Diabetic Neuropathy: Causes, Complications, and Treatment

Nerve damage is the most common problem diabetics encounter, affecting about half of everyone with the disease (1). This condition often leads to many long term difficulties that impact both quality of life and increase the risk of more dangerous complications, including death.  

Consistently controlling blood sugars is the best way to prevent all complications of diabetes, including neuropathy. 

What is Diabetic Neuropathy? 

Diabetic neuropathy is nerve damage caused by high blood sugar levels in people with both type 1 and type 2 diabetes.

Neuropathy happens when the levels of sugar (glucose) and fat (ie: triglycerides) in your blood are too high for too long. 

There are many types of neuropathy because almost any nerve in the body can be affected by diabetes. 

Symptoms of diabetic neuropathy depend on which nerves are affected by the disease. People can experience numbness and tingling, abdominal pain, nausea, vomiting, problems with vision, sexual dysfunction, and chronic pain. 

The longer a person has diabetes and the more uncontrolled their blood sugars are, the more likely it is that they will develop neuropathy. 

The main categories of diabetic neuropathy are peripheral, focal and autonomic.

Peripheral Neuropathy

The most common type of diabetic neuropathy is peripheral neuropathy. This refers to the nerves that control the feeling in our arms and legs. It occurs in about 1/3rd to 1/2 of all people with diabetes (2). 

People with diabetic peripheral neuropathy may experience numbness, tingling, and pain in their extremities. Most people experience some level of decreased sensation - meaning they can’t feel things as well as they used to. 

This can be especially problematic when it leads to increase the risk wounds and infections, particularly in diabetic feet

People also often feel muscle weakness and can have more problems with their balance (3). 

These sensation changes are most often equal on both sides. Sometimes one side can be more affected than the other, a condition called focal neuropathy.

Focal Neuropathy 

Focal neuropathies most often occur when nerves become compressed by being entrapped between other body tissue. An example of this is carpal tunnel syndrome. People with diabetes are also more likely to develop focal neuropathies (4). 

Autonomic Neuropathy 

Our autonomic nerves control parts of our body that we don’t often think about, like our internal organs. 

Autonomic neuropathy happens when there is damage to these nerves. This affects functions like food digestion, urination, heart rate, blood pressure, vision, and sexual function.  

Diabetic Gastroparesis

When the nerves controlling part of the intestines become damaged it can be harder for food to travel from the stomach to the small intestine. This condition is called gastroparesis and can cause people to experience abdominal pain, nausea, and vomiting that’s often worse after eating (5).  

Other digestive problems that can also occur from diabetes nerve damage include frequent episodes of diarrhea, constipation and/or bloating. 

Vision Changes

Vision problems are also created when there is damage to the nerves helping eye function. This can lead to changes in your vision if the pupil is not constricting correctly or if your eye muscle control is compromised. 

Urination Problems 

If the nerves controlling your bladder are damaged it may be harder for you to know if you need to urinate. This can lead to frequent urinary tract infections if your bladder isn't able to regularly empty as needed. Some people are also unable to control their urination and leak urine without intending to, called incontinence. 

Heart Rate and Blood Pressure Problems

If the nerves that help to regulate our blood pressure and heart rate are damaged, our bodies can’t adjust to basic changes as easily.  Autonomic nerves that help to prevent blood pressure from dropping when going from a seated to a standing position may not be working as well, and lead to feeling dizzy.  For example, this may be noticed in everyday activities such as standing up from a seated position. It may also make your heart feel like it's beating too fast or too slow. 

Damage to these autonomic nerves may also make it harder for diabetics to tell if they’re having a heart attack

Sexual Dysfunction 

Sexual behaviors are also often affected by diabetic neuropathy. This includes being a cause of erectile dysfunction for men and vaginal dryness in women. It can also be a cause of feeling numbness in the groin of diabetics. 

Cause of Diabetic Neuropathy 

The development of diabetic neuropathy is complicated. However, all of the suspected causes are rooted in blood glucose levels being too high for too long. 

Diabetic Neuropathy Prevention 

Like almost every other diabetic complication, the best way to prevent neuropathy is to successfully control your blood sugar. 

Effective blood glucose control means as little fluctuation in blood sugar throughout each day as possible. Consistently eating the right diet and regular exercise are critical to achieving this goal.

It’s also very important to take all of your medications as prescribed, check your blood sugar regularly and work closely with your doctor to ensure you’re consistently reaching your glucose goals.  

Diabetic Neuropathy Treatment

So what if you already have neuropathy? Well, controlling glucose is still the mainstay of therapy - again by diet, exercise and medications. Your doctor may also give you medications that can help the uncomfortable sensation of neuropathy. 

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