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Diabetic nerve pain (DNP), nerve damage or neuropathy can be very hard to live with. It affects so many different parts of the body that most people do not even realize all the pain they have been suffering comes from DNP. According to the American Diabetes Association (ADA) a little more than half of people who are diagnosed with diabetes have or will develop some type of nerve damage during their lifetime. However, it is more common for those who have been suffering from diabetes for a number of years.
Diabetic nerve pain, defined as diabetic neuropathy comes in many different types but there are four main types that diabetic patients are diagnosed with: peripheral, autonomic, proximal, or focal neuropathies. To find out more about these neuropathies, we need to delve into each one individually.
Peripheral Neuropathy
This is the most common type of diabetic neuropathy and is sometimes defined as distal symmetric or sensorimotor neuropathy. It causes both pain and loss of feeling in arms, hands, legs, feet and toes. Generally speaking, the lower extremities are affected before the upper.
Peripheral Neuropathy Symptoms
- Sharp pain/cramps
- Tingling, prickling or burning sensation
- Numbness/insensitivity to temperature or pain
- Loss of balance
- Extreme sensitivity to certain areas
- Muscle weakness
- Loss of reflexes, more so in the ankle
- Blisters and sores- these can take a while to heal and if left untreated can lead to an infection in the bone and a possible need for amputation.
- Difficulty swallowing
- Erectile dysfunction in men
- Vaginal dryness in women
These symptoms tend to worsen at night.
Autonomic Neuropathy
This type of neuropathy affects bowel/bladder function, digestion, sexual response, perspiration as well as nerves that affect the heart, lungs and eyes. Diabetic patients who are diagnosed with autonomic neuropathy sometimes develop hypoglycemia unawareness. This is a condition which does not allow a person who is hypoglycemic to realize that there blood sugar is lowering. When blood sugar drops below 70 mg/dL, symptoms of shakiness, palpitations and sweating begin to occur. With hypoglycemic unawareness, these symptoms may not appear which can cause the body other health issues including a stroke, heart attack, coma or death.
Basic Autonomic Neuropathy Anatomy Facts and Symptoms
Cardiovascular System
Blood circulation, blood vessels and the heart are all affected by autonomic neuropathy. It is the damage to these nerves that cause a rapid increase/decrease in both blood pressure and heart rate when a person stands up or is even resting.
Digestive System
Constipation, nausea, vomiting, bloating and uncontrolled diarrhea can be caused by nerve damage caused by automatic neuropathy. The damage of the nerves can also cause gastroparesis, a condition that causes the stomach to empty slowly which can cause blood glucose levels to fluctuate.
Urinary Tract/Sexual Function
Urination and sexual function issues come with nerve damage due to automatic neuropathy as well such as the prevention of the bladder emptying completely, frequent bladder infections and urinary tract infections. Nerve damage can also decrease sexual response in men and women.
Perspiration
Nerve damage can impact the sweat glands and therefore the body does not regulate temperature properly. Night sweats can became more common through nerve damage as well.
Eyes
The pupil in the eyes can be affected by autonomic neuropathy. Averagely, the pupils become less responsive to light changes. Driving at night becomes harder as well as being able to see when a light is on in a dark room.
Proximal Neuropathy
This type of neuropathy also known as diabetic amyotrophy, lumbar plexopathy and diabetic femoral neuropathy affects the hips, thighs, buttocks and legs. This type of neuropathy happens when blood glucose levels become too high for long periods of time. High glucose levels can cause a disruption in signal transmission and compromise blood flow due to weak capillaries which results in prominent nerve damage.
Usually elderly patients who have been diagnosed with Type 2 diabetes develop this type of neuropathy and it becomes harder to stand from a sitting position while tingling, numbness and pain is felt in the things, hips and buttocks.
Proximal Neuropathy Symptoms
- Pain and irritation in hips, thighs, buttocks and legs
- Numbness or weakness in these areas
Focal Neuropathy
This type of neuropathy also known as mononeuropathy happens when there is rapid weakness in one nerve or a group of nerves that causes pain and muscle weakness. Nerve damage from diabetes isn’t just located in one area; it can affect any nerve in the body. However, there are some common areas that are affected: thigh, foot, wrist, back, chest, facial muscles and eyes.
This particular type of neuropathy occurs less often than any other type and most often occurs in elderly diabetics. The symptoms of focal neuropathy usually come on very quickly and tend to improve on their one between 6 and 8 weeks. But there is no cure for it.
Focal Neuropathy Symptoms
- Focalized pain in the wrist or foot
- Pain in the eyes, trouble moving eyes, double vision
- Chest or abdomen pain
- Lower back weakness, can cause paralysis.
What Causes Diabetic Nerve Pain (Neuropathy)?
The short answer is blood vessel and nerve damage.
A longer answer however is that the nerve fibers became exposed to high blood sugar which causes neuropathy, which in turns causes many more symptoms that, can lead to more health issues. When blood sugar is high it omits the ability for nerves to transmit signals, it also weakens the small blood vessel walls that create a supply of oxygen and nutrients to the nerves.
Other Causes of Neuropathy
Nerve pain can also be caused by an autoimmune response. This happens when the immune system decides to attack another part of the body, as though it is a foreign. Genetics also play a role because a person’s medical family history can make them more susceptible to nerve damage.
Drinking and smoking can lead to nerve damage as well and having diabetic’s increases to risk, two-fold.
What Are The Risk Factors For Neuropathy?
Diabetics are already prone to neuropathy as soon as they become diagnosed but there are certain factors that can increase the risk and the complications that come from neuropathy.
Risk Factors Include
Kidney disease
Having diabetes alone can cause damage to kidneys and this allows toxins into the blood that can cause nerve damage.
Length of time a person has been a diabetic
The longer a person’s body has endured the rise and fall of blood sugar so rapidly can also put a person at more risk for nerve damage. This risk is further increased if the blood sugar hasn’t been managed properly.
Overweight
A body mass index larger than 24 can increase a person’s change of developing neuropathy.
Smoking
Smoking is so bad but even worse for someone who has been diagnosed a diabetic. Wounds and scabs tend to heal slower when a person is smoking which can lead to other health concerns or even a possible amputation.
Poor blood sugar control
Managing blood sugar is a full time process when it comes to a person who is diabetic. Keeping it well managed allows for less risk of nerve damage and other complications. But not managing can lead to so many other problems, not just nerve pain such as a heart attack, a stroke, coma or even death.
Complications From Neuropathy
Millions of people have diabetes in America alone but as long as it is well managed, they live their lives healthy and happy. However, when diabetes is not managed properly, it can lead to some serious life-threatening complications.
Complications Include
Loss of an Extremity
Nerve damage can cause lack of feeling in different limbs of the body. Sores or cuts can also develop without a person becoming aware of it due to the lack of feeling. If these sores and cuts go untreated, they can cause an infection that goes to the bone, leading to gangrene. This means the extremity has to be amputated.
Charcot Joint
Nerve damage can cause a joint to deteriorate which caused it to lose sensation, swell and become unstable. Deformity can also happen as well but early treatment can prevent this.
Urinary Tract Infections
Because of the amount of nerve damage, the bladder can stop working properly and hold some urine instead of emptying completely. This can cause bacteria that will lead to an infection. Nerve damage can also cause incontinence as muscle control can become weak.
Low Blood Pressure
Nerve damage creates poor circulation issues so if a diabetic patient is sitting for quite some time and then they stand up, their blood pressure can drop sharply, causing them to feel faint.
Hypoglycemia Unawareness
Hypoglycemia presents symptoms of shakiness, sweating, fast heartbeat, and dizziness but nerve damage can cause a diabetic to go about unaware that their blood sugar has dropped, leading to other health issues.
Increased/Decreased Sweating
Sweat glands can become affected by nerve damage. This means the body cannot regulate temperature accurately and that can cause other issues, some even life-threatening.
Sexual Dysfunction
Sex organs are also affected by neuropathy. Erectile dysfunction in men and dryness in women can become frequent issues.
Digestive Issues
Digestion is affected by nerve damage and can cause nausea, constipation, diarrhea, vomiting, bloating and a loss of appetite.
How Do You Find Out If You Have Nerve Damage?
Doctors usually go based on a symptom check alone when it comes to nerve pain. However, there are some other tests that can be implemented as well.
Testing For Neuropathy
Filament Test
This test judges the sensitivity to touch by using soft nylon fiber.
Nerve Conduction Study
This test measures the quickness of nerves in the arms of legs when electrical signals are conducted.
Electromyography (EMG)
This test measures electrical discharges that are produced in the muscles.
Quantitative Sensory Test
This test is used to find out how nerves are responding to temperature change and vibration.
Automatic Neuropathy Test
Tests for blood pressure in different positions and tests to measures the ability to sweat may be implemented.
Foot Exam
According to the ADA, each person who is diagnosed with diabetes should have a good exam once a year by their doctor of a foot specialist. Feet should also be checked on a regular basis for cracked skin, sores, blisters and ulcers.
Treating Neuropathy
While there is no cure for nerve pain, there are some treatment options that can help with the pain and prevent the symptoms from becoming worse.
Treatment Options
Blood Sugar Management. One easy way to prevent nerve damage is to keep your blood sugar regulated. This means diet, exercise and continuous glucose monitoring to make sure blood sugar isn’t increasing too much or decreasing too far down.
Regular Blood Sugar Levels (According to the Mayo Clinic):
80-120 mg/dL for people who are 59 or younger with no medical conditions
100-140 mg/dL for people who are 60 or older with no medical conditions
Slowing Nerve Damage
- No smoking
- No drinking or drink in moderation
- Maintain a healthy weight
- Exercise regularly
- Eat smart and healthy
- Take care of your feet, examining them regularly
- Manage blood pressure
Relieving Diabetic Nerve Pain
- Physical Therapy
- Acupuncture
- Capsaicin Cream (made from chili peppers)
- Anti-seizure Medications (doctor prescribed) such as Gralise, Neurotin, Lyrica, Carbatrol, Tegretol
Diabetes can cause nerve damage and frequent it does but there is so much that can be done to prevent the amount of damage that is done. Once the damage is done, however, there is nothing that can be done at this point in medical history to cure it. Therefore, it is very important to get ahead of nerve damage by knowing all the facts about neuropathy and the affect that it can have on the body. There are so many different misfortunes that come from diabetes, having to manage pain from nerve damage shouldn’t be one of them.
