Improving Other Risk Factors
Although getting blood glucose under control is important, it might not be enough. It is also important to control other risk factors such as high triglycerides or cholesterol, treat high blood pressure and quit smoking. Daily aerobic exercises are shown to protect the nerves and improve neuropathy outcomes. Losing weight is also important if a patient is obese or overweight.
Increased Pain At Night
Whether its because you are no longer distracted by the concerns of the day or the hypersensitivity and pain caused by even the sheet touching your feet, diabetic nerve pain is often much worse at night, making sleep impossible.
Because poor sleep and increased pain are bidirectional, one makes the other more intense in a cycle that is hard to break.
What Is Autonomic Neuropathy
Autonomic neuropathy affects the nerves that control the heart, regulate blood pressure, and control blood glucose levels. Autonomic neuropathy also affects other internal organs, causing problems with digestion, respiratory function, urination, sexual response, and vision. In addition, the system that restores blood glucose levels to normal after a hypoglycemic episode may be affected, resulting in loss of the warning symptoms of hypoglycemia.
Autonomic neuropathy affects the nerves in your heart, stomach, intestines, bladder, sex organs, sweat glands, eyes, and lungs.
Normally, symptoms such as shakiness, sweating, and palpitations occur when blood glucose levels drop below 70 mg/dL. In people with autonomic neuropathy, symptoms may not occur, making hypoglycemia difficult to recognize. Problems other than neuropathy can also cause hypoglycemia unawareness.
Heart and Blood Vessels
The heart and blood vessels are part of the cardiovascular system, which controls blood circulation. Damage to nerves in the cardiovascular system interferes with the body’s ability to adjust blood pressure and heart rate. As a result, blood pressure may drop sharply after sitting or standing, causing a person to feel light-headed or even to faint. Damage to the nerves that control heart rate can mean that the heart rate stays high, instead of rising and falling in response to normal body functions and physical activity.
Urinary Tract and Sex Organs
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How Is Diabetic Neuropathy Diagnosed
Early diagnosis of diabetic neuropathy gives patients the best chance of effective treatment. But since not all foot or limb pain means diabetic neuropathy, accurate diagnosis is important to ensure appropriate treatment.
Diagnosis of diabetic neuropathies is based on history, clinical examination and supporting laboratory tests. Your doctor may:
- Check muscle strength and reflexes.
- Check muscle sensitivity to position, vibration, temperature and light touch.
- Request additional tests, such as:
- Ultrasound to determine how parts of the urinary tract are functioning.
- Electromyography to determine how muscles respond to electrical impulses.
- Nerve conduction studies to check flow of electrical current through a nerve.
- Skin biopsies to evaluate cutaneous nerve innervation.
- Nerve and muscle biopsies for histopathological evaluation.
A comprehensive evaluation including a review of blood pressure, cholesterol and blood glucose screenings combined with more advanced screening, helps the doctor rule out other causes and identify the core problem.
What Causes Diabetic Neuropathy
Although the exact causes of diabetic neuropathy are unknown, several factors may contribute to the disorder, including:
- High blood sugar . High blood glucose causes chemical changes in nerves and impairs the nerves ability to transmit signals. It can also damage blood vessels that carry oxygen and nutrients to the nerves.
- Metabolic factors. In addition to glucose levels, high triglyceride and cholesterol levels are also associated with increased risk of neuropathy. Patients who are overweight or obese are also at increased risk of developing neuropathy.
- Inherited factors. There are some genetic traits that may make some people more susceptible to nerve disease than others.
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Controlling Blood Glucose Levels
Getting blood glucose levels under control cant reverse nerve damage but can prevent further damage from occurring. Your doctor will give you specific blood sugar goals. Managing these levels includes eating a healthy diet high in protein and low in carbs. When you eat carbs, try to choose food with a higher fiber content, avoiding chips and soda.
Regular exercise can help keep blood sugar levels manageable by increasing insulin sensitivity, meaning youll need to take less insulin each day. Getting enough sleep is also important, as we often crave high-carb foods when overly tired.
Does Pins And Needles Sensation Means You Have Diabetes
The sensation of pins and needles is technically known as a form of paresthesia. Paresthesias are abnormal sensations and include sensations of burning, tingling, prickling, skin crawling or itching, often in the hands and/or feet. All the forms of paresthesia are due to nerve damage, either because of some disease affecting the nerves , by traumatic injury or entrapment , by strokes or by tumors pressing on the nerves.
Paresthesias can also be caused by Vitamin B12 deficiency, heavy metal poisoning, alcohol abuse and by a low-functioning thyroid . Paresthesias can also be caused by various medications such as antihistamines, blood pressure medication, antibiotics and other medications can cause paresthesias such as that sensation of pins and needles.
Just about everyone has experienced temporary paresthesiasthese are those times when your leg fell asleep as you sat cross-legged or your hands were tingling or vibrating for some time after weed whacking or using some power tool. Paresthesias are usually not painful unless they are cause by spinal or traumatic injury, but they can become chronic and can affect your overall quality of life.
In diabetes, paresthesias often precede and are part of a complication of diabetes, peripheral neuropathy. Peripheral neuropathy is believed to result from chronically high levels of blood sugar. The high levels of blood sugar can act as a toxin on the nerve cells, damaging them over time.
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What Does Diabetic Nerve Pain Feel Like
So what does diabetic nerve pain feel like? There are many symptoms, including early onset symptoms that may be mild and challenging to diagnose. Diabetic neuropathy symptoms usually begin in the toes and work their way towards the head.
The first symptoms you may experience are tingling and numbness in the toes or fingers. This may resemble the feeling of pins and needles when a foot that has fallen asleep begins to wake up. You may also experience cramping in the feet, poor reflexes, and poor balance or coordination. Some people experience hypersensitivity and feel painful sensations with the slightest touch .
In one of the few visual symptoms of diabetic peripheral neuropathy, a person may develop what is known as a hammertoe. This foot deformity causes the toes to begin to curl under and develops as a result of unconscious modification of the gait due to pain or other symptoms.
As the condition progresses, symptoms become more pronounced and more challenging to treat.
Keep An Eye On Your Feet
Early warning signs occur most often in the feet. Check your feet daily for blisters, cracks, ingrown toenails, or wounds that are slow-healing or getting worse.
The American Diabetes Association recommends an annual foot exam, but daily foot checks are crucial for early detection and treatment. If you are unable to bend down to see the soles of your feet, use a mirror or ask a family member to help.
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Avoiding Or Quitting Smoking
Diabetes is more common among people who smoke, although researchers are not sure exactly why.
Smoking damages the walls of the arteries, causing fat to build up, narrowing blood vessels, and impeding circulation. Poor circulation contributes to neuropathy.
Smoking also increases the risk of cardiovascular disease, which can lead to a stroke or heart attack. In addition, it may worsen insulin resistance.
Treating Painful Diabetic Peripheral Neuropathy: An Update
MATTHEW J. SNYDER, DO, and LAWRENCE M. GIBBS, MD, Saint Louis University Family Medicine Residency, Belleville, Illinois
TAMMY J. LINDSAY, MD, Saint Louis University Family Medicine Residency, St. Louis, Missouri
Am Fam Physician. 2016 Aug 1 94:227-234.
Patient information: See related handout on nerve pain in diabetes, written by the authors of this article.
Painful diabetic peripheral neuropathy occurs in approximately 30% of patients with diabetes mellitus who are hospitalized and in 25% of patients with diabetes who are treated in the office setting.1 It develops as a late manifestation of uncontrolled or long-standing diabetes.1 As many as 12% of patients with painful DPN do not report symptoms, and 39% of patients with the disorder do not receive any treatment.2
A = consistent, good-quality patient-oriented evidence B = inconsistent or limited-quality patient-oriented evidence C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to .
Distal symmetric polyneuropathy, which is characterized by burning pain, paresthesias, and numbness that follows a stocking-glove pattern and progresses proximally, occurs in approximately 26% of patients with DPN. Less than 20% of patients with diabetes experience dynamic mechanical allodynia , thermal hyperalgesia , or pain attacks.
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Urinary And Sexual Problems
To clear up a urinary tract infection, the doctor will probably prescribe an antibiotic. Drinking plenty of fluids will help prevent another infection. People who have incontinence should try to urinate at regular intervalsevery 3 hours, for examplebecause they may not be able to tell when the bladder is full.
To treat erectile dysfunction in men, the doctor will first do tests to rule out a hormonal cause. Several methods are available to treat erectile dysfunction caused by neuropathy. Medicines are available to help men have and maintain erections by increasing blood flow to the penis. Some are oral medications and others are injected into the penis or inserted into the urethra at the tip of the penis. Mechanical vacuum devices can also increase blood flow to the penis. Another option is to surgically implant an inflatable or semirigid device in the penis.
Vaginal lubricants may be useful for women when neuropathy causes vaginal dryness. To treat problems with arousal and orgasm, the doctor may refer women to a gynecologist.
Treatments For Diabetic Nerve Pain
Damaged nerves cant be replaced. However, there are ways that you can prevent further damage and relieve your pain.
First, control your blood sugar so the damage doesnt progress. Talk to your doctor about setting your blood sugar goal, and learn to monitor it. You may be asked to lower your blood sugar before meals to 70 to 130 milligrams per deciliter and your blood sugar after meals to less than 180 mg/dL.
Use diets, exercise, and medications to decrease your blood sugar to a healthier range. Monitor other health risks that can worsen your diabetes, such as your weight and smoking. Ask your doctor about effective ways to lose weight or quit smoking, if necessary.
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What Are The Symptoms Of Diabetic Neuropathy
The most common symptoms of diabetic neuropathy are numbness, tingling, a burning sensation, aching, cramps and weakness. Most people find symptoms usually begin in their hands or feet. These symptoms may later spread to their arms and legs.
Diabetic neuropathy can also cause:
- pain and discomfort in yours arms or legs, especially at night
- not being able to feel sores or cuts
- sleep problems
- problems with walking
- dry skin
If you suspect you might have diabetes, talk to your doctor or call the National Diabetes Services Scheme Helpline on 1800 637 700.
How Does Diabetes Affect The Health Of My Feet
Diabetes-related foot pain is mainly caused by high blood sugar levels. Over time, high levels of sugar in the blood damage both the nerve endings and blood vessels throughout the body. This combination causes nerve pain and poor circulation.
The feet are especially prone to poor circulation because theyre so far away from the heart. Diabetes-related nerve pain can appear in the hands, but most people who experience it feel it in their feet first.
Other factors that can increase your risk of developing diabetes-related foot pain include being overweight, kidney disease, and smoking.
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What Is Peripheral Neuropathy
Peripheral neuropathy, also called distal symmetric neuropathy or sensorimotor neuropathy, is nerve damage in the arms and legs. Feet and legs are likely to be affected before hands and arms. Many people with diabetes have signs of neuropathy that a doctor could note but feel no symptoms themselves. Symptoms of peripheral neuropathy may include:
- Numbness or insensitivity to pain or temperature
- A tingling, burning, or prickling sensation
- Sharp pains or cramps
- Extreme sensitivity to touch, even light touch
- Loss of balance and coordination
These symptoms are often worse at night.
Peripheral neuropathy affects the nerves in your toes, feet, legs, hands, and arms.
Peripheral neuropathy may also cause muscle weakness and loss of reflexes, especially at the ankle, leading to changes in the way a person walks. Foot deformities, such as hammertoes and the collapse of the midfoot, may occur. Blisters and sores may appear on numb areas of the foot because pressure or injury goes unnoticed. If an infection occurs and is not treated promptly, the infection may spread to the bone, and the foot may then have to be amputated. Many amputations are preventable if minor problems are caught and treated in time.
What Is Proximal Neuropathy
Proximal neuropathy, sometimes called lumbosacral plexus neuropathy, femoral neuropathy, or diabetic amyotrophy, starts with pain in the thighs, hips, buttocks, or legs, usually on one side of the body. This type of neuropathy is more common in those with type 2 diabetes and in older adults with diabetes. Proximal neuropathy causes weakness in the legs and the inability to go from a sitting to a standing position without help. Treatment for weakness or pain is usually needed. The length of the recovery period varies, depending on the type of nerve damage.
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Causes Of Tingling In The Head
The head tingling and numbness associated with paresthesia and primarily signs of nerve disorders in the affected area. Basically, certain nerves in the face and head become hyperactive, signaling pain sensations that arent there. This occurs due to nerve impingement , disruptions of blood circulation, nerve inflammation or damage, or chronic underlying conditions.
The list of health conditions that lead to this is extensive.
How To Avoid Diabetic Neuropathy
About one-third to one-half of people with diabetes have some kind of nerve damage, reports the National Institute of Diabetes and Digestive and Kidney Diseases .
Anyone with diabetes can get nerve damage at anytime, explains Dr. Bolash. There is an association with very high levels ofblood sugar and the development of diabetic neuropathy, but the two do notalways go hand in hand.
Unfortunately, even patients with very mild cases ofdiabetes may be affected with severe cases of nerve pain, he says, while otherscan be spared. According to the NIDDK, the highest rates of nerve damageare among people who have had diabetes 25 years or longer.
To avoid diabetic neuropathy, Dr. Bolash advises:Control your blood sugar and keep it as close to nondiabeticlevels as possible.
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When To See A Gp
It’s important to see your GP if you experience the early symptoms of peripheral neuropathy.
- pain, tingling or loss of sensation in the feet
- loss of balance or weakness
- a cut or ulcer on your foot that’s not getting better
It’s also recommended that people at highest risk of peripheral neuropathy, such as people with diabetes, have regular check-ups.
A GP will ask about your symptoms and may arrange some tests to help identify the underlying cause.
You may be referred to hospital to see a neurologist, a specialist in health problems affecting the nervous system.
Generally, the sooner peripheral neuropathy is diagnosed, the better the chance of limiting the damage and preventing further complications.
What Is Pins And Needles
Pins and needles feels like pricking, tingling or numbness on the skin.
It happens when the blood supply to the nerves is cut off. This is usually when you sit or sleep on part of your body. It only lasts a few minutes.
You often get pins and needles in your:
It usually stops when the weight is taken off the body part and your blood supply returns to the nerves.
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Tingling In Hands And Feet: Symptoms & Signs
Tingling in the hands and feet is often associated with other symptoms like pain, burning, or numbness in the hands and feet. These type of sensations commonly reflect damage to the nerves in the area because these are peripheral areas of the body, the term peripheral neuropathy is used to refer to this type of symptom. Peripheral neuropathy has a number of causes and varies in severity among affected people. Vitamin deficiency, diabetes, and kidney failure are among the medical causes of tingling in the hands and feet due to nerve damage. Taking certain medications can also cause tingling in the hands and feet. Other potential causes of peripheral neuropathy include autoimmune diseases, toxins, alcoholism, and infections. REFERENCES: Kasper, D.L., et al., eds. Harrison’s Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015. United States. National Institute of Neurological Disorders and Stroke. “Peripheral Neuropathy Fact Sheet.” Dec. 18, 2014.
Types Of Nerve Damage
There are four main types of nerve damage. You can have more than one type. Symptoms depend on the type of nerve damage you have and which nerves are affected.
Peripheral nerve damage
Have you felt pins and needles or tingling in your feet? Maybe you feel like youre wearing socks or gloves when you arent. Your feet may be very sensitive to toucheven a bed sheet can hurt. These are all symptoms of peripheral nerve damage.
Peripheral nerve damage affects your hands, feet, legs, and arms, and its the most common type of nerve damage for people with diabetes. It generally starts in the feet, usually in both feet at once.
Other symptoms may include:
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