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Dear Diabetes: What Is Diabetic Neuropathy?

Understanding diabetic neuropathy

Dear Diabetes: I’ve heard confusing things about diabetic neuropathy. Could you help me understand what it is?

Author, health coach, and international speaker Riva Greenberg had symptoms of diabetic peripheral neuropathy after she was diagnosed with type 1 diabetes. Every night in bed, as she pulled the blanket up over her legs to go to sleep, she felt a burning sensation in her right calf. “It was awful,” she says. Over the next few years, however, as Riva’s blood sugar control improved, the burning became more of an intermittent tingling.

“Many people who experience diabetic neuropathy are not aware that the sensations they’re feeling are related to diabetes,” Riva says.  “And some living with diabetes don’t know anything about neuropathy at all.”

Because neuropathy can have serious consequences, it is crucial for every person with type 1 or type 2 diabetes to understand what neuropathy is and be aware of its symptoms.

What is diabetic neuropathy? 

In a nutshell, diabetic neuropathy is nerve damage caused by high blood glucose levels.  There are several types of diabetic neuropathy, including:

Diabetic Peripheral Neuropathy (DPN)

The most common form, sometimes called sensory neuropathy, is nerve damage that affects the feet, legs, arms, and hands. “People experience DPN in a variety of ways,” says Dr. Zachary Bloomgarden, clinical professor at Mount Sinai School of Medicine, and an editor of the journal Diabetes Care. Among the symptoms: people may feel burning in both feet, shooting pain, throbbing, pins and needles, foot pain at night, extreme sensitivity in hands and feet or have no sensation at all in their extremities.

Autonomic neuropathy affects the autonomic nerves, which control the bladder, heart and blood vessels, intestinal tract, and genitals, among other organs.

Who’s at risk for diabetic neuropathy?

According to Dr. Bloomgarden, “Everybody with diabetes is at risk for diabetic neuropathy. It’s a common complication, and there are severe complications that can occur after long periods of high blood glucose.”

Neuropathy affects about half of all people living with diabetes, according to the American Diabetes Association (the Association), and is more common in those who have had the disease for a number of years. Screening for neuropathy is important and the Association recommends that people with diabetes be screened for peripheral neuropathy once a year, starting at diagnosis for those living with type 2 diabetes and five years after diagnosis for those living with type 1.

Neuropathy can lead to loss of feeling in the feet, and therefore a person with diabetes may not be aware of a foot sore. “Make sure you check your feet every day and don’t wear shoes that pinch your toes,” Dr. Bloomgarden advises.  “And ask your doctor to examine your feet. Your doctor has a special tool to test for sensation in your feet, and it can help identify your neuropathy risk.” (Read more about foot care here.)

The reason you need to diagnose neuropathy, according to Aristidis Veves, MD, DSc, of Harvard Medical School, is because “you have to identify patients at risk for foot ulcerations. People with ulcers – sores that won’t heal – need to receive education about taking care of their feet and preventing injury.”

If you have neuropathy:

“The most important thing to do if you have neuropathy is to take care of yourself,” says Dr. Bloomgarden. “Health care providers can help monitor diabetic neuropathy. Good blood glucose control may help slow the progression of all types of neuropathy.”

“We don’t understand enough about neuropathy to know what makes one patient experience loss of sensation and another have uncomfortable shooting pains,” says Dr. Bloomgarden. It’s important to note that not everyone with DPN has painful symptoms. A lack of symptoms doesn’t necessarily mean a lack of neuropathy, therefore, screening is a must for everyone living with diabetes.

And Riva Greenberg reminds us that when managing neuropathy, “I believe in following the same general advice for managing my diabetes: keep your blood sugar in range as much as possible, eat healthy, maintain a normal weight, get active.”

Jessica Apple is the co-founder and editor in chief of the online diabetes lifestyle magazine A Sweet Life. Her writing has appeared in many publications, including The New York Times Magazine, The Financial Times Magazine, The Southern Review, The Bellevue Literary Review, and Tablet Magazine. Apple is a paid contributor for The DX. All opinions contained in this article reflect those of the contributor and interviewees, and not of Sanofi US, its employees, agencies, or affiliates.

© 2014 The DX: The Diabetes Experience

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