Diabetic Neuropathy is characterized by damage to the nerves due to chronically elevated blood sugar. The nerves are needed to carry signals from the brain to the body and affect all body systems. Therefore, while the most common symptoms of neuropathy involve the small nerves of the hands and feet, symptoms in other areas such as the gi tract, sex organs, and heart can also occur. Neuropathy is a very common condition for diabetic patients, nearly 60% of all people with diabetes will have some form of neuropathy ranging from mild to severe.

Symptoms: may begin gradually or have a sudden onset

• reduced sensation in feet and hands
• numbness and tingling
• pain
• burning sensation
• weakness
• sexual dysfunction
• slowed digestion and constipation
• carpal tunnel syndrome
• loss of bladder control

Treatment will be individualized based on symptoms, but prevention with tight blood sugar control is key.

Treatment of pain

• Avoid alcohol
• Physical therapy/ massage
• Capsaicin and lidocaine patches
• Antidepressants
• Anticonvulsants

*Tip: Make sure to also check for B-12 deficiency, which can also cause many of these symptoms. Normal B12 range is 200-900.

Types of Neuropathy

1. Peripheral Neuropathy
   • Effects the nerves that control movement and sensation in the most distal portion of the body (feet/leg, hands/ arms)The most common form or neuropathySymptoms include numbness, tingling, burning, weakness, and increased sensation of the lower limpsPain occurs in 1 in 4 patientsTypically affects feet first then handsSymptoms are typically worse at night time
2. Autonomic Neuropathy
   • Effects the parasympathetic (relax) and sympathetic (fight or flight response) nerve fibers of the central nervous system
   • May effect any organ in the body
     • Gastric
       • Bloating and feeling of fullness early in meal due to slowed digestion and delayed gastric emptying
       • Nausea
       • Vomiting
       • Constipation
       • Diarrhea
       • Heartburn
     • Genitourinary
       • Loss of bladder control
       • Impotence
3. Cardiovascular
   • Orthostatic (blood pressure that is affected by change in position)
   • Cardiovascular disease