Managing blood sugar levels is crucial for individuals with diabetes as it not only promotes overall well-being but also helps prevent long-term health complications. Diabetic neuropathy, characterised by tingling and numbness in the body, is a condition that can develop over time due to uncontrolled or persistently high blood sugar levels. Elevated blood sugar can cause nerve damage, leading to various health issues ranging from mild numbness to debilitating pain that hampers daily activities. However, with consistent blood sugar management and adopting a healthy lifestyle, it is possible to prevent or slow down the progression of diabetic neuropathy, a serious complication that affects approximately 50% of people suffering from diabetes.

Types of Diabetic Neuropathy and Their Symptoms

Diabetic neuropathy has four primary types, and individuals may experience one or multiple types, depending on the affected nerves. The symptoms experienced vary based on the specific type and the nerves involved. Typically, symptoms develop gradually, and they may go unnoticed until significant nerve damage has already taken place.

1. Peripheral Neuropathy

This form of neuropathy is commonly referred to as distal symmetric peripheral neuropathy and is the most prevalent type among diabetics. It primarily affects the legs and feet initially, followed by the arms and hands. Symptoms of peripheral neuropathy often worsen during nighttime and may include:

• Burning or tingling feeling
• Numbness or lower ability to feel temperature changes or pain 
• Muscle weakness
• Cramps or sharp pains
• Serious foot problems like infections, ulcers, and joint and bone damage
• Extreme sensitivity to touch

2. Autonomic Neuropathy

Your autonomic nervous system regulates various bodily functions such as blood pressure, sweating, heart rate, vision, digestion, sexual function, and bladder control. Diabetes can impact the nerves in any of these areas, leading to potential symptoms such as:

• Drop in blood pressure when standing up that may result in fainting or dizziness  (orthostatic hypotension)
• A lack of awareness about low blood sugar levels (hypoglycemia unawareness)
• Bowel or bladder problems
• Difficulty swallowing
• Slow stomach emptying, which can cause nausea, sensation of fullness, vomiting, and loss of appetite
• Changes in the adjustment of eyes to different lighting conditions 
• Sexual problems like erectile dysfunction in men and vaginal dryness in women
• Decreased or increased sweating

3. Proximal Neuropathy

This particular form of neuropathy typically affects the nerves in the hips, thighs, legs, or buttocks. It can also involve the chest and abdominal regions. Symptoms usually manifest on one side of the body but may eventually extend to the other side. Proximal neuropathy may exhibit the following symptoms:

• shrinking and weak thigh muscles
• Severe pain in the hip, buttock, or thigh
• Abdominal or chest pain
• Difficulty standing up from a sitting position

4. Mononeuropathy (Focal Neuropathy)

This kind of neuropathy affects a single, specific nerve, which may be in the torso, face, leg, or arm. The symptoms of mononeuropathy may include:

• Double vision or difficulty focusing 
• Tingling or numbness in the fingers or hand 
• Paralysis on one side of the face
• Pain in the foot or shin 
• Weakness in the hand resulting in dropping things
• Pain in the front of the thigh
• Weakness leading to difficulty in lifting the front part of the foot 

Causes of Diabetic Neuropathy

Neuropathy is not always a direct symptom of diabetes; rather, it is a complication that typically arises in the later stages of the disease. The development of diabetic neuropathy is attributed to long-term exposure to high blood sugar levels and elevated levels of fats in the blood, both of which contribute to nerve damage. While the precise mechanisms behind this process are not fully understood, researchers have identified several factors that can contribute to the occurrence of neuropathy, including:

• Genetic predisposition
• Smoking and alcohol use
• Injuries like carpal tunnel syndrome (affects the hand)
• Neurovascular issues that can damage the blood vessels bringing oxygen and nutrients to your nerves
• Nerves that experience inflammation related to autoimmune conditions
• Suffering from kidney disease
• Obesity
• High blood pressure & cholesterol levels

Furthermore, your risk of developing neuropathy increases with age and the longer you’ve suffered from diabetes. The highest prevalence of this condition can be seen in those who’ve lived with diabetes for 25 years or more. 

Prevention of Diabetic Neuropathy

Maintaining your blood sugar within your target range is crucial for preventing or delaying nerve damage. Here are some additional steps you can take to prevent neuropathy:

1. Control your blood pressure

Keep your blood pressure below the recommended target set by your doctor or healthcare provider. High blood pressure, combined with diabetes, increases the risk of complications. Regularly monitor your blood pressure at home using bp monitors.

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2. Engage in regular physical activity

Physical exercise helps lower blood sugar levels, promotes a healthy heart, and improves blood flow. Aim for at least 75 minutes of vigorous or 150 minutes of moderate aerobic activity per week. Take short breaks from sitting every 30 minutes between the bursts of activity.

3. Quit smoking or avoid starting

Tobacco use can lead to poor circulation in the feet, which hinders the healing process. If you smoke, consult your doctor for assistance in quitting.

4. Follow a healthy eating plan

Adopt a balanced diet that includes a variety of nutritious foods, with an emphasis on fruits, vegetables, and whole grains. Control portion sizes to maintain or achieve a healthy weight.

5. Take prescribed medications on time

Adhere to your doctor's prescribed medication regimen to effectively manage blood sugar levels and prevent complications such as neuropathy.

Treatment of Diabetic Neuropathy

While there is currently no known cure for diabetic neuropathy, treatment aims to slow its progression, alleviate pain, address complications, and restore function. Maintaining consistent blood sugar levels within the target range is crucial for preventing or delaying nerve damage.

Additionally, controlling blood pressure, achieving a healthy weight, and engaging in regular physical activity are important measures to slow down or prevent the worsening of neuropathy. Several prescription medications are available to help manage diabetes-related nerve pain. These may include pain-relieving treatments such as:

1. Anti-seizure drugs: Certain medications commonly prescribed for seizure disorders like epilepsy are also used to alleviate nerve pain.

2. Antidepressants: Tricyclic antidepressants, in particular, may provide relief for mild to moderate nerve pain.

In some cases, doctors prescribe a combination of both anti-seizure drugs and antidepressants. There are a few non-pharmaceutical treatment options to relieve diabetes-related nerve pain. These include:

• Magnetic or electric stimulation
• Physical therapy
• Pain-relieving topical creams
• Exercise

How to Manage Complications Associated with Diabetic Neuropathy?

To address complications associated with neuropathy, you may require care from various specialists. The specific treatment required will depend on the specific neuropathy-related complications you are experiencing. For example:

1. Urinary Tract Problems

Depending on the medication's impact on bladder function, your doctor may suggest discontinuing or changing medications. To address bladder problems, urinating every few hours or following a strict urination schedule while gently applying pressure to the bladder area may be helpful. In some cases, techniques like self-catheterisation might be necessary to empty the bladder affected by nerve damage.

2. Digestive Problems

For mild symptoms of gastroparesis such as indigestion, nausea, belching, or vomiting, diabetics may try eating more frequent and smaller meals. Dietary adjustments and medications may also help alleviate symptoms of gastroparesis, constipation, diarrhoea, and nausea.

3. Low Blood Pressure Upon Standing (Orthostatic Hypotension)

Simple lifestyle changes such as avoiding alcohol, staying hydrated, and transitioning from sitting to standing slowly can be effective in managing orthostatic hypotension. Sleeping with the head of the bed elevated 4 to 6 inches can help prevent overnight high blood pressure. Your doctor might also suggest using compression support for the thighs and abdomen. Various medications may be prescribed to treat orthostatic hypotension.

4. Sexual Dysfunction

Oral or injectable medications may improve sexual function in some men, but their safety and efficacy vary amongst individuals. Mechanical vacuum devices can enhance blood flow to the penis, and vaginal lubricants may benefit women experiencing sexual dysfunction.

When to Consult a Doctor?

It’s highly advisable to see your doctor if you have:

• Tingling, weakness, pain, or burning in your feet or hands that hamper sleep or everyday activities
• A sore or cut on the foot that won’t heal or is infected
• Fainting and dizziness
• Changes in urination, digestion, or sexual function

It is recommended that anyone who is diagnosed with type 2 diabetes immediately starts getting screened for diabetic neuropathy. Those diagnosed with type 1 diabetes should begin screening after five years. It’s a good idea to make it a practice to get screened once every year.

Takeaway

Numbness or tingling in the feet and hands can be a symptom of various conditions, including diabetes. Poorly controlled blood sugar levels in individuals with diabetes can increase the risk of experiencing such complications. Diabetics should consult with their doctor to discuss measures they can take to prevent the development of diabetic neuropathy and other diabetes-related issues.

You can also try the Apollo 24|7 Diabetes Self-Management Tool to log your sugar values, track patterns, know all about food nutrition and more.

For more information,  Consult Apollo’s Expert Diabetologists

FAQs

Q. Can diabetes numbness go away?

No, diabetic neuropathy is irreversible. It can only be managed and prevented from worsening. 

Q. What are the early signs of nerve damage?

Some of the first signs of nerve damage include numbness, tingling, muscle weakness, inability to hold onto objects, sharp pains in the limbs, and a buzzing sensation. 

Q. Can diabetes develop suddenly?

While type 1 diabetes can be diagnosed all of a sudden, symptoms of type 2 diabetes usually develop gradually over several years.

Q. How to check if the nerves are fine?

To check for nerve damage, doctors usually recommend an Electromyogram (EMG), which uses electrical impulses to identify the level of damage.

Q. Can nerve damage heal on its own?

In some cases, the nerve is just bruised and can heal on its own. However, if the nerve damage is caused by diabetes, getting timely treatment is essential to prevent its progression. 

Medically reviewed by Dr Sonia Bhatt.