NEUROPATHY

There are three kinds of diabetic neuropathy.

Peripheral neuropathy is damage to nerves outside the brain and spinal cord. This type affects the nerves of the extremities. Symptoms include the:

• Numbness
• Tingling sensation
• Pain
• Inability to determine joint position
• Extreme sensitivity to touch

Autonomic neuropathy is damage to the involuntary nervous system. These nerves control things like your heartbeat, blood pressure, sweating, digestion, urination, and sexual function.

Symptoms include:

• Nausea, vomiting or abdominal bloating after meals
• Urinary symptoms such as the feeling of difficulty to start urinating or the feeling of incomplete emptying of the bladder
• Impotence
• Dizziness or fainting
• Constipation or diarrhea
• Blurred vision
• Heat tolerance of decreased ability to sweat
• Unaware of hypoglycemia

Focal neuropathy affects just one nerve, usually in the wrist, thigh, or foot. This type of nerve damage usually happens suddenly.

Your symptoms will depend on which nerves are injured. You may not be able to feel pain, especially in your feet. This can lead to serious infections, because sores or other problems may not get treated.

DIAGNOSIS

The diagnosis of neuropathy and its cause starts with a thorough medical history and physical examination to help your health care professional determine the cause and severity of neuropathy. A neurological examination, testing the reflexes and function of sensory and motor nerves, is an important component of the initial examination.

When neuropathy is suspected, blood tests are often used to check for the presence of diseases and conditions that may be responsible for nerve damage.

Imaging studies such as X-rays, CT scans, and MRI scans may be performed to look for sources of pressure on or damage to nerves.

Specific tests of nerve function include:

• Electromyography (EMG) is a test that measures the function of the nerves.
• A nerve conduction velocity test (NCV) measures the speed at which signals travel through the nerves. This test is often done with the EMG.
• Nerve biopsy may be recommended. A biopsy is the surgical removal of a small piece of tissue for examination under a microscope.

RECOMMENDED MEDICATIONS

Treatment goals are to manage the condition causing your neuropathy and to relieve symptoms.

Peripheral neuropathy

Many people with peripheral neuropathy have mild to severe pain in specific parts of their bodies. Some people find these treatments helpful:

• Medicines such as pain relievers or creams to relieve pain. Prescription medicines often used to reduce pain from diabetic neuropathy may include tricyclic antidepressants and the antidepressant duloxetine hydrochloride, and medicines that control seizures, such as pregabalin and gabapentin.
• Complementary therapies such as acupuncture and biofeedback
• Physical therapy such as exercises, stretching, and massage. If you are told to use heat or ice, be careful. Neuropathy can make it hard for you to feel changes in temperature.
• Transcutaneous electrical nerve stimulation (TENS), which is a type of therapy that reduces pain by applying brief pulses of electricity to nerve endings in the skin.

Autonomic neuropathy

Autonomic neuropathy-which affects nerves that regulate internal functions-can affect digestion, urination, sweating, sexual function, blood pressure, and other involuntary body functions.

• Mild constipation. Eating small, frequent meals that are high in fiber and low in fat may help.
• Frequent diarrhea. Eating foods that are high in fiber may help.
• Mild gastroparesis. This is a condition that causes the stomach to empty very slowly. It may get better if you eat small, frequent meals that are low in fiber and fat.
• Abnormal sweating. If you sweat a lot, try to avoid intense heat and humidity. If you don’t sweat enough, you can use moisturizers to help with dry or cracked skin. Drinking more water can prevent overheating. Try to avoid places that are very hot or very cold.
• Lack of awareness of low blood sugar level. This is also called hypoglycemia unawareness. You can adjust your insulin and allow your blood sugar levels to be a little bit higher than the target range. Usually it is recommended that you keep your A1c in a target range.
• Urinary problems. Urinary problems can be treated with antibiotics for urinary tract infections and medicines to improve bladder control.
• Sexual problems. Your doctor may suggest using medicines or devices to improve erections. Or you may need nonprescription lubricants and estrogen creams for vaginal dryness.
• Blood pressure problems. High blood pressure may be treated with angiotensin-converting enzyme (ACE) inhibitors, such as benazepril and enalapril. Low blood pressure can be treated with medicines and by wearing support stockings (also called compression stockings).