Diabetic neuropathy refers to a group of conditions that damage the nervous system in individuals with diabetes mellitus; they affect various organ systems such as the musculoskeletal, cardiovascular, gastrointestinal, and urogenital systems. The most common form is distal symmetric polyneuropathy, which primarily affects the lower limbs and feet and ultimately reduces quality of life.
What is diabetic neuropathy?
Diabetic neuropathies are a group of conditions that damages the nervous system of people with diabetes mellitus. They include distal symmetric polyneuropathy, diabetic peripheral neuropathy, diabetic autonomic neuropathy, cardiac autonomic neuropathy, and gastrointestinal neuropathies. These neuropathies can damage nerves and impair normal function in several organ systems, including the musculoskeletal system (especially the lower limbs and feet), the cardiovascular system, the gastrointestinal system, and the urogenital system (kidneys, bladder, and genitals). Distal symmetric polyneuropathy is the most common form of diabetic neuropathy, affecting the lower limbs and feet.[1][2] Consequently, diabetic neuropathies reduce a person’s quality of life.
What are the main signs and symptoms of diabetic neuropathy?
Diabetic neuropathies have several non-specific signs and symptoms that are also caused by other conditions. Therefore, diabetic neuropathy can go undiagnosed and untreated. Symptoms include numbness and tingling (paresthesia) in the fingers and toes, pain in the lower legs and feet, foot ulcers, lightheadedness/dizziness when standing up, erectile dysfunction, and gastrointestinal issues such as nausea, bloating, heartburn, diarrhea, and constipation.[1][2] The signs are revealed with diagnostic tests showing poor nerve function (e.g., inability to sense a pinprick), impaired sensations (e.g., inability to distinguish hot from cold), orthostatic hypotension (a drop in blood pressure when standing up), resting tachycardia (high resting heart rate), and delayed gastric emptying (gastroparesis).[1][2]
How is diabetic neuropathy diagnosed?
People who’ve had type 1 diabetes for at least five years, and all people with type 2 diabetes, are typically assessed annually for diabetic neuropathies.[1][2] Assessment includes clinical tests exploring a person’s sensations of vibration, thermal changes, and pain.[1][2] But, since diabetic neuropathies are a collection of several conditions with non-specific signs and symptoms, and since nondiabetic neuropathies can also occur in people with diabetes, the diagnosis of diabetic neuropathy is a process of exclusion — i.e., alternative causes of the presenting signs and symptoms are systematically ruled out before a final diagnosis.
What are some of the main medical treatments for diabetic neuropathy?
There are no specific treatments for nerve damage, but lowering hyperglycemia (persistently high blood glucose concentrations) reduces the risk of diabetic neuropathy.[3][4][5] Therefore, the main treatment is to improve blood glucose control using lifestyle behavior change (diet, exercise, and weight management counseling) and glucose-lowering drugs.[1][2]
Since diabetic neuropathies can impair sensation, healthcare providers regularly examine patients’ feet for signs of damage to help prevent diabetic foot ulcers. To treat pain associated with diabetic neuropathies, pain-reducing medications (e.g., pregabalin or duloxetine) are used to improve quality of life.[6][7] Reducing pain also helps patients increase their levels of daily physical activity, which improves blood glucose control.[8]
Have any supplements been studied for diabetic neuropathy?
Yes, research has examined the effects of several supplements on diabetic neuropathy. These include vitamin D, vitamin B12, L-carnitine, alpha-lipoic acid (ALA), and more.[9][10][11][12][13][14] However, additional high-quality randomized controlled trials are needed to make firm conclusions concerning the effectiveness of supplements in reducing the risk of diabetic neuropathy or relieving its symptoms (e.g., pain).
How could diet affect diabetic neuropathy?
Lifestyle behavior change improves blood glucose control in people with diabetic neuropathies.[1][2] This includes an individualized diet to help patients lose weight and minimize postprandial (after-meal) rises in blood glucose concentrations.
Specific micronutrients might also play a role. For example, deficiencies in vitamin D [15][16][17][18] and vitamin B12 [19] are associated with an increased risk of diabetic neuropathy. Therefore, people with diabetes who don’t consume vitamin D-containing foods (oily fish, egg yolks, liver, etc.), or who eat a plant-based diet that excludes meat, might be at a greater risk of diabetic neuropathy. However, studies are needed to test these hypotheses.
Are there any other treatments for diabetic neuropathy?
Aerobic exercise and sensorimotor training to improve motor control (balance, posture, etc.) can relieve some of the signs and symptoms of diabetic peripheral neuropathy.[20] Furthermore, low-frequency electrical stimulation of the spinal cord (also known as neuromodulation therapy) can reduce pain associated with diabetic neuropathies.[21][22] However, more high-quality randomized controlled trials are needed to draw conclusions about the efficacy and safety of neuromodulation therapy.
Examine Database: Diabetic Neuropathy
Research FeedRead all studies
Does vitamin E improve glycemic control in people with diabetes?
In this meta-analysis of randomized controlled trials, supplementation with vitamin E in men and women with diabetes improved some markers of glycemic control. However, the findings were based mostly on trials of poor methodological quality.
Can supplemental vitamin B12 ease the symptoms of diabetic neuropathy?
Supplemental vitamin B12 in addition to metformin for people with type 2 diabetes
Coenzyme Q10 for painful diabetic neuropathy
Curcumin for depression in diabetes: Striking gold?
Frequently asked questions
What is diabetic neuropathy?
Diabetic neuropathies are a group of conditions that damages the nervous system of people with diabetes mellitus. They include distal symmetric polyneuropathy, diabetic peripheral neuropathy, diabetic autonomic neuropathy, cardiac autonomic neuropathy, and gastrointestinal neuropathies. These neuropathies can damage nerves and impair normal function in several organ systems, including the musculoskeletal system (especially the lower limbs and feet), the cardiovascular system, the gastrointestinal system, and the urogenital system (kidneys, bladder, and genitals). Distal symmetric polyneuropathy is the most common form of diabetic neuropathy, affecting the lower limbs and feet.[1][2] Consequently, diabetic neuropathies reduce a person’s quality of life.
What are the risk factors for diabetic neuropathy?
Quick answer:
Risk factors for diabetic neuropathy include hypertension, hyperglycemia, dyslipidemia, high BMI, older age, longer duration of diabetes, cigarette smoking, and deficiencies in vitamin D and vitamin B12. Further research is needed to clarify the direct causative role of these factors.
Hypertension (high blood pressure), hyperglycemia (high blood glucose), dyslipidemia (e.g. elevated blood triglycerides and LDL-cholesterol), and a high body mass index (BMI) are associated with an increased risk of diabetic neuropathy.[23][24] In people with type 1 diabetes, additional risk factors for diabetic neuropathy include a greater age, a longer duration of diabetes, and cigarette smoking.[25] Furthermore, people with deficiencies in vitamin D [15][16][17][18] or vitamin B12 [19] also have an increased risk of diabetic neuropathy. However, further investigation is needed to determine whether these factors directly cause diabetic neuropathy.
What are the main signs and symptoms of diabetic neuropathy?
Diabetic neuropathy occurs with nonspecific symptoms such as numbness, tingling, pain in the legs and feet, gastrointestinal issues, and erectile dysfunction, which can lead to misdiagnosis. Diagnostic tests may reveal poor nerve function, impaired sensations, orthostatic hypotension, resting tachycardia, and delayed gastric emptying.
Diabetic neuropathies have several non-specific signs and symptoms that are also caused by other conditions. Therefore, diabetic neuropathy can go undiagnosed and untreated. Symptoms include numbness and tingling (paresthesia) in the fingers and toes, pain in the lower legs and feet, foot ulcers, lightheadedness/dizziness when standing up, erectile dysfunction, and gastrointestinal issues such as nausea, bloating, heartburn, diarrhea, and constipation.[1][2] The signs are revealed with diagnostic tests showing poor nerve function (e.g., inability to sense a pinprick), impaired sensations (e.g., inability to distinguish hot from cold), orthostatic hypotension (a drop in blood pressure when standing up), resting tachycardia (high resting heart rate), and delayed gastric emptying (gastroparesis).[1][2]
How is diabetic neuropathy diagnosed?
Diabetic neuropathy is diagnosed through annual assessments for people with type 1 diabetes (after 5 years) and all individuals with type 2 diabetes; these assessments involve clinical tests for sensations like vibration, thermal changes, and pain. The diagnosis is a process of exclusion, in which alternative causes for the symptoms are ruled out before confirming diabetic neuropathy.
People who’ve had type 1 diabetes for at least five years, and all people with type 2 diabetes, are typically assessed annually for diabetic neuropathies.[1][2] Assessment includes clinical tests exploring a person’s sensations of vibration, thermal changes, and pain.[1][2] But, since diabetic neuropathies are a collection of several conditions with non-specific signs and symptoms, and since nondiabetic neuropathies can also occur in people with diabetes, the diagnosis of diabetic neuropathy is a process of exclusion — i.e., alternative causes of the presenting signs and symptoms are systematically ruled out before a final diagnosis.
What are some of the main medical treatments for diabetic neuropathy?
The main medical treatments for diabetic neuropathy focus on improving blood glucose control through lifestyle changes and glucose-lowering medications because there are no specific treatments for nerve damage. Additionally, pain-reducing medications like pregabalin or duloxetine are used to alleviate pain and enhance quality of life, which can also encourage increased physical activity.
There are no specific treatments for nerve damage, but lowering hyperglycemia (persistently high blood glucose concentrations) reduces the risk of diabetic neuropathy.[3][4][5] Therefore, the main treatment is to improve blood glucose control using lifestyle behavior change (diet, exercise, and weight management counseling) and glucose-lowering drugs.[1][2]
Since diabetic neuropathies can impair sensation, healthcare providers regularly examine patients’ feet for signs of damage to help prevent diabetic foot ulcers. To treat pain associated with diabetic neuropathies, pain-reducing medications (e.g., pregabalin or duloxetine) are used to improve quality of life.[6][7] Reducing pain also helps patients increase their levels of daily physical activity, which improves blood glucose control.[8]
Have any supplements been studied for diabetic neuropathy?
Research has investigated several supplements for diabetic neuropathy, including vitamin D, vitamin B12, L-carnitine, and alpha-lipoic acid. However, more high-quality randomized controlled trials are necessary to determine their effectiveness in reducing the risk or alleviating symptoms of diabetic neuropathy.
Yes, research has examined the effects of several supplements on diabetic neuropathy. These include vitamin D, vitamin B12, L-carnitine, alpha-lipoic acid (ALA), and more.[9][10][11][12][13][14] However, additional high-quality randomized controlled trials are needed to make firm conclusions concerning the effectiveness of supplements in reducing the risk of diabetic neuropathy or relieving its symptoms (e.g., pain).
How could diet affect diabetic neuropathy?
Diet can affect diabetic neuropathy by improving blood glucose control through making individualized dietary changes that are aimed at weight loss and minimizing postmeal blood sugar spikes. Additionally, deficiencies in specific micronutrients like vitamin D and vitamin B12 may increase the risk of diabetic neuropathy, particularly in people with limited dietary sources of these vitamins.
Lifestyle behavior change improves blood glucose control in people with diabetic neuropathies.[1][2] This includes an individualized diet to help patients lose weight and minimize postprandial (after-meal) rises in blood glucose concentrations.
Specific micronutrients might also play a role. For example, deficiencies in vitamin D [15][16][17][18] and vitamin B12 [19] are associated with an increased risk of diabetic neuropathy. Therefore, people with diabetes who don’t consume vitamin D-containing foods (oily fish, egg yolks, liver, etc.), or who eat a plant-based diet that excludes meat, might be at a greater risk of diabetic neuropathy. However, studies are needed to test these hypotheses.
Are there any other treatments for diabetic neuropathy?
Aerobic exercise and sensorimotor training can help alleviate symptoms of diabetic peripheral neuropathy, and low-frequency electrical stimulation of the spinal cord may reduce the associated pain. However, further high-quality randomized controlled trials are necessary to assess the efficacy and safety of neuromodulation therapy.
Aerobic exercise and sensorimotor training to improve motor control (balance, posture, etc.) can relieve some of the signs and symptoms of diabetic peripheral neuropathy.[20] Furthermore, low-frequency electrical stimulation of the spinal cord (also known as neuromodulation therapy) can reduce pain associated with diabetic neuropathies.[21][22] However, more high-quality randomized controlled trials are needed to draw conclusions about the efficacy and safety of neuromodulation therapy.
What causes diabetic neuropathy?
The exact causes of diabetic neuropathy are not fully understood, but it is believed that persistently high blood glucose and lipids contribute to neuronal oxidative stress and chronic low-grade inflammation, which result in nerve damage.
References
Examine Database References
- Diabetic Neuropathy Symptoms - K K Kiew, W B Wan Mohamad, A Ridzuan, M MafauzyEffects of sulbutiamine on diabetic polyneuropathy: an open randomised controlled study in type 2 diabeticsMalays J Med Sci.(2002 Jan)
- Diabetic Neuropathy Symptoms - Foster TSEfficacy and safety of alpha-lipoic acid supplementation in the treatment of symptomatic diabetic neuropathyDiabetes Educ.(2007 Jan-Feb)
- Diabetic Neuropathy Symptoms - Ziegler D, Low PA, Litchy WJ, Boulton AJ, Vinik AI, Freeman R, Samigullin R, Tritschler H, Munzel U, Maus J, Schütte K, Dyck PJEfficacy and safety of antioxidant treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trialDiabetes Care.(2011 Sep)
- Diabetic Neuropathy Symptoms - Dinesh Selvarajah, Rajiv Gandhi, Celia J Emery, Solomon TesfayeRandomized placebo-controlled double-blind clinical trial of cannabis-based medicinal product (Sativex) in painful diabetic neuropathy: depression is a major confounding factorDiabetes Care.(2010 Jan)
- Diabetic Neuropathy Symptoms - Mark S Wallace, Thomas D Marcotte, Anya Umlauf, Ben Gouaux, Joseph H AtkinsonEfficacy of Inhaled Cannabis on Painful Diabetic NeuropathyJ Pain.(2015 Jul)
- Diabetic Neuropathy Symptoms - Sheyu Li, Xiang Chen, Qianrui Li, Juan Du, Zhimin Liu, Yongde Peng, Mian Xu, Qifu Li, Minxiang Lei, Changjiang Wang, Shaoxiong Zheng, Xiaojuan Zhang, Hongling Yu, Jinyu Shi, Shibing Tao, Ping Feng, Haoming TianEffects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double-blind, controlled trialJ Diabetes Investig.(2016 Sep)
- Blood glucose - Li XS, Zheng WY, Lou SX, Lu XW, Ye SHEffect of Ginkgo leaf extract on vascular endothelial function in patients with early stage diabetic nephropathyChin J Integr Med.(2009 Feb)
- Endogenous Advanced Glycation End Products - Alkhalaf A, Kleefstra N, Groenier KH, Bilo HJ, Gans RO, Heeringa P, Scheijen JL, Schalkwijk CG, Navis GJ, Bakker SJEffect of benfotiamine on advanced glycation endproducts and markers of endothelial dysfunction and inflammation in diabetic nephropathyPLoS One.(2012)