There are four main types of diabetic neuropathy — nerve damage that can occur as a result of high blood sugar when you have diabetes. You may have just one type or symptoms of several types. Most types of diabetic neuropathy develop gradually, and you may not notice problems until considerable damage has occurred.
Talk to your doctor about any of the following symptoms. The sooner they can be diagnosed and treated, the better the chance of preventing further complications.
Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms. Possible signs and symptoms of peripheral neuropathy include:
- Numbness or reduced ability to feel pain or changes in temperature, especially in your feet and toes
- A tingling or burning feeling
- Sharp, jabbing pain that may be worse at night
- Extreme sensitivity to the lightest touch — for some people even the weight of a sheet can be agonizing
- Muscle weakness
- Loss of reflex response
- Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain
A doctor can usually diagnose diabetic neuropathy by performing a physical exam and carefully reviewing your symptoms and medical history.
Your doctor will check your:
- Overall muscle strength and tone
- Tendon reflexes
- Sensitivity to touch and vibration
Along with the physical exam, your doctor may perform or order specific tests to help diagnose diabetic neuropathy, such as:
- Sensory testing This noninvasive test is used to tell how your nerves respond to vibration and changes in temperature.
- Nerve conduction testing This test measures how quickly the nerves in your arms and legs conduct electrical signals. It’s often used to diagnose carpal tunnel syndrome.
- Muscle response testing Called electromyography, this test is often done with nerve conduction studies. It measures electrical discharges produced in your muscles.
Diabetic neuropathy has no known cure. The goals of treatment are to:
- Slow progression of the disease
- Relieve pain
- Manage complications and restore function
Consistently keeping your blood sugar within your target range is the key to preventing or delaying nerve damage. Good blood sugar management may even improve some of your current symptoms. Your doctor will figure out the best target range for you based on factors including your age, how long you’ve had diabetes and your overall health.
Blood sugar levels may need to be individualized. But, in general, the American Diabetes Association recommends the following target blood sugar levels for most people with diabetes:
- Between 80 and 130 mg/dL, which is 4.4 and 7.2 millimoles per liter (mmol/L) before meals
- Less than 180 mg/dL (10.0 mmol/L) two hours after meals
Many prescription medications are available for diabetes-related nerve pain, but they don’t work for everyone. When considering any medication, talk to your doctor about the benefits and possible side effects to find what might work best for you.
Pain-relieving prescription treatments may include:
- Anti-seizure drugs. Some medications used to treat seizure disorders (epilepsy) are also used to ease nerve pain. The American Diabetes Association recommends starting with pregabalin. Gabapentin also is an option. Side effects may include drowsiness, dizziness and swelling.
- Antidepressants. Some antidepressants ease nerve pain, even if you aren’t depressed. Tricyclic antidepressants may help with mild to moderate nerve pain. Drugs in this class include amitriptyline, desipramine and imipramine . Side effects can be bothersome and include dry mouth and drowsiness.Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another type of antidepressant that may help with nerve pain and have fewer side effects. The American Diabetes Association recommends duloxetine (Cymbalta) as a first treatment. Another that may be used is venlafaxine (Effexor XR). Possible side effects include nausea, sleepiness, dizziness, decreased appetite and constipation.
Sometimes, an antidepressant may be combined with an anti-seizure drug. These drugs can also be used with pain-relieving medication, such as an over-the-counter medication including acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) or a skin patch with lidocaine (a numbing substance).