Diabetic neuropathy

Neuropathy means nerve damage. Diabetic neuropathy is nerve damage caused by high blood glucose levels. It most commonly affects the nerves to the feet, but any nerves can be involved including those that control internal organs.

Estimates suggest that up to 60 per cent of people with diabetes have some degree of neuropathy, but most (about 40 per cent) do not have symptoms. There is no cure. Treatment aims to ease symptoms and reduce the risk of further complications.

Symptoms
Most people with diabetic neuropathy have no symptoms and are unaware that they have the condition, so annual check-ups are essential. When symptoms do occur, they may include:

• Reduced ability to feel pain in the feet
• Unpleasant sensations in the feet such as numbness, tingling, shooting or burning pains
• Injuries to the feet that go unnoticed and untreated
• Altered walking style
• Digestion problems
• Heart problems
• Erection problems in men
• Loss of muscular strength (rarely, only in severe cases).

• Sensory nerves – these send information to the brain about the outside world, including temperature, texture or pain. Damaged sensory nerves can cause unpleasant tingling, ‘pins and needles’ and numbness. The toes and feet tend to be affected first. This type of neuropathy is called peripheral neuropathy or distal symmetric neuropathy.
• Motor nerves – these send messages from the brain and spinal cord to muscles, enabling voluntary movement such as walking or grasping objects with the hands. Damaged motor nerves can cause a loss of strength. However, diabetes does not usually cause significant problems with motor nerves.
• Autonomic nerves – these regulate the functioning of organs and glands without our conscious effort. For example, autonomic nerves control heart rate, blood pressure and digestion. Damaged autonomic nerves can cause a range of problems depending on which nerves are affected. This type of neuropathy is called autonomic neuropathy.

• Medical history
• Physical examination
• Blood tests to check glucose levels
• Neurological tests to check responses to stimuli such as temperature, touch and vibration
• Tests to exclude other possible causes of neuropathy.

• Education about how to look after your feet and what shoes to wear, in order to prevent ulcers
• Medication, diet and careful exercise to help control blood glucose levels
• Drugs to manage pain, including analgesics or antidepressants
• If needed, care by a podiatrist to treat a neuropathic ulcer – treatment may include special dressings and antibiotics.

• Maintain your blood glucose levels within the recommended ranges.
• Exercise regularly.
• Maintain a healthy weight for your height.
• Don’t smoke.
• Limit your alcohol consumption (if you drink alcohol). No more than two standard drinks per day if you are a man or one if you are a woman. Have at least two alcohol-free days every week.
• Address other health concerns such as high blood cholesterol or high blood pressure, as these conditions are thought to increase the risk of diabetic neuropathy.
• See your doctor promptly if you have symptoms including pain, numbness or tingling in your hands or feet.
• Have your feet checked yearly by your doctor, podiatrist or diabetes educator.

• Your doctor
• Podiatrist
• Diabetes educator
• An Accredited Practising Dietitian, contact the Dietitians Association of Australia
• Quitline Tel. 13 1848 www.quit.org.au
• Diabetes Australia – Vic Tel. (03) 9667 1778 or 1300 136 588
• Baker IDI Heart and Diabetes Institute Tel. (03) 9258 5000

• Diabetic neuropathy is nerve damage caused by high blood glucose levels.
• The nerves of the feet are most commonly affected by diabetic neuropathy.
• Most people with diabetic neuropathy do not have any symptoms, so annual examinations are essential.
• See your doctor promptly if you have symptoms including pain, numbness or tingling in your hands or feet.

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