Neuropathy is one of the long-term complications of diabetes. How diabetes causes nerve damage is not fully understood. However, high blood glucose (sugar) levels (hyperglycaemia) are known to harm the nerves’ ability to transmit signals, and damage the blood vessels that carry oxygen and nutrients to the nerves. So good diabetes control is important to reducing the risk of nerve damage.
What is neuropathy?
Neuropathy is nerve damage. Nerves carry messages between the brain and every part of our bodies, making it possible to see, hear, feel and move. Nerves also carry signals that we are not aware of to parts of the body such as the heart, causing it to beat, and the lungs, causing us to breathe. Although neuropathy is a very common problem for people who have diabetes most people are neither aware of it nor inconvenienced by it. There are three different types of neuropathy: sensory, autonomic and motor. You can also find out more about these in our leaflet 'Diabetic Neuropathy', which you can download from our online shop.
The effects of neuropathy
Below are some of the ways neuropathy can affect the various parts of your body and the treatments available.
Skin
You may be less able to feel heat, cold, or pain. It can lead to pain and numbness or tingling in the hands, legs or feet. If you lose sensation in your feet you may not realise that you have trodden on something sharp or that the ground is hot if you walk barefoot.
You should be checked for this kind of neuropathy at your annual diabetes review. They should look for damage to your skin, test that you can sense gentle touch and vibration and check your blood flow.
Treatment: Paracetamol can help with this kind of discomfort. Your doctor can prescribe other tablets if this does not work. Keep a record of whether the painkiller is effective so your doctor knows whether to change the dose or medication. You may be referred to a pain clinic for specialist advice.
Muscles
Your muscles could become weak, which may be painful, and can cause muscle wasting in the thigh (although you may recover over time). If the nerves that supply the muscles in your feet are affected and you also have sensory neuropathy, the weakened muscles cannot stop the bones breaking when stressed. Because you may not feel the damage being done, your foot may become misshapen. This is called Charcot foot and you will need to see a podiatrist for treatment. Calluses and ulcers may form when bony protrusions rub inside the shoes and these could become infected.
Treatment: If you have Charcot foot you may be given specially made shoes or insoles, moulded to shape, to remove pressure from the fragile bones. It is important to protect your foot from further damage by resting it. Your foot may be put into a cast or splint and you may be given crutches to use or even a wheelchair. If your foot has healed into a poor shape then you may need an operation to remodel the bones.
Stomach and intestines
The movement of food through the gut can become slow when your stomach takes too long to empty (gastroparesis), causing nausea, bloating, vomiting, diarrhoea, constipation, general discomfort or unintentional weight-loss.
Treatment: Your doctor will be able to prescribe tablets or treatments to help speed digestion and relieve the other symptoms.
Bladder
It can cause you to develop problems passing urine properly or you may feel that you have emptied your bladder completely, when you have not. If this goes untreated it could cause you to become incontinent or even lose the ability to pass urine altogether.
Treatment: You may need to visit the toilet every three hours even if you don’t feel you need to go.
Antibiotics may be needed if it causes a urine infection.
Penis
This area can lead to erectile dysfunction or impotence.
Treatment: Your doctor can prescribe various treatments to help including tablets, injection, vacuum pump or implant.
Blood vessels
You may get low blood pressure as you stand up, especially when you first get out of bed, which causes dizziness or weakness. Your ability to feel the pain of angina or a heart attack may also be impaired.
Treatment: Compression stockings may help treat dizziness from standing up too quickly.
Sweat glands
It can become difficult for your body to regulate temperature. An inability to sweat in the lower limbs can lead to the skin on the feet becoming dry and cracked. Gustatory (when eating) sweating may start quite soon after chewing and can be brought on by certain foods. It often starts on the forehead, and spreads to the face, scalp and neck, sometimes affecting the upper part of the body. This is very rare and there is no treatment other than good blood glucose control.
Treatment: Use an emollient (moisturiser) on your skin but do tell your doctor if the skin cracks open as infection can get in.
Ways to help yourself
- Keep your blood glucose levels as near to your agreed target as possible.
- Examine your feet regularly
- Don’t forget your appointments with your doctor, nurse or podiatrist.
- Tell your doctor if you think you may have any signs of neuropathy.
- Your diabetes healthcare team are there to help you.