Neuropathy - Nerve Damage - Summary


Diabetic neuropathy is not a singular condition, it is the term used to describe a multitude of problems that arise as a result of nerve damage caused by the effects of diabetes.

People with diabetes may develop one or more types of neuropathy, and sometimes it may be a transient problem, which resolves itself over the course of a few months. Some forms of neuropathy involve damage to a single nerve and are called mononeuropathies (also classified as focal neuropathy). More commonly though, a number of nerves are affected, potentially causing any of a number of polyneuropathies.

Neuropathies are frequently referred to simply as being either somatic (sensorimotor) or autonomic; however classifications found in the medical literature more fully describe the multitude of problems that can arise. The Summary Table shows one way in which diabetic neuropathies can be classified. Each of the various conditions are described in detail in either Part 2 - which looks at somatic neuropathies - or Part 3 - which looks at autonomic neuropathies.



What's covered on this page


Diagnosing Diabetic Neuropathy
Symptoms of Diabetic Neuropathy
Somatic or Sensorimotor Neuropathy
Autonomic Neuropathy
What Causes Neuropathy?
Summary Table
of Neuropathies




? Confused by the terminology - the technical language and the various medical terms used? Try the Online Medical Dictionary... Still confused? >> Let me know!

 

Diagnosing Diabetic Neuropathy

A simple definition of diabetic neuropathy (DN) has been agreed upon in the medical community:

"... the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes, after the exclusion of other causes."

Diabetic neuropathy should not be diagnosed without first carrying out a careful clinical examination, including the evaluation of symptoms, and the performance of some diagnostic tests.

All people with diabetes should be screened for signs of neuropathy every year, as part of the routine "Annual Review". This is a thorough health check that should be offered once a year, every year, to all people in New Zealand. Depending on the arrangements with your local DHB, this may be subsidised or even free of charge. But this should not preclude you from visiting your doctor at any time if you suspect that your are suffering from symptoms that may be related to diabetic neuropathy.

Stay on top of your diabetes by maintaining close contact with your health care team and address potential prolems early, before things have chance to get out of hand. There are many treatments that can help to relieve problems associated with diabetic neuropathy - so seek help, don't suffer in silence.

As with all complications of diabetes, one of the most important things that you can do to slow down any deterioration in health is to maintain good control of blood pressure and blood glucose levels. Stop smoking, and go easy on the alcohol too - smoking and/or too much alcohol can exacerbate problems related to nerve function in people with diabetes. Maybe it is time to re-evaluate your lifestyle.

It is not uncommon to suffer from a combination of different types of somatic (and/or autonomic) neuropathy; this may result in a pattern of symptoms (see below) that is somewhat confused by the interaction of the different neuropathies. Diagnosing the specific type(s) of neuropathy that you are suffering from may therefore not be quite so straightforward. You may be referred to a doctor that specialises in nerve disease (a neurologist) for some tests that check the ability of nerves to conduct signals and convey messages.

 

WARNING!

Once neuropathy has been diagnosed, it becomes even more important that you look after your feet on a regular, daily basis. Check out the section on legs and feet and the subsection on foot care.

 

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Symptoms of Diabetic Neuropathy

Each nerve in the body has a highly specialised function, and a wide range of symptoms can occur, especially if a number of nerves are damaged.

Somatic or Sensorimotor Neuropathy

Symptoms are often much worse at night

Sensory symptoms

Pain, sensitivity to touch, pins and needles, prickling or tingling ("paraesthaesia"), burning sensation, numbness, paralysis (inability to move), cramps

Muscular symptoms

Muscle weakness (note this is not the same as 'fatigue'), muscle twitching, muscle wasting, balance problems, unsteadiness

Autonomic Neuropathy

Cardiovascular symptoms

Exercise intolerance, fatigue, dizziness, fainting, balance problems

Gastrointestinal symptoms

Loss of appetite, bloating, nausea, vomiting, acid reflux, diarrhea, constipation, loss of bowel control

Genitourinary symptoms

Loss of bladder control, recurrent urinary tract infections, erectile dysfunction in men, pain during sex, and/or vaginal dryness in women

Sudomotor symptoms

Excessive sweating, dry skin, calloused or reddened patches of skin, loss of hair on limbs

Other 'non-specific' symptoms

Depression, anxiety, sleep disorders

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What Causes Neuropathy?


 

Summary Table of Neuropathies

Use the 'Search' facility if you are looking for a specific type of neuropathy and don't recognise the technical terms in this table.

This table outlines a classification of diabetic neuropathies which has been based on that described by Thomas (REF). It has been adapted here, for ease of presentation such that the green shaded areas are described in Part 2 - Somatic Neuropathies and the yellow shaded areas are covered in Part 3 - Autonomic Neuropathies.

Rapidly reversible neuropathy
"Generalised polyneuropathies"

Acute sensory neuropathy

Chronic sensorimotor neuropathies
Autonomic neuropathies

Cardiovascular
& Vasomotor

Gastrointestinal
Genitourinary
Skin
Cranial
Hypoglycaemia unawareness
Focal and multifocal neuropathies Focal Cranial Neuropathies
Thoracolumbar radiculoneuropathy
Focal limb neuropathy
Proximal motor neuropathy (amyotrophy)
Chronic inflammatory demyelinating neuropathy (superimposed)