Diabetic neuropathies are neuropathic disorders that are associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves (vasa nervorum). Relatively common conditions which may be associated with diabetic neuropathy include third nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; a painful polyneuropathy; autonomic neuropathy; and thoracoabdominal neuropathy.Symptoms may include:
* Numbness and tingling of extremities
* Dysesthesia (decreased or loss of sensation to a body part)
* Erectile dysfunction
* Urinary incontinence (loss of bladder control)
* Facial, mouth and eyelid drooping
* Vision changes
* Muscle weakness
* Difficulty swallowing
* Speech impairment
* Fasciculation (muscle contractions)
* Burning or electric painDiagnosis
Diabetic peripheral neuropathy is the most likely diagnosis for someone with diabetes who has pain in a leg or foot, although it may also be caused by vitamin B12 deficiency or osteoarthritis. A glucose tolerance test is recommended for someone with peripheral pain who has not been diagnosed with diabetes. Neurological tests may show reduced functioning of the peripheral nerves, but seldom correlate with the severity of diabetic peripheral neuropathy and are not appropriate as routine tests for the condition. Treatment
Despite advances in the understanding of the metabolic causes of neuropathy, treatments aimed at interrupting these pathological processes have been limited by side effects and lack of efficacy. Thus, with the exception of tight glucose control, treatments are for reducing pain and other symptoms and do not address the underlying problems.
The only two drugs approved by the FDA for diabetic peripheral neuropathy are the antidepressant duloxetine and the anticonvulsant pregabalin. Before trying a systemic medication, people with localized diabetic periperal neuropathy may find relieve from lidocaine patches.Other treatments
α-lipoic acid, an anti-oxidant that is a non-prescription dietary supplement has shown benefit in a randomized controlled trial that compared once-daily oral doses of 600 mg to 1800 mg compared to placebo, although nausea occurred in the higher doses.
Though not yet commercially available, C-peptide has shown promising results in treatment of diabetic complications, including neuropathies. Once thought to be a useless by-product of insulin production, it helps to ameliorate and reverse the major symptoms of diabetes.Tight glucose control
Treatment of early manifestations of sensorimotor polyneuropathy involves improving glycemic control.Tight control of blood glucose can reverse the changes of diabetic neuropathy, but only if the neuropathy and diabetes is recent in onset. Conversely, painful symptoms of neuropathy in uncontrolled diabetics tend to subside as the disease and numbness progress.Prognosis
The mechanisms of diabetic neuropathy are poorly understood. At present, treatment alleviates pain and can control some associated symptoms, but the process is generally progressive.
As a complication, there is an increased risk of injury to the feet because of loss of sensation (see diabetic foot). Small infections can progress to ulceration and this may require amputation.
More information:Diabetic Nerve Problems @ MedlinePlusDiabetic Peripheral Neuropathic Pain: Effective ManagementRestoration of sensation, reduced pain, and improved balance in subjects with diabetic peripheral neuropathy: a double-blind, randomized, placebo-controlled study with monochromatic near-infrared treatment.Improvement of sensory impairment in patients with peripheral neuropathy.