The Basics of Diabetic Neuropathy

Peripheral Neuropathy2Diabetic neuropathy is the medical term for nerve damage that occurs in people who have diabetes mellitus. Known as a complication of diabetes, neuropathy causes pain in the extremities, usually the legs and feet. In people with diabetes, high blood sugar levels decrease blood flow to the nerves of the feet and lower legs.

This results in damage to the nerve endings. Approximately half of people with diabetes develop this type of neuropathy, and around 85,000 people in the U.S. have amputations each year as a result of diabetic neuropathy.

Symptoms of Diabetic Neuropathy

The symptoms of diabetic neuropathy gradually develop and worsen over many years. These include:

  • Feeling full after eating small amounts of food
  • Trouble digesting food, causing heartburn and bloating
  • Nausea, constipation, or diarrhea
  • Feeling like you step on something sharp
  • Tingling, numbness, and burning of the legs and/or hands
  • Feeling lightheaded when standing up
  • Sexual dysfunction
  • Sweating more than normal

Diagnosis of Diabetic Neuropathy

To diagnose diabetic neuropathy, the doctor will take a medical history and conduct a physical examination. Findings include:

  • Loss of or decrease in reflexes of the anklesperipheral neuropathy
  • Changes in skin color and tone
  • Loss of feeling in the feet
  • Notable decreased blood pressure with standing
  • Loss of feeling in the feet (this is checked with a brush-like instrument called a monofilament)
  • Changes in the skin
  • Loss of the ability to sense movement of your joints (proprioception)
  • Drop in blood pressure when you stand up after sitting or lying down

To confirm the presence of diabetic neuropathy, the doctor will order several tests. These include:

  • EMG – An electromyogram (EMG) involves recording electrical activity in the muscles.
  • Nerve conduction velocity (NCV) – A recording of the speed nerve signals travel.
  • Gastric emptying test – Done to check how fast food leaves the stomach after eating.

Treatment Options for Diabetic Neuropathy

 

  • Medications – Certain medications are indicated for neuropathy, such as Neurotin and Lyrica.

 

  • Lumbar sympathetic nerve block (LSNB) – This procedure is done to relieve pain in the legs. The doctor injects a local anesthetic near the sympathetic nerves of the low back under x-ray guidance. During the procedure, the patient’s leg may feel warm, and back soreness and temporary numbness are common side effects.Spinal Cord Stimulator3

 

  • Celiac plexus block – To relieve pain of the abdomen area, a celiac plexus block is used. The doctor places a needle into the back and injects a numbing agent into the group of nerves called the celiac plexus. This injection is also performed using x-ray guidance and offers long-lasting pain relief.

 

  • Spinal cord stimulation – One effective measure for treating neuropathic pain is spinal cord stimulation. The doctor surgical implants a device near the spinal cord that stimulates the spine and alleviates nerve pain.

 

  • Intrathecal pump implant – This device is surgically implanted near the spine to deliver strong medication directly into the cerebrospinal fluid. This pain measure avoids unpleasant side effects because it bypasses the gastrointestinal tract.

 

Resources

Centers for Disease Control and Prevention (2007). Diabetes Public Health Resource. Retrieved from: http://www.cdc.gov/diabetes/statistics/hosplea/diabetes_complications/fig4_neuro.htm

Mayo Clinic (2014). Diabetic neuropathy. Retrieved from: http://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/basics/definition/con-20033336