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Neuropathy - What is it? Can I prevent it?

Neuropathy is a nerve disease that usually happens as a consequence of diabetes. People with diabetes can, over time, have damage to nerves throughout the body.

The longer a person has diabetes, the greater the risk.

Neuropathy leads to numbness and sometimes pain and weakness in the hands, arms, feet, and legs. Problems may also occur in every organ system, including the digestive tract, heart, and sex organs.

An estimated 50 percent of those with diabetes have some form of neuropathy, but not all with neuropathy have symptoms. The highest rates of neuropathy are among people who have had the disease for at least 25 years. Diabetic neuropathy also appears to be more common in people who have had problems controlling their blood glucose levels, in those with high levels of blood fat and blood pressure, in overweight people, and in people over the age of 40. The most common type is peripheral neuropathy, also called distal symmetric neuropathy, which affects the arms and legs.

Nerve damage is likely due to a combination of factors:

• metabolic factors, such as high blood glucose, long duration of diabetes, possibly low levels of insulin, and abnormal blood fat levels
• neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to the nerves
• autoimmune factors that cause inflammation in nerves
• mechanical injury to nerves, such as carpal tunnel syndrome
• inherited traits that increase susceptibility to nerve disease
• lifestyle factors such as smoking or alcohol use

What are the usual symptoms?
Symptoms depend on the type of neuropathy and which nerves are affected. Some people have no symptoms at all. For others, numbness, tingling, or pain in the feet is often the first sign. A person can experience both pain and numbness.

Often, symptoms are minor at first, and since most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Symptoms may involve the sensory or motor nervous system, as well as the involuntary (autonomic) nervous system. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe.

Symptoms may include numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers wasting of the muscles of the feet or hands indigestion, nausea, or vomiting diarrhea or constipation dizziness or faintness due to a drop in postural blood pressure problems with urination erectile dysfunction (impotence) or vaginal dryness weakness.

How is a diagnosis done?
Neuropathy is diagnosed on the basis of symptoms and a physical exam. During the exam, the doctor may check blood pressure and heart rate, muscle strength, reflexes, and sensitivity to position, vibration, temperature, or a light touch. The doctor may also do other tests to help determine the type and extent of nerve damage.

A comprehensive foot exam assesses skin, circulation, and sensation. The test can be done during a routine office visit. Other tests include checking reflexes and assessing vibration perception, which is more sensitive than touch pressure.

If you have diabetes, make sure to ask your doctor to check you for neuropathy in your next visit.

Any treatment choices?
The first step is to bring blood glucose levels within the normal range to prevent further nerve damage.

Blood glucose monitoring, meal planning, exercise, and oral drugs or insulin injections are needed to control blood glucose levels.

Although symptoms may get worse when blood glucose is first brought under control, over time, maintaining lower blood glucose levels helps lessen neuropathic symptoms.

Importantly, good blood glucose control may also help prevent or delay the onset of further problems.

Prevent it NOW!
Yes you can prevent or delay onset of neuropathy if you take care of yourself. Start by watching your food intake, exercising daily, measure your blood sugars and your blood pressure. As you take care of yourself, you will feel the difference. Don't think it is too late. It is never too late to do something about it. So start now!

• Pay close attention to the things you eat (reduce fat intake)
• Exercise or start being more active daily
• Measure your blood sugars
• Measure your blood pressure

Adapted by Editorial Staff, September, 2005
Last update, July 2008