FAQs of Diabetic Neuropathy


Diabetic neuropathy is a common disorder defined as symptoms of peripheral nerve dysfunction in a patient with diabetes mellitus (DM). This type of neuropathy affects 1-2% of the general adult population in the U.S., with a rate of 4.3% in India. Approximately two-thirds of all diabetics have some form of diabetic neuropathy.

What causes diabetic neuropathy?

People with diabetes have high levels of blood glucose, which over time damages blood damages blood vessels. When there is decreased blood flow, the nerves become damaged, as well.

What are the symptoms of diabetic neuropathy?

Diabetic neuropathy symptoms develop slowly over many years. Nerves in the feet and legs are most commonly affected. Symptoms typically start in the feet and toes, which include burning, tingling, and/or deep aching pain. The nerve damage also can occur in the hands and fingers, which causes similar sensations of pain, tingling, and burning.

As the damage worsens, the patient may lose feeling in the feet and/or legs. When the nerves that control digestion are damaged, the patient has trouble digesting food. Symptoms associated with the gastrointestinal system include heartburn, nausea, bloating, feelings of fullness, swallowing difficulties, and throwing up undigested food after eating.

Can diabetic neuropathy affect other areas of the body?

Many patients develop sexual problems, such as trouble getting an erection in men and vaginal dryness in women. Bladder problems often occur, which include urine leakage and problems emptying the bladder. In addition, abnormal sweating occurs at unusual times.

How is diabetic neuropathy diagnosed?

To diagnose diabetic neuropathy, the doctor will assess your reflexes, look for changes of the skin, evaluate sensations of the feet and hands, and look for any loss of ability to sense movement (proprioception). Tests that are often ordered include an electromyogram (EMG), which records electrical activity in the muscles and a nerve conduction velocity (NCV) test, which records the speed of signals along the nerves.

How is diabetic neuropathy treated?

There are several treatment options for the pain associated with chronic diabetic neuropathy. These include:

 

  • Medications – Certain medications are indicated for the nerve pain associated with diabetic neuropathy, such as Neurotin and Lyrica.
  • Lumbar sympathetic nerve block (LSNB) – During this procedure, the doctor injects a local anesthetic near the sympathetic nerves of the low back under x-ray guidance. The patient’s leg may feel warm immediately after the injection, but this is only temporary. In a recent clinical study, LSNB had a 77% success rate for pain relief.
  • Celiac plexus block – To relieve pain of the abdomen area, a celiac plexus block can be done. With this procedure, the doctor uses x-ray guidance to place a needle into the back, then injects an anesthetic agent into the group of nerves called the celiac plexus. In a recent clinical study, the block was found to be 85-90% effective.
  • Spinal cord stimulation (SCS) – One effective measure for treating neuropathic pain is spinal cord stimulation. With this treatment, the doctor surgical implants a device near the spinal cord that sends safe electrical currents to the spine. In a recent clinical study, SCS was successful in 77% of patients over a 6-month period.
  • Intrathecal pump implant – This device is surgically implanted near the spine to deliver strong medication directly into the cerebrospinal fluid. This pain measure avoids unpleasant side effects because it bypasses the gastrointestinal tract.