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Prolonged diabetes for 10 to 20 years leads to diabetic neuropathy. No doubt elevated blood sugar causes damage to the body, but it is the nerves, most often the peripheral nervous system that connects brain and the spine to other parts of the body, suffers the most. The nerves in the feet and legs become the easy victims.

Continued high blood sugar damages the capillaries or blood vessels feeding the nerves. Bereaved of adequate blood flow, oxygen and nutrients, the delicate nerve fibers become weak and degenerate. As a result, nerves suffer from damaged and turn less effective. Patients experience pain and numbness in legs, feet and upper extremities as diabetic neuropathy grows.

Symptoms of diabetic neuropathy depend on its type and segment of nerves, such as sensory, motor, and autonomic, affected. In many cases, symptoms do not appear for a long time. However, there are some common signs that may indicate possibility of neuropathy in diabetics. Patients experience pain, numbness or tingling sensation in the feet, arm, leg, toe, hands or fingers.

There may be also wasting of leg and hand muscles, constant indigestion, constipation, urination problem, drop in blood pressure after normal activities, erectile dysfunction or dry vagina symptoms, lightheadedness, difficulty in swallowing and continued weakness along with burning leg and arm pain in patients with the disorder. These symptoms become more visible and nerve damage progresses.

There are four different types of diabetic neuropathy, each with unique symptoms.

Peripheral diabetic neuropathy - Impacts peripheral nervous system in the leg and foot first and then arm and hand. Symptoms worsen at night, including numbness, tingling, sharp pain, loss of reflexes, balance and coordination, abnormal touch sensitivity, and weakness felt in the muscles. Later stage it may cause deformities, bone and joint pain and infections.

Autonomic neuropathy - Impact autonomic nervous system and damages nerves feeding to digestive, respiratory, reproductive and vision systems. Symptoms include urinary tract infection and incontinence, sharp pain, uncontrolled diarrhea or constipation, loss of appetite, gastroparesis, swallowing problem, abnormal fluctuation blood pressure, temperature,, vision and heart rate, sexual difficulties.

Femoral neuropathy - Impacts nerves in legs, buttock and thighs in those with type 2 diabetes. Symptoms, including sudden, intense pain in said areas, weakened thigh muscles, abdominal swelling, sudden weight loss, and problem in standing from a sitting posture, start on one side and gradually affect the other.

Mononeuropathy - Impacts a specific nerve in the leg, torso or face. Sudden, severe pain, eye pain, double vision, Bell’s palsy, pain in pelvis, lumbar area, foot, thigh or abdomen for a temporary period and weakness in muscles are important signs.

Diabetes is the primary cause of diabetic neuropathy. This coupled with the following factors ensures onset and progress of nerve damages.

Persistent high blood sugar level

Low insulin and higher blood fat levels

Autoimmune inflammation

Mechanical injury to nerves and delayed healing due to diabetes

Lifestyle that enhances susceptibility to nerve disease

Uncontrolled diabetes

Pain due to neuropathy

Nerve damage impacting functions of extremities, heart, digestive tract, and sex organs

Loss of limb as numbness prevents realization of soreness and ulcers and gangrene are likely to develop for lack of care

Swelling, degeneration, numbness, instability in joints due to reduced blood flow and nerve damage

Frequent problems in urinary and digestive tracks, bladder infections, urinary incontinence

Inability to notice drop in blood sugar drops despite symptoms

Blood circulation problem and low blood pressure

Digestive problems leading to constipation, loss of appetite, gastroparesis or diarrhea that impacts the nutrition intake

Sexual dysfunction

Consult a doctor if you feel pain, tingling or weakness in hand or feet. Another urgency is dictated by non-healing of wounds in the leg or arm. Even frequent urinary incontinence and digestive pattern change can be an indication for diabetic neuropathy.

There are various methods to diagnose diabetic neuropathy. This includes the following.

Analysis of painful condition and symptoms. The American Diabetes Association suggests complete examination of foot once a year to check if there is diabetic neuropathy.

Nerve damage impacting functions of extremities, heart, digestive tract, and sex organs

Nerve conduction test or response of nerves to electrical impulses to check health of nerves

Filament study to analyze sensitivity of nerves

Electromyography to probe muscle health

Quantitative sensory test that studies the response of nerves to vibration

Autonomic test that asses blood pressure in a variety of positions

Diabetics with increased cholesterol, continued high blood pressure, obesity and unhealthy lifestyle are at greater risk of neuropathy. Genetic factors, poor nutrition and severe tissue injury also exacerbate the nerve damage process.

The major focus of diabetic neuropathy is managing the pain patients experiencing. There are number of such non-invasive procedures to reduce pain severity and disability.

Blood Glucose Control - This can be achieved through a strict diet, exercise and medication. Lower blood sugar prevents the disorder from spreading progressing or slows it down. This reduces painful symptoms. Foot injuries should also be avoided.

Medication - Tricyclic antidepressants, narcotic analgesics or anti-seizure medications are prescribed to treat pain from diabetic neuropathy.

Pain Management - Depending on the area and extent of nerve damage and pain intensity patients can go for any of the following pain management procedures.

Celiac plexus block, an abdominal nerve numbing performed to obstruct pain signals offers about 90 percent pain relief on semi-permanent basis.

Lumbar sympathetic nerve block is done using local anesthetic injections has 75 percent success rate in managing pain for a longer duration.

Spinal cord stimulation can help prevent pain perception for years.