doctor will talk to you, examine you, and may recommend that you have some blood tests.

They will also check your past blood sugar levels to see how well your diabetes has been controlled.

Your doctor might refer you to a specialist doctor for further treatment or to another health professional.

How is diabetic neuropathy treated?

Treatment will depend on the nerves that are affected. Treatment for symptoms related to nerve damage in the legs or arms may include the following.

• Discuss with your doctor or diabetes nurse how to protect your skin and deal with any pain.
• Pain relievers, such as paracetamol and ibuprofen, might not work with the pain of diabetic neuropathy. If so, talk to your doctor about other forms of pain relief.
• When you have diabetes it is important to take care of your feet. Appropriate footwear is important. You can also visit a podiatrist (up to 5 visits a year are subsidised for people living with diabetes). They will give you advice on the best shoes and socks to help your feet.

Talk to your doctor about treatments for problems with autonomic nerve damage such as low blood pressure on standing or digestive or sexual problems.

Can diabetic neuropathy be prevented?

The most important thing to do to prevent diabetic neuropathy is to control your blood sugar levels. This means:

• eating a balanced healthy diet
• being active every day
• checking your blood sugar levels regularly
• taking or using any medication that your doctor has prescribed
• not smoking
• drinking alcohol in moderation

Complications of diabetic neuropathy

Complications will depend on the nerves affected. Some of the possible complications include:

• if you lose feeling in your feet, an ulcer can develop from an injury, without you realising it. In severe cases, this can lead to the need for removal of a toe, foot or lower leg
• fainting as a result of low blood pressure