Massachusetts General Hospital

Diabetic Neuropathy (Nerve Problems)

What is diabetic neuropathy?

Diabetic neuropathy, a nerve disorder, is a complication of diabetes that can lead to problems throughout your body.

If you have diabetes, you can develop nerve problems at any time. Significant nerve problems, or clinical neuropathy, can develop within the first 10 years after receiving a diabetes diagnosis. The risk of developing neuropathy increases the longer you have diabetes. About half of people with diabetes have some form of neuropathy.

What causes diabetic neuropathy?

Although the exact causes of diabetic neuropathy are unknown, several factors may contribute to the disorder, including the following:

• High blood glucose. High blood glucose causes chemical changes in nerves and impairs the nerves' ability to transmit signals. It also has the potential to damage blood vessels that carry oxygen and nutrients to the nerves.

• Inherited factors. There are some genetic traits that may make some people more susceptible to nerve disease than others.

What are the symptoms of diabetic neuropathy?

The following are the most common symptoms of diabetic neuropathy. However, each individual may experience symptoms differently. Symptoms include:

• Numbness in the hands or feet

• Pain in the hands, feet, or legs

• Problems with internal organs, such as the digestive tract, heart, or sexual organs causing the following:

  • Indigestion

  • Diarrhea or constipation

  • Dizziness

  • Bladder infections

  • Impotence

  • Weakness

  • Weight loss

  • Depression

The symptoms of diabetic neuropathy may resemble other conditions or medical problems. Always consult your doctor for a diagnosis.

What are the different types of diabetic neuropathy?

Diffuse neuropathy is neuropathy that affects many parts of the body, and includes the following:

• Diffuse peripheral neuropathy. Neuropathy affecting nerves in the extremities (legs, feet, arms, and hands).
  
  Symptoms include:

  • Numbness

  • Tingling, burning, or prickling

  • Sharp pains or cramps

  • Extreme sensitivity to touch

  • Loss of balance or coordination

  • Insensitivity to pain or temperature changes
    
    

• Diffuse autonomic neuropathy. Neuropathy that affects nerves that serve internal organs, processes, and systems of the heart, digestive system, sexual organs, urinary tract, and sweat glands.
  
  Symptoms include:

  • Incontinence

  • Digestive problems

  • Low blood pressure

  • Dizziness

  • Fainting

  • Impaired perception of pain

  • Hypoglycemia

  • Profuse sweating
    
    

• Focal neuropathy. Neuropathy that affects a single, specific nerve and part of the body, such as the eyes, facial muscles, hearing, pelvis and lower back, thighs, and abdomen.
  
  Symptoms include:

  • Pain in the thighs

  • Severe pain in lower back or pelvis

  • Pain in the chest, stomach, or flank

  • Chest or abdominal pain that mimics angina, heart attack, or appendicitis

  • Aching behind the eyes

  • Inability to focus the eyes

  • Double vision

  • Paralysis on one side of face

  • Hearing problems

How is neuropathy diagnosed?

In addition to a complete medical history and physical examination, the doctor may:

• Check muscle strength

• Check muscle reflexes

• Check muscle sensitivity to the following:

  • Position

  • Vibration

  • Temperature

  • Light touch

• Request additional tests, such as:

  • Nerve conduction studies (to check flow of electrical current through a nerve)

  • Electromyography (to determine how muscles respond to electrical impulses)

  • Ultrasound (to determine how parts of the urinary tract are functioning)

  • Nerve biopsy (to remove a sample of nerve for examination)

What is the treatment for neuropathy?

Your doctor will determine specific treatment for your neuropathy, based on:

• Your age, overall health, and medical history

• Extent of the disease

• Your tolerance for specific medications, procedures, or therapies

• Expectations for the course of the disease

• Your opinion or preference

The goal of treatment is to relieve pain and discomfort, as well as to prevent additional tissue damage. Treatment may include:

• Pain medications

• Antidepressant medications

• Topical creams

• Transcutaneous electronic nerve stimulation (TENS) therapy

• Hypnosis

• Relaxation training

• Biofeedback training

• Acupuncture

Treatment may also be prescribed for complications of neuropathy, such as gastrointestinal problems, dizziness and weakness, and urinary or sexual problems.