What is diabetic neuropathy?
Diabetic neuropathy is when diabetes causes damage to your nerves. It can affect different types of nerves in your body, including in your feet, organs and muscles.
Nerves carry messages between the brain and every part of our bodies so that we can see, hear, feel and move. They also carry signals to parts of the body such as the heart, making it beat at different speeds, and the lungs, so we can breathe.
Damage to the nerves can therefore cause serious problems in various parts of the body for people with type 1, type 2 or other types of diabetes.
Types of diabetic neuropathy
There are four main types of diabetic neuropathy - see below.
People with the condition could have just one or any combination of the types.
Your healthcare team should tell you which areas are affected and give advice on what to do about any symptoms you are having. The type of treatment you need will depend on the type of neuropathy.
Causes of diabetic neuropathy
Neuropathy is one of the long-term complications of diabetes.
Over time, high blood glucose (sugar) levels can damage the small blood vessels that supply the nerves in your body. This stops essential nutrients reaching the nerves. As a result, the nerve fibres can become damaged, and they may disappear. This can cause problems in many different parts of your body, depending on the type of nerve affected.
Can diabetic neuropathy be reversed?
No, diabetic neuropathy can't be reversed (but the symptoms can be treated).
Once the nerves have been damaged they cannot repair themselves.
But careful diabetes management including keeping your blood sugars as close to target as possible, and managing blood fat levels and blood pressure can prevent the damage from happening or prevent further damage if you already have some of the symptoms.
Treatment for diabetic neuropathy
There are many treatments available to relieve the symptoms caused by neuropathy.
This may include medication for nausea and vomiting, painkillers for sensory neuropathy or treatment to help with erectile dysfunction.
Keeping your blood sugar levels within your target range and also your blood fat levels (cholesterol) and blood pressure can also help to improve the symptoms of neuropathy and reduce the progression of the nerve damage.
Diabetic neuropathy pain
Why is diabetic neuropathy so painful?
The nerves carry chemical messages to and from the brain about what we can feel. When the nerves are damaged these messages cannot be sent properly which leads to a change in sensation or feeling. This can lead to feelings of numbness, tingling, burning, discomfort or shooting pains.
Sometimes these sensations can be worse at night. We are not sure exactly why this is, but could be to do with cooler temperatures in the evening, stress at the end of a long day and fewer distractions in the evening meaning you notice the pain more.
Living with any type of long-term pain (whether you can always feel it or you regularly get periods of pain), can be very distressing and have a negative impact on your mental health and general wellbeing. If you are experiencing regular or frequent pain which you are struggling to cope with you should contact your GP for advice and support. You can also contact our helpline or reach out on our forum.
Steps you can take to prevent diabetic neuropathy
You can help avoid diabetic neuropathy by keeping your blood sugar levels within your target range, which will help protect the blood vessels that supply your nerves.
You should also check your feet every day and have your feet checked by a healthcare professional once a year. This is particularly important if you think you’ve lost the feeling in your feet. Speak to your diabetes healthcare team for advice if you think you’re developing any signs of neuropathy.
Peripheral neuropathy is the most common type of neuropathy and is damage to the nerves outside the brain and spinal cord. It affects the nerves particularly in the feet and hands and can be motor neuropathy, sensory neuropathy or both. Nerves in your feet should be checked during your routine annual diabetes check-up.
For more information on peripheral neuropathy including treatment and symptoms, go to the NHS website.
Sensory neuropathy is damage to nerves that tell us how things feel, smell and look. It affects the nerves that carry messages of touch, temperature, pain and other sensations from the skin, bones and muscles to the brain. It mainly affects the nerves in the feet and the legs, but people can also develop this type of neuropathy in their arms and hands.
The main danger of sensory neuropathy for someone with diabetes is loss of feeling in the feet, especially if you don’t realise that this has happened.
Loss of feeling is dangerous because you may not notice minor injuries, for example if you step on something sharp while barefoot or get a blister from badly-fitting shoes.
If ignored, minor injuries may develop into infections or ulcers. That's why it's important to look after your feet when you have diabetes.
Symptoms of sensory neuropathy in feet, legs, hands and arms
- tingling and numbness
- loss of ability to feel pain
- loss of ability to feel changes in temperature
- loss of coordination – when you can’t feel the position of your joints
- burning or shooting pains – these may be worse at night
People with diabetes are more likely to be admitted to hospital with a foot ulcer than with any other diabetes complication. We’ve got lots of information on taking care of your feet when you have diabetes.
If you have neuropathy, you’re more at risk of developing Charcot foot. This is one of the serious foot complications caused by diabetes. We've got more information about what causes Charcot foot, as well as how to treat and prevent it.
Autonomic neuropathy is damage to the nerves that carry information to your organs and glands. They help to control functions we don’t even have to think about like your stomach emptying, how regularly your heart beats, and how your sexual organs work.
Examples of autonomic neuropathy
- gastroparesis – when food can’t move through the digestive system efficiently. Symptoms of this can include bloating, constipation or diarrhoea.
- loss of bladder control, leading to incontinence (not being able to control when you pee)
- irregular heart beats
- problems with sweating - either not being able to sweat properly and intolerance to heat, or sweating related to eating food (gustatory)
- impotence (inability to keep an erection).
Motor neuropathy affects the nerves that control movement. Damage to these nerves leads to weakness and wasting of the muscles that receive messages from the affected nerves.
Motor neuropathy symptoms
Nerve damage can lead to problems such as muscles weakness, which could cause falls or problems with doing tasks like fastening buttons, and muscles wasting where muscle tissues is lost because it’s less active. It can also lead to muscle twitching and cramps.