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Integrated Pain Management


Diabetic Neuropathy

A Diabetic Neuropathy disorder associated with diabetes mellitus. This condition is believed to result from diabetic microvascular injury that involves small blood vessels supplying nerves.

High blood pressure has the ability to damage nerve fibers in the body but in cases involving diabetic neuropathy, the damages will occur in the leg and foot.

Diabetic Neuropathy

The symptoms of diabetic neuropathy will depend on the affected nerves and will range from numbness and pain experienced in the extremities to problems associated with the heart, blood vessels, urinary tract and digestive system.

For some patients the symptoms of diabetic neuropathy are mild and for others the condition is disabling, painful and in some cases fatal. Diabetic neuropathy is a serious complication but can be controlled.


The symptoms of diabetic neuropathy will depend on the nerves affected. Some patients with damaged nerves will have no symptoms while others will experience pain, tingling and numbness.

The symptoms will be mild initially and this is because the nerve damage will occur over a long period of time and the mild cases might go for long periods without being noticed.

Most of the symptoms will involve involuntary, autonomic, motor or sensory nervous systems. In patients with focal neuropathy, the pain experienced can be severe and sudden.

Symptoms that are associated with diabetic neuropathy include:

  1. > Weakness 

  2. > Vaginal dryness in females and erectile dysfunction in males 

  3. > Urination related problems 

  4. > Constipation and diarrhea 

  5. > Vomiting, indigestion, and nausea 

  6. > Faintness and dizziness as a result of blood pressure drop after sitting or standing 

  7. > Some patients experience numbness, tingling and pain in the hands, arms, fingers, legs and toes. 

  8. > Wasting of hand and feet muscles.

There are symptoms that are not neuropathic but will accompany this condition such as depression and weight loss.

Types of Diabetic Neuropathy

Diabetic neuropathy is classified in different categories namely autonomic, proximal, peripheral and focal. Each of the categories affects different parts of the body.

Autonomic neuropathy

This type of diabetic neuropathy causes alterations in the digestive system, bowel and bladder function, respiration, and sexual response this condition also affects nerves that serve the heart, lungs and eyes.

This condition is known to cause hypoglycemia unawareness which is a condition where the patient will no longer get the low blood glucose level symptoms


Proximal neuropathy

This condition causes pain in the hips, buttocks and thighs and is known to cause leg weakness.

Focal neuropathy

This type of diabetic neuropathy causes muscle weakness and pain through weakening of bone or group of nerves. Any nerve in the body is at risk of being affected.

Peripheral neuropathy

This type of diabetic neuropathy is the most common of the four and causes loss of feeling or pain in the feet, legs, arms, and hands.Anyone who notices a sore or cut on the foot that does not seem to heal should see a doctor especially if it only gets worse with time.

Other signs that a person should see a medical practitioner include weakness, pain, tingling or burning sensation in the feet or hands, dizziness, alteration of urination, digestion or sexual function.

The symptoms will not always be as a result of nerve damage, they might be caused by other serious conditions that require immediate medical attention.


Diabetic neuropathy can be caused by the prolonged exposure of nerves to high blood sugar levels. In this situation the exact cause is difficult to pinpoint but there are a number of factors that are believed to cause the condition such as the complicated interaction between the blood vessels and the nerves.

High blood sugars will disrupt the ability of the nerves to transmit signals. These elves will also weaken the small blood vessel walls that supply nutrients and oxygen to the nerves.

Other factors that are known to contribute to diabetic neuropathy include nerve inflammation which is caused by an autoimmune response.

This is where the immune system in the body treats a certain part of the body as foreign organism and attacks it. Genetic factors are also associated with diabetic neuropathy and are unrelated to neuropathy but play a role in the development or susceptibility to nerve damage.

Alcohol abuse and smoking will both damage blood vessels and nerves and put an individual at a greater risk of developing diabetic neuropathy.

Risk Factors

Anyone with diabetes can have diabetic neuropathy but there are factors that will increase the risk of developing the condition.Poor blood sugar control has been found to increase diabetic neuropathy risk because it can cause nerve damage. The best way to prevent any complications is to maintain the blood sugar at target ranges.

The duration an individual suffers from diabetes is also related to diabetic neuropathy because the longer someone has diabetes the higher the risk of developing diabetic neuropathy becomes.

Kidney disease caused by diabetes might lead to the increased levels of toxins in the body leading to damage of nerves. Smoking has been found to narrow and harden arteries and this decreases the blood flow to the feet and legs.Body overweight has also been identified as a factor that increases the risk of developing diabetic neuropathy.


Diabetic neuropathy will be diagnosed using the symptoms described by the patient, their medical history and a physical examination. The doctor will check muscle strength, tendon reflexes, and sensitivity to vibration, temperature and touch.

Other tests that might be conduced include filament test, nerve conduction studies, electromyography, autonomic testing, and quantitative sensory testing. It is recommended that all diabetic patients have comprehensive foot exams at least once in a year.


Diabetic neuropathy has no known cure and the treatment process will be aimed at slowing the progression of the disease and improving some of the symptoms.

Relieving pain to improve the quality of life and allow the patient to handle normal life activities, and managing the complications that might arise and restoring function. There is an increased risk of feet injuries due to loss of sensation and infections can lead to ulcerations which will need amputation.