The body is controlled by two systems of nerves in the body. The first system is the central nervous system (CNS), which includes the brain and the spinal cord. The second system is the peripheral nervous system (PNS). This system consists of the wide-ranging network of nerves that spread throughout the body from the spinal column.

Most people are familiar with conditions that can occur as a result of damage to the central nervous system, but many do not know that the peripheral nervous system can be impacted by a variety of conditions and injuries. One of these is called diabetic peripheral neuropathy.

Types of nerves

There are three types of nerves that make up the two systems.

  • Autonomic: These nerves run on automatic. They control reflexive functions such as breathing, heartbeat, temperature, digestion, and blood pressure.
  • Motor: These nerves pass signals from the brain into the muscles to direct and control movement.
  • Sensory: These nerves deal with information sent from your skin. The sensory nerves help the body detect heat, pain, and other sensations.

What is diabetic neuropathy?

Diabetic neuropathy is a condition that can develop when any of these nerve systems are damaged. As the name suggests, this condition occurs most often in those with diabetes of either type. Type 1 diabetics are generally born with the condition and depend on daily insulin to regulate sugar levels. Type 2 diabetics are usually diagnosed at a later age and do not typically rely on insulin (although the disease can progress to insulin dependence).

If diabetics of either type do not manage their diabetes, glucose (sugar) levels in the blood can rise to dangerous levels. Over time, this high level of glucose in the blood can cause damage to the capillary walls. Capillaries are responsible for delivering blood to the nerves, and the damaged walls will eventually manifest in the following symptoms:

  • Pain, numbness, or tingling in extremities
  • Nausea or vomiting
  • Erectile dysfunction
  • Constipation
  • Feeling full after eating very little (early satiety)
  • Weakness
  • Dizziness when standing suddenly
  • Extreme sensitivity when touched

These symptoms can all be tied to a corresponding type of nerve (i.e., nausea and vomiting can be tied to autonomic nerves). Doctors estimate that 60-70% of people with diabetes suffer from some type of diabetic neuropathy, and the risk of developing diabetic neuropathy increase with age and the length of time that a patient has been living with diabetes. Diabetic peripheral neuropathy specifically affects the extremities.

Risk factors for developing diabetic peripheral neuropathy

Other risk factors for developing diabetic peripheral neuropathy are:

  • Smoking. Smoking constricts capillaries and makes them work much harder to move blood through the body to the nerves. Diabetics who smoke are nearly three times as likely to develop diabetic neuropathy than those patients who have diabetes but do not smoke.
  • Alcohol use/abuse. Drinking alcohol as a diabetic is very dangerous. In addition to the sugar that is hard to regulate, alcohol also constricts veins and slows the flow of blood to the extremities (which, being farther from the heart, receive blood last). Alcohol is also dehydrating to the body, and dehydration is very dangerous for diabetics.
  • Nutritional deficiency. A lack of B6 and B12 vitamins can cause symptoms of diabetic peripheral neuropathy. Drinking alcohol and undergoing gastric bypass surgery both contribute to a lack of these vitamins, so even if the intake is sufficient, a patient may not be getting the full amount if either of those factors are also present.
  • Autoimmune disorders. Multiple sclerosis, Guillain-Barré syndrome, and lupus are just three autoimmune disorders that put a patient at risk of peripheral diabetic neuropathy.

The first and best defense against diabetic neuropathies of any type is a good offense. People with diabetes need to be vigilant in monitoring blood sugar and controlling it with insulin if necessary but also taking the following steps.

  • Exercise. Study after study shows an overwhelming correlation between diabetes management and exercise. “In studies that focused on exercise only, blood glucose improved twice as much as in studies that focused on exercise, diet and medication adherence,” said Vicki Conn, professor and associate dean of research in the MU Sinclair School of Nursing. Exercise increases sensitivity to insulin, lowers blood sugar, increases cardiovascular health, and improves mood. Even moderate exercise helps, so starting with a few minutes of daily walking can yield positive results.
  • Proper eating habits. Meal planning is crucial, especially for patients newly diagnosed with diabetes. Patients should talk with their doctor about an appropriate diet, working with a nutritionist if possible.

Treating diabetic peripheral neuropathy

If peripheral diabetic neuropathy is present, physicians may treat it with tricyclic anti-depressants like amitriptyline and imipramine or other types such as duloxetine or buproprione. Prescription opioids are sometimes utilized but carry a high risk of dependence and are not used long-term for that reason. Topical solutions are also sometimes prescribed. Capsaicin creams and lidocaine patches may provide some relief.

Because symptoms typically intensify at night, patients may try something called a bed cradle. This keeps blankets and sheets from touching sensitive skin.

Non-traditional methods of treatment include biofeedback, acupuncture, and physical therapy. Some patients use magnet therapy to find relief. Several vitamin supplements have shown promise in treatment of symptoms. These can include things like St. John’s wort, vitamin E, evening primrose oil, L-arginine, taurine, and L-glutamine.

The best way to prevent diabetic peripheral neuropathy is to carefully manage your diabetes with diet and exercise. SugarStats offers a free online tool for tracking blood sugar and OnlineFitnessLog helps chart fitness goals and milestones. What helps you stay on track?

Image by Army Medicine via Flickr


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