Diabetic Neuropathy

There are several forms of diabetic neuropathy, each affecting different parts of the body:

• Diabetic polyneuropathy (most common type): affects both feet and legs in a “glove-and-stocking” pattern.
• Diabetic cachectic neuropathy (acute painful neuropathy): sudden painful nerve damage in older men with poorly controlled diabetes and weight loss.
• Diabetic lumbosacral radiculo-plexus-neuropathy (Bruns–Garland syndrome): severe pain and weakness in hips, thighs, or legs.
• Diabetic truncal radiculoneuropathy – nerve pain in the chest, abdomen, or back.
• Cranial neuropathies: affect nerves of the head and face, causing eye movement problems, facial weakness, or vision issues.
• Mononeuropathies: damage to a single nerve (e.g., carpal tunnel syndrome) causing numbness, tingling, or weakness in one area.

Depending on the type, symptoms may include:

• Numbness, tingling, burning, or stabbing pain in feet and hands
• Weakness in leg or foot muscles
• Loss of balance or reflexes
• Sudden severe hip, thigh, or chest pain
• Facial weakness, ringing in the ears, altered smell, drooping eyelid, or double vision (in cranial neuropathy)
• Tingling or “pins and needles” in isolated areas
• Digestive, bladder, or sexual dysfunction (in autonomic involvement)

The exact cause remains unknown, but long-term high blood sugar damages nerves and their blood supply, leading to neuropathy. Some factors increase the risk of developing diabetic neuropathy:

• Poor blood sugar control
• Duration of diabetes
• Kidney disease
• Being overweight
• Smoking
   

To confirm diabetic neuropathy and rule out other causes, doctors may recommend:

• Nerve conduction studies (NCV): check speed and strength of nerve signals.
• Electromyography (EMG): detects muscle changes caused by nerve damage.
• MRI (with contrast): to check for spinal or plexus nerve involvement.
• CSF testing: in selected cases to rule out other causes like infection or cancer.
• MRA (angiography): in cranial neuropathies to rule out aneurysm.

There is no permanent cure, but treatments help manage symptoms and prevent worsening:

• Strict blood sugar control: the most important step.
• Foot care: to prevent diabetic ulcers and infections.
• Medications for nerve pain: gabapentin, pregabalin, amitriptyline, carbamazepine, lamotrigine.
• Pain relief therapies: physiotherapy, splints, or corticosteroid injections.
• Regular ophthalmologic and renal evaluations
• Surgery: in severe nerve compression cases.
• Other interventions for cranial neuropathies: microvascular decompression, radiosurgery, or nerve stimulation (rare cases).

Most painful forms often improve gradually with better diabetes management.

Seek medical advice if you have:

• Persistent numbness, tingling, or burning pain in feet or hands
• Vision problems like double vision
• Muscle weakness or imbalance while walking
• Non-healing foot wounds or ulcers

Good diabetes management is key:

• Keep blood sugar, blood pressure, and cholesterol under control
• Maintain a healthy weight
• Quit smoking and limit alcohol
• Inspect feet daily and wear proper footwear

A Neurologist is the right specialist for diagnosis and treatment of diabetic neuropathy. In some cases, an Endocrinologist (diabetes specialist) may also be involved.