The Diabetes Self Management Education and Support (DSME/S) Program is an outpatient program designed for adults, children, and seniors with Type 1 or Type 2 Diabetes.
The Mass General Diabetes Clinical Center is one of the oldest outpatient centers in the country dedicated to the comprehensive treatment of persons with diabetes, pre-diabetes, and associated disorders.
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Massachusetts General Hospital's Center for Pain Medicine delivers comprehensive, multidisciplinary care for individuals with painful disorders including diabetic neuropathy, peripheral nerve injuries, myofascial pain and other musculoskeletal disorders.Refer a patient
Call for more information: 617-726-8810
What is diabetic neuropathy?
Diabetic neuropathy is nerve damage due to diabetes. Over time, high blood sugar (glucose) can damage the tiny blood vessels that supply your nerves, especially in the legs.
Nerves send messages to and from your brain about pain, temperature, and touch. They tell your muscles when and how to move. They also control the systems in the body that digest food and pass urine.
If you have diabetes, you can develop nerve problems at any time. Serious nerve problems can develop within the first 10 years after being diagnosed with diabetes. The risk of getting neuropathy grows the longer you have diabetes. About half of people with diabetes have some form of nerve damage.
What causes diabetic neuropathy?
The exact cause of diabetic neuropathy is unknown. Several things may contribute to it, including:
- High blood sugar. High blood sugar (glucose) causes chemical changes in nerves. This impairs the nerves' ability to send signals. It can also damage blood vessels that carry oxygen and nutrients to the nerves.
- Your genes. Certain genetic traits can increase risk for nerve disease.
What are the symptoms of diabetic neuropathy?
These are the most common symptoms of diabetic neuropathy:
- Numbness in the hands or feet, often on both sides
- Pain in the hands, feet, or legs
- Multiple foot problems including calluses, dry skin and skin breaks, claw toes, and collapse of the ankles
- Problems with your internal organs, such as the digestive tract, heart, sex organs, or eyes. This can lead to:
- Diarrhea or constipation
- Dizziness, especially when first standing up
- Bladder infections
- Erectile dysfunction
- Vaginal dryness
- Weight loss
- Visual changes, including inability to see or drive in the dark
The symptoms of diabetic neuropathy may look like other conditions or medical problems. See your healthcare provider for a diagnosis.
How is neuropathy diagnosed?
To diagnose neuropathy, you will need a physical exam and other special tests. For example, ultrasound is used to check urinary issues. Ultrasound uses sound waves to visualize your bladder. Stomach issues can be identified with X-rays and other diagnostic tests.
In addition, your healthcare provider may:
- Check muscle strength
- Check muscle reflexes
Check how your nerves respond to:
- Light touch
Request more tests, such as:
- Nerve conduction studies to check flow of electrical current through a nerve
- Electromyography (EMG) to see how muscles respond to electrical impulses
- Ultrasound to determine how parts of the urinary tract are working
- Nerve biopsy to remove a sample of nerve for testing
How is diabetic neuropathy treated?
Your healthcare provider will find the best treatment based on:
- How old you are
- Your overall health and medical history
- How sick you are
- How well you can handle specific medicines, procedures, or therapies
- How long the condition is expected to last
- Your opinion or preference
The goal of treatment is to ease pain and discomfort. It’s also important to prevent more tissue damage. Treatment may include:
- Pain medicines
- Antidepressants that act on the nervous system to ease pain and discomfort
- Creams you apply to the skin
- Transcutaneous electronic nerve stimulation (TENS) therapy
- Relaxation training
- Special shoes to give extra protection to your feet to avoid injuries
Treatment may also be prescribed for complications of neuropathy. This could be GI (gastrointestinal) problems, dizziness and weakness, and urinary or sexual problems.
What are the complications of diabetic neuropathy?
One complication of neuropathy can occur when the bladder becomes paralyzed. When this happens, the nerves of the bladder no longer respond normally as the bladder fills with urine. As a result, urine remains in the bladder, leading to urinary tract infections.
Neuropathy may cause erectile dysfunction (ED) when it affects the nerves that control erection. However, the desire for sex does not usually fall.
Diarrhea may occur when the nerves that control the small intestine are damaged. The diarrhea occurs mostly at night. Constipation is another result of damage to nerves in the intestines.
Sometimes, the stomach is also affected. It may lose the ability to move food easily through the digestive system, causing vomiting and bloating. This is called gastroparesis. It changes how fast the body absorbs food. It can make it more difficult to match insulin doses to food portions.
Vision can also be affected by retinopathy, which begins with changes in blood vessels of the retina. This affects the light-sensitive tissues at the back of the eye. In some cases, the blood vessels can swell or leak fluid. In other cases, there is abnormal growth of new blood vessels on the surface of the retina. Over time, this can lead to vision loss and blindness.
Your eye care doctor may treat retinopathy by using a laser to make tiny burns. These burns seal the blood vessels and stop them from growing and leaking.
You may lose the protective warnings signals of low blood sugar, such as nervousness and shakiness.
- Diabetic neuropathy is nerve damage due to diabetes.
- Nerve problems can develop within the first 10 years after being diagnosed with diabetes. The risk of developing neuropathy grows the longer you have diabetes. About half of people with diabetes have some form of nerve damage.
- Common symptoms of diabetic neuropathy include numbness in the hands or feet, and pain in the hands, feet, or legs. Problems with internal organs, such as the digestive tract, heart, sex organs, or your eyes may also occur.
- If you have high blood sugar or diabetes, see a healthcare provider who specializes in diabetes and its complications.
Tips to help you get the most from a visit to your healthcare provider:
- Know the reason for your visit and what you want to happen.
- Before your visit, write down questions you want answered.
- Bring someone with you to help you ask questions and remember what your provider tells you.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
- Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
- Ask if your condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if you do not take the medicine or have the test or procedure.
- If you have a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your provider if you have questions.
Mass General experts discuss diabetes - 11/3/2009, Mass General
Our physicians discuss the education, management and prevention of diabetes, a condition affecting nearly 24 million adults and children in the United States.
Overcoming Barriers to Care - 6/22/2009, Mass General
Massachusetts General Hospital develops model diabetes program to help close the gap in care.