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Diabetic Peripheral Neuropathy

by Laura Hieronymus, MSEd, APRN, BC-ADM, CDE, and James Borders, MD

Pain is a part of the body’s magic.
It is the way the body transmits a sign
to the brain that something is wrong.

–Norman Cousins

Neuropathy is an abnormality anywhere in a nerve pathway that disrupts nerve signals, causing the brain to misinterpret feelings or sensations. Different types of neuropathy go by different names, depending on the number of nerves affected, their function, and where in the body they are located.

Peripheral neuropathy is the name for nerve damage that causes malfunction of the peripheral nerves — the nerves that go to the arms, hands, legs, and feet. Damage to a single peripheral nerve is called mononeuropathy. If the damage is in two or more nerves, it is called multiple mononeuropathy. If damage occurs to many nerves simultaneously in the peripheral nervous system, it is called polyneuropathy.

Diabetes is associated with several types of neuropathy, including chronic polyneuropathy. Chronic polyneuropathy occurs slowly, often over months or years, and usually begins in the feet and hands.

Peripheral neuropathy
There are over a hundred types of peripheral neuropathy, each of which has a characteristic set of symptoms and pattern of development. The type of nerve damaged determines what symptoms are experienced and what effect the damage has on physical functioning. Peripheral neuropathy can be inherited, or it can be acquired. Acquired peripheral neuropathy is usually caused by physical injury to the nerve, tumors, deficiencies in nutrition, alcoholism, or vascular (blood vessel) disease. Neuropathy can also be acquired from toxins produced, for example, by certain bacteria or by some types of cancer. In addition, metabolic disorders such as diabetes can contribute to the development of peripheral neuropathy.

If you have damage to your peripheral nerves, you might not be able to feel pain, heat, or cold normally in your arms, hands, legs, and feet. In some people, peripheral neuropathy can make these body parts feel numb. Other people say they feel shooting pains, electrical-shock–like sensations, burning, tingling, or a feeling of being pricked by pins. These feelings are often worse at night and can interfere with sleep. While the sensations can occur on just one side of the body, most of the time they occur on both sides — in both feet or both hands, for example.

Sometimes peripheral nerve damage leads to changes in the shape of the feet. The muscles in the feet weaken, while the tendons in the feet get shorter. In this case, a health-care provider may prescribe special shoes or shoe inserts to help protect the feet.

Medicare and other health insurance programs may pay for shoes that are prescribed by your health-care provider. Your health-care provider or diabetes educator can help you find out how and where to get such shoes.

About 50% of older individuals with Type 2 diabetes have diabetic peripheral neuropathy. Over the years, high blood glucose levels damage the blood vessels that bring oxygen to some nerves. High blood glucose can also hurt the coverings of the nerves. Damaged nerves may stop sending messages or, in some cases, send messages too slowly or at the wrong times, resulting in symptoms such as numbness or pain.

A diagnosis of diabetic peripheral neuropathy is made on the basis of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes. However, since people with diabetes can develop neuropathy from other causes, it’s important to rule those out before concluding that diabetes is the cause. In its very early stages, diabetic peripheral neuropathy may cause no symptoms. But even without symptoms, its presence raises the risk for foot ulcers by 5% to 7%. (In contrast, a person who does not have neuropathy has a less than 1% annual risk for a foot ulcer.)

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