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The causes of diabetic neuropathy are decreased blood flow and increased blood sugar, which damages the peripheral nerves. Over time, with high glucose levels in the bloodstream and poor circulation, the nerves start to degenerate, causing the nerves to be less effective. Without an adequate supply of oxygen and nutrients from the blood, the nerve fibers become damaged or disappear.

Doctors categorize diabetic neuropathy into four groups. These include:

. Peripheral diabetic neuropathy - The most common type, this causes pain and numbness in peripheries, such as the hands, fingers, feet, and toes.
. Autonomic neuropathy - This type affects systems regulated by the autonomic nervous system, which causes changes in bladder control, bowel movement, sexual function, and blood pressure.
. Focal neuropathy - Also called mononeuropathy, this type involves damage to one specific nerve. Focal neuropathy occurs suddenly, and causes pain of the face, torso, or leg.
. Proximal neuropathy - This type affects the buttocks, hips, thighs, and legs, leading to problems with gait and leg weakness.

Not all diabetics with neuropathy have symptoms. Nerve damage affects the extremities, heart, digestive tract, and sex organs. The symptoms of diabetic neuropathy are lightheadedness, swallowing problems, loss of sensation in the hand, arms, feet, and/or lower legs, tingling of the upper/lower extremities, and burning leg/arm pain. The symptoms can be mild at first, but as the condition progresses to more advanced stages, the symptoms worsen.

The doctor will conduct a physical examination and order some diagnostic tests. Electrodiagnostic testing is done by nerve conduction studies (NCS), which can exclude other abnormalities.

The treatment of diabetic neuropathy depends on the type of neuropathy the patient has, the extent of nerve damage, and the severity of pain. Treatment options include:

Blood glucose control - Maintaining normal blood glucose may be able to prevent further nerve damage.

Medications - For the pain and associated symptoms, the doctor will prescribe tricyclic antidepressants, such as amitriptyline, desipramine, and imipramine. Anti-seizure medications are also approved to treat neuropathic pain, and include gabapentin, pregabalin, lamotrigine, and carbamazepine. For severe pain, narcotic analgesics are used short-term.

Celiac plexus block - For abdominal pain, the doctor can use an anesthetic to “block” a group of nerves called the celiac plexus. The doctor uses x-ray guidance to place a needle into the back near the nerves, and then injects the medication onto the celiac plexus. The success rate of this block is 85-90%, according to a recent clinical study.

Lumbar sympathetic nerve block - According to a recent clinical study, the efficacy rate of this block is 77%. The doctor injects a long-acting anesthetic near the sympathetic nerves of the lower back, using x-ray guidance.

Spinal cord stimulation (SCS) - This is an effective method of treating neuropathic pain. The doctor surgical implants electrodes near the spinal cord, which attach to a small device implanted in the abdomen or buttocks. Electrical currents are delivered to the spine to block pain signals. SCS has a success rate of 77% over a six-month period, as reported in a recent clinical study.