Diabetic Neuropathy
Diabetic neuropathy is a form of nerve damage that can happen in people living with diabetes. When blood sugar stays high over a long period of time, it can damage nerves throughout the body. Diabetic neuropathy most often affects the nerves in the legs and feet.
Symptoms can range from pain and numbness in the legs and feet to problems with digestion, urination, circulation, blood pressure and heart rate. They can be mild or disabling.
How Common Is Diabetic Neuropathy?
One large study estimated that about 28.5% of people with diabetes have neuropathy, with higher rates in type 2 than type 1 diabetes. The risk rises with age, reaching 44.2% in people with diabetes over age 70 (2). Other estimates are higher. Because many people have prediabetes or undiagnosed type 2 diabetes, the true numbers are hard to measure, and they are likely to keep rising as rates of obesity and diabetes increase.
What Causes Diabetic Neuropathy?
Diabetes is the most common cause of peripheral neuropathy worldwide. Both type 1 and type 2 diabetes commonly lead to nerve problems (1). Over time, high blood sugar damages nerves in several ways. It can harm the nerve fibers themselves, damage the protective coating around them, and injure the tiny blood vessels that supply nerves with oxygen and nutrients. This leaves nerves more likely to break down.
What Are the Symptoms of Diabetic Neuropathy?
The most common symptoms of diabetic neuropathy are numbness and tingling, loss of feeling in the skin, and increased pain. Other symptoms can include trouble with balance and coordination, muscle weakness, and a feeling of bloating or fullness after eating.
What Are the Risk Factors for Diabetic Neuropathy?
The biggest predictors of diabetic neuropathy are how long a person has had diabetes and their hemoglobin A1c, a measure of long-term blood sugar. Insulin resistance, high blood pressure and obesity are also common risk factors.
In people with type 2 diabetes, high triglycerides, high blood pressure and low HDL (“good”) cholesterol are consistently linked to neuropathy. Other risk factors include smoking, heavy alcohol use, greater height and older age (9).
Genetics may also play a role. Some studies have linked variations in the ACE and MTHFR genes to a higher risk of diabetic neuropathy (10).
What Are the Complications of Diabetic Neuropathy?
Diabetic neuropathy can lead to serious complications. These include digestive problems such as gastroparesis, bladder problems, sexual dysfunction, trouble regulating blood pressure and body temperature, and foot infections. In severe cases, infections can lead to the loss of a toe, foot or leg.
How Does Diabetic Neuropathy Affect the Brain?
Your brain depends on constant feedback from your body to know where you are in space. It needs ongoing information from your muscles and joints to coordinate movement. That information travels through the same peripheral nerves that diabetic neuropathy can damage. As a result, balance and coordination can suffer, which raises the risk of falls and injuries.
Research suggests that reduced input from the nerves may also affect the brain. Imaging studies have found changes in brain connections related to body awareness and pain processing in people with chronic diabetic neuropathy (6). Diabetic neuropathy has also been associated with a higher risk of problems with thinking and memory (7).
Diabetes itself can affect brain function. In people with type 2 diabetes, poor blood sugar control has been linked to lower performance on tests of learning, memory, reasoning and complex movement. Researchers have also found changes in the brain’s white matter, the wiring that connects different brain regions. In young adults with long-standing type 1 diabetes, studies have found changes in gray matter in areas related to language and memory. People with chronically high blood sugar, early-onset diabetes or repeated episodes of severe low blood sugar appear to be at higher risk for these changes (11).
High blood sugar has been linked to problems with thinking, depression and dementia, and it can worsen the effects of a stroke. Low blood sugar can also affect thinking and, in severe cases, cause seizures or loss of consciousness (12).
Poorly controlled blood sugar can also affect the vestibular system, the inner ear’s balance system. The vestibular system helps your brain know where your body is in space and triggers the reflexes that keep you steady. It works together with feedback from your feet and legs to help prevent falls. When vestibular problems combine with reduced feeling in the feet, the risk of falls and injuries can rise significantly (13).
How Is Diabetic Neuropathy Diagnosed?
Diabetic neuropathy is usually diagnosed through a careful history and physical exam. It can affect both large and small nerve fibers. Damage to large fibers reduces the sense of touch, vibration and joint position, along with reflexes and muscle strength. Damage to small fibers can cause burning pain and changes in temperature sensation.
Additional tests may be used to confirm the diagnosis, such as nerve conduction studies and electromyography, or autonomic tests of blood pressure and sweating.
How Is Diabetic Neuropathy Usually Treated?
The foundation of managing diabetic neuropathy is good blood sugar control, along with care for blood pressure and cholesterol. Your physician or diabetes care team plays the central role in this, and we’re glad to work alongside them.
Lifestyle also matters a great deal, especially for type 2 diabetes. Regular exercise, good sleep, stress management and a healthy diet can all help prevent diabetes and improve blood sugar control.
Diet is one of the most important tools for managing diabetes. Studies show that the Mediterranean diet can help prevent diabetes and improve blood sugar control (4). This way of eating limits sugar-sweetened drinks, added sugars, processed meats, refined grains, refined oils and other highly processed foods, and it keeps red meat low. It emphasizes fresh fruits and vegetables, nuts, seeds, legumes, whole grains, herbs, spices, fish, seafood and extra virgin olive oil, with moderate amounts of poultry and dairy. Talk with your doctor before making major diet changes, especially if you take insulin or other medications that lower blood sugar.
Once neuropathy develops, foot care becomes essential. Reduced feeling in the feet can make it hard to notice small injuries like cuts, blisters and ingrown toenails, and poor circulation can make them more likely to become infected. Check your feet every day, and see your doctor or a podiatrist promptly for any sore that doesn’t heal.
How the NeuroRescue Program Can Help
Along with your medical care and blood sugar management, there are therapies that aim to support the nerve fibers you still have and help them work better. Our NeuroRescue Program works alongside your diabetes care, including any medications you take. Please don’t change any medication without talking with your prescriber.
Electrical stimulation. Several studies have found that electrical stimulation of the legs can reduce neuropathic pain, using a variety of types of stimulation (5). Your program may include one or more forms of electrical stimulation, such as somatosensory stimulation, which uses repeated electrical pulses to activate peripheral nerves, or the Rebuilder, a device that uses several currents at once to stimulate the full sensory area of a nerve. All of these are applied through the skin, and we choose the type based on the details of your case.
Laser therapy. Studies suggest that both low-level and high-intensity laser therapy can help reduce pain from diabetic neuropathy (14, 15).
Transcranial magnetic stimulation. TMS has been studied for reducing neuropathic pain (16). At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it’s appropriate for you.
Nutritional support. Some research supports antioxidants like alpha-lipoic acid for diabetic neuropathy symptoms, and earlier research has explored plant compounds like luteolin and quercetin (19). When appropriate, we may recommend supplements as part of your program.
Balance and fall prevention. Because diabetes can affect the balance system while neuropathy reduces feeling in the feet, fall risk is a major concern. When testing shows a need, your program will include vestibular rehabilitation and gait training to help improve your balance and lower your risk of falls (18).
Recovery between sessions. Some programs include mild hyperbaric therapy as a structured recovery option between more demanding therapy sessions.
Every nervous system is different, so every NeuroRescue Program is different too. Your plan is based on your test results and the specific factors of your case.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
Because symptoms that look like peripheral neuropathy can sometimes involve the brain and spinal cord as well, we also evaluate your central nervous system. We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions.
Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving energy, endurance and function in the systems that need support. Our testing also helps us decide when to push and when to let you rest.
We can’t bring back nerve cells that have been lost. What we can do is work with the pathways that remain, helping them work more efficiently and work better together. Our goal is to help you manage your symptoms, improve your balance and function, and enjoy more of your life.
Your Next Step
Living with diabetic neuropathy can be challenging, but there is hope for managing symptoms and improving function. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
It’s never too late to take the next step.
References:
1. https://www.sciencedirect.com/science/article/pii/B9780444529022000333?via%3Dihub
2.. https://www.ncbi.nlm.nih.gov/pubmed/8458529
3. https://www.ncbi.nlm.nih.gov/pubmed/24365351
4. https://link.springer.com/article/10.1007/s00125-009-1292-0
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876364/
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563856/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437981/
8. https://pubmed.ncbi.nlm.nih.gov/30617218/
9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7096070/
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4447004/
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797942/
12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623586/
13. https://pubmed.ncbi.nlm.nih.gov/26251477/
14. https://pubmed.ncbi.nlm.nih.gov/31405692/
15. https://pubmed.ncbi.nlm.nih.gov/28075022/
16. https://pubmed.ncbi.nlm.nih.gov/31824787/
17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8084668/
