Nerve disease, also known as diabetes-related neuropathy, is one of the most common diabetes-related complications – occurring in approximately 1 in 2 people living with the condition.
Our nervous system is a complex network of millions of nerves that connect to create a communication system throughout our body. This network allows us to feel, understand, and respond to the world around us.
Nerves are protected by a special substance called the myelin sheath, which acts like an insulator, enabling messages to be sent quickly and efficiently. The development of neuropathy in people with diabetes is complex. This damage can cause the nerves to “short-circuit,” resulting in messages being sent incorrectly or not at all.
The primary cause of nerve damage is prolonged elevated glucose levels and high blood pressure, which can cause biochemical changes that harm nerve tissues. When the nerves become damaged, various bodily functions are severely affected. The most common and significant impact is on the lower limbs, particularly the feet.
Both men and women can experience sexual dysfunction caused by nerve damage. In men, nerve damage can lead to erectile dysfunction (ED), the most reported sexual health issue among men with diabetes, with approximately 50% of men with type 1 diabetes experiencing the complication. Meanwhile, about 35-70% of women with type 1 and type 2 diabetes experience diminished sexual response due to nerve damage.
Nerve disease can also affect the digestive system, leading to complications in digestion and absorption of nutrients. Some of the main symptoms are constipation, which sometimes alternates with diarrhoea, and difficulty swallowing. Damage to the nerves that activate stomach muscles can result in gastroparesis, a condition that slows or stops the stomach emptying. This disorder causes nausea, vomiting, bloating, and loss of appetite.
When the nerves become damaged, various bodily functions are severely affected. The most common and significant impact is on the lower limbs, particularly the feet.
Many factors linked to diabetes can cause types of neuropathy, each with differing symptoms. Understanding these types and recognising their symptoms early can lead to timely intervention, potentially preventing further nerve damage.
Peripheral neuropathy commonly affects the feet and legs, but can also impact the arms and hands, leading to pain, numbness, and weakness. The main cause is prolonged high glucose levels that can damage the nerves. Other causes are metabolic factors, such as abnormal cholesterol levels and high blood pressure, and neurovascular factors, such as damage to the blood vessels that carry oxygen and nutrients to the nerves.
Autonomic neuropathy affects the autonomic nervous system that controls involuntary body functions. The causes are linked to nerve damage regulating internal processes, including heart rate, digestion and bladder control.
Proximal neuropathy, also known as diabetes-related amyotrophy, leads to severe pain in the thighs, hips or buttocks, often resulting in weakness in the legs. The condition can severely impact mobility and quality of life. For people with diabetes, the causes of proximal neuropathy stem from high glucose levels.
Focal neuropathy, or mononeuropathy, involves sudden weakness or pain in specific nerves, often in the head, torso or leg. Over time, elevated levels of glucose and lipids, such as triglycerides, caused by diabetes can damage the nerves and small blood vessels that nourish the nerves, leading to focal neuropathy. The condition occurs when nerves are compressed or trapped in narrow passages between bones and tissues. When focal neuropathy involves trapped nerves, it is known as entrapment. People with diabetes are more likely to experience entrapments than people without diabetes.
Behavioural factors, such as tobacco and excessive alcohol consumption, can worsen nerve damage. Making the necessary lifestyle adjustments can limit the progression of nerve disease and improve overall physical and mental well-being.
Early identification of the signs of diabetes-related neuropathy is crucial for effective management. Symptoms can vary widely depending on the type of neuropathy, the nerves affected and the progression of the condition. People often experience numbness or tingling at the onset, particularly in their feet and hands. These are typically the first indications of nerve damage.
Pain, frequently described as sharp, burning, or aching, is another common symptom, especially with peripheral neuropathy. Muscle weakness may also develop, impacting mobility and daily activities. At the same time, increased sensitivity to touch can cause discomfort even with light pressure.
As the condition progresses, more advanced symptoms can emerge. These can include a loss of coordination, making walking or keeping balance difficult. Some people may also experience digestive problems such as nausea, vomiting, or diarrhoea due to autonomic neuropathy. Heart rate or blood pressure changes may also occur, indicating an impact on the cardiovascular system.
Symptoms can vary widely depending on the type of neuropathy, the nerves affected and the progression of the condition.
Regular check-ups are the first step in monitoring nerve health and guaranteeing effective management. People living with type 1 diabetes are recommended to have check-ups for signs of nerve damage five years after diagnosis, and those with type 2 from the time of diagnosis.
These check-ups employ four key assessment methods to identify nerve damage early. Healthcare providers often begin with a comprehensive physical examination to evaluate sensation and reflexes, followed by neurological tests that assess motor and sensory functions, helping to pinpoint areas of nerve damage.
More specialised tests include measuring the electrical activity of muscles and assessing the speed and strength of electrical signals in nerves. Both provide valuable insights into nerve function and help identify abnormalities.
In addition to these clinical assessments, people with diabetes can use self-monitoring techniques to manage their nerve health. Inspecting feet regularly for sores, blisters or skin colour changes can help catch issues early. Keeping a symptom diary to record unusual sensations or pain can also help healthcare providers in diagnosis.
Early detection is key, and by combining professional check-ups with daily self-monitoring routines, people with diabetes can manage their nerve health and prevent complications.
Early detection is key, and by combining professional check-ups with daily self-monitoring routines, people with diabetes can manage their nerve health and prevent complications.
Successfully managing neuropathy involves a combination of pharmacological and non-pharmacological treatments tailored to address different symptoms and improve overall quality of life.
Pharmacological interventions include pain relievers such as over-the-counter acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs) that offer mild pain relief. For more severe pain, certain antidepressants like amitriptyline and anticonvulsants such as gabapentin and pregabalin have been effective in managing neuropathic pain.
A comprehensive care plan that includes non-pharmacological lifestyle interventions can complement medication-based approaches. Physical therapy can help improve mobility and reduce pain.
Another form of pain management is transcutaneous electrical nerve stimulation (TENS), which uses low-voltage electrical currents as an alternative pain relief method.
Additionally, cognitive behavioural therapy (CBT) addresses the psychological aspects of chronic pain, helping people affected develop coping strategies and improve their mental well-being.
Along with regular check-ups with healthcare providers, people with diabetes can take steps to keep their nerves healthy and reduce the risk of neuropathy.
Healthy lifestyle interventions, such as nutritional modifications for healthy, balanced meals rich in antioxidants and regular exercise to improve blood flow and nerve health, can prevent further nerve damage and help manage the condition.
Living with diabetes requires a comprehensive approach to managing health, particularly concerning nerve integrity. Regular check-ups, effective treatment options, and lifestyle modifications are vital components in maintaining nerve health, leading to a better quality of life. By understanding the risks, recognising symptoms, and integrating management strategies, individuals can significantly reduce the likelihood of developing diabetes-related neuropathy.
The IDF School of Diabetes Understanding Diabetes platform offers a free online course on nerve health and diabetes in English and Spanish, designed for people living with diabetes and their caregivers. In this 30-minute course, you will learn about how diabetes affects the nerves, signs and symptoms of diabetes-related neuropathy, routine nerve checks for diabetes care, treatment options for neuropathy, and strategies for keeping nerves healthy to reduce the risk of neuropathy. Learn more.
