Brief overview
- Description: Neurological condition that can develop as a result of diabetes disease.
- Forms: Mainly peripheral (diabetic) neuropathy and autonomic (diabetic) neuropathy. In addition, other rare forms of progression.
- Symptoms: Symptoms depend on the form of progression: They range from sensory disturbances and numbness to tingling and stabbing pain in the hands or feet. Autonomic neuropathies disturb the function of internal organs.
- Diagnosis: physical examinations, sensitivity tests (touch, vibration, sensation of heat and cold), blood test, special neurological examinations (electroneurography, electromyography).
- Treatment: No causative (drug) treatment of neuropathy available, healthy lifestyle, well-controlled blood glucose levels, treatment of symptoms.
- Prevention: Lifestyle adjustments prevent diabetic neuropathy.
What is diabetic neuropathy?
Diabetic neuropathy is a possible complication of advanced diabetes mellitus. It is a multi-faceted neurological condition in which nerve cells and nerve pathways are progressively damaged by elevated blood glucose. It therefore belongs to the so-called metabolic-toxic polyneuropathies.
In addition, the so-called autonomic nervous system can be attacked. It controls the function of the internal organs. Therefore, symptoms range from impaired function of the gastrointestinal tract, the cardiovascular system, and the urinary tract to impaired sexual function.
Estimates of the prevalence of diabetic neuropathy vary. It is thought that nearly one in two diabetics may be affected in the course of the disease.
What are the different forms of diabetic neuropathy?
A distinction is made between different forms of diabetic neuropathy.
According to the location of the nerve damage, these are:
Other diabetic neuropathies: In focal (diabetic) neuropathy, nerve damage is (severely) localized to individual nerve cords either in the hands, legs, or even trunk. Proximal neuropathy, on the other hand, is characterized by nerve damage in the hip region. Often, only one half of the body is affected. Both forms are rare.
In addition to the above-mentioned classification based on the location of the nerve damage that occurs, diabetic neuropathies can also be classified according to other criteria:
Subclinical neuropathy: Since diabetic neuropathy usually has an insidious onset, the first signs are often not obvious. In this phase, everyday activities are not restricted, but neurological examinations already show abnormalities. Preventive measures are particularly effective in this phase.
Chronic painful neuropathy: It is characterized by permanent pain sensation. This usually has a major impact on the quality of life of the affected persons.
What is the life expectancy for diabetic neuropathy?
How does diabetic neuropathy manifest itself?
Diabetic neuropathy usually sets in gradually over many years. It is therefore possible that those affected often pay no attention to the first symptoms. How the symptoms manifest themselves in the further course depends to a large extent on the present form of progression and the progress of the disease.
Symptoms of peripheral diabetic neuropathy
In advanced stages, the complaints are increasingly accompanied by typical movement restrictions:
- Altered gait
- Balance disorders
- Increased susceptibility to falls
- Loss of muscle strength
- Loss of muscle tone
- Pain when walking – often accompanied by swollen feet.
Symptoms of autonomic diabetic neuropathy
However, the most common manifestations of autonomic diabetic neuropathy are:
Autonomic neuropathy of the genitourinary tract: If nerves controlling the urinary tract are damaged, involuntary leakage of urine (incontinence) or the inability to empty the bladder (micturition disorders) may occur. In addition, disorders of sexual function may develop.
How does a diabetic neuropathy develop?
Several factors are probably involved in the development of diabetic neuropathy. Although not yet conclusively clarified, permanently elevated blood sugar (presumably) promotes the following – mutually reinforcing – damage processes in the affected tissues and thus in the nerves running there:
- Impairment of metabolism at the cellular level: Due to the increased blood sugar, it is suspected that the “power plants of the cell” (mitochondria) do not function optimally. The nerve cells affected thereby perish over time.
- Harmful metabolic products: It is suspected that harmful metabolic products can be formed as a result of the (chronically) elevated blood sugar – such as neurotoxic (glycated) proteins.
- Duration of existing diabetes
- Permanently elevated blood sugar (hyperglycemia, poorly controlled metabolism)
- Increased blood pressure (hypertension)
- Pre-existing conditions (e.g.: peripheral arterial disease / pAVK, renal insufficiency, diabetic nephropathy, etc.)
- Alcohol and nicotine
- Lack of physical activity
How is diabetic neuropathy diagnosed?
Close monitoring makes it possible to detect diabetic neuropathies at an early stage. Screening usually takes place once a year. If initial suspicion of nerve damage arises at such appointments, examinations take place every three to six months.
Other physical examinations usually include:
- Measuring sensitivity to light touch or vibration (tuning fork test)
- Testing the sensation of cold and heat
- Testing muscle reflexes and gait
- Measuring nerve conduction velocity (electromyography, electroneurography)
- Heart function test (electrocardiogram, ECG) to clarify possible damage to the cardiovascular system
Doctors also check for any accompanying symptoms that may exist, such as characteristic deformations of the foot (neuroosteoarthropathy, “Charcot foot”).
In the case of existing diabetes in combination with non-specific complaints, it may also be necessary for your attending physician to perform further blood tests, if necessary:
- Blood sedimentation rate (ESR)
- Thyroid-stimulating hormone (TSH)
- Vitamin B12, folic acid
- Creatinine
- Alanine Aminotransferase (ALAT)
If certain constellations of symptoms occur, you may suspect an autonomic diabetic neuropathy. In such a case, your attending physicians will consult other specialist disciplines – such as neurology, cardiology or urology.
What can be done about diabetic neuropathy?
Basically, the strategies for the treatment and prevention of both peripheral and autonomic diabetic neuropathy are similar. They are aimed at healthy living habits, an adapted diet, a well-controlled diabetes treatment and an individual care of the affected body parts.
Depending on the present course and the progress of the neuropathy, measures such as physiotherapy, strength training or orthopedic aids such as specially adapted shoes can provide support.
How can I prevent diabetic nerve pain?
There is a good chance of reducing the risk of diabetic neuropathy and slowing the progression of existing symptoms.
Therefore, it is important to prevent diabetic neuropathy in the best possible way:
- A permanently well-controlled blood glucose level – especially in type 1 diabetes.
- A normal body weight with blood fat and blood pressure values in the normal range.
- Avoidance of alcohol and nicotine.
- A balanced diet (diabetic diet) in combination with regular exercise.
- Attend regular routine check-ups to take countermeasures in good time.
