eMedicine Specialties > Neurology > Neuromuscular Diseases

Diabetic Neuropathy: Follow-up

Author: Dianna Quan, MD, Associate Professor of Neurology, Director, Electromyography Laboratory, University of Colorado Health Sciences Center
Contributor Information and Disclosures

Updated: Oct 22, 2009

Follow-up

Deterrence/Prevention

  • The importance of protection and care of insensitive feet cannot be overemphasized. Patients should be instructed to trim their toenails with great care and to be fastidious about foot hygiene. Any fungal or bacterial infection mandates prompt medical attention. The need for well-fitting shoes should be stressed.
  • Diabetic polyneuropathy is usually associated with diabetic retinopathy and nephropathy. Patients with neuropathy should be counseled to seek appropriate eye care and discuss renal care and follow-up with their primary care physicians or endocrinologists.

Complications

  • The presence of neuropathy increases the risk of foot ulceration and infection, which in turn may lead to gangrene and the need for amputation.
  • The economic burden of taking care of patients with diabetic neuropathy is huge.

Prognosis

Treating diabetic neuropathy is a difficult task for the physician and patient. Most of the medicines mentioned in the Medication section do not lead to complete symptom relief. Clinical trials are underway to help find new ways to treat symptoms and delay disease progression.

Patient Education

Patient education should begin in the primary care office. The following outline reviews some common questions and answers that can serve as a springboard for discussion. 

  • What is diabetic neuropathy?
    • Diabetic neuropathy is nerve damage caused by diabetes. In the United States, diabetes is one of the most common causes of nerve damage, also known as peripheral neuropathy. Diabetic neuropathy can affect nerves that supply feeling and movement in the arms and legs. It can also affect the nerves that regulate unconscious vital functions such as heart rate and digestion.
  • How does diabetic neuropathy occur?
    • Doctors have been studying this problem for many years, but they do not yet understand exactly how diabetes damages nerves. However, they have observed that good control of blood sugar levels helps prevent diabetic neuropathy and slows its progression.
  • What are the symptoms?
    • Symptoms of diabetic neuropathy may include the following:
      • Numbness or loss of feeling (usually in the feet and legs first, then the hands)
      • Pain ranging from minor discomfort or tingling in toes to severe pain. Pain may be sharp or lightninglike, deep and aching, or burning. Extreme sensitivity to the slightest touch can also occur (allodynia).
      • Muscle weakness
      • Low blood pressure and dizziness when rising quickly from sitting or lying down
      • Rapid or irregular heartbeats
      • Trouble having an erection
      • Nausea or vomiting
      • Difficulty swallowing
      • Constipation or diarrhea
  • How can I help prevent diabetic neuropathy?
    • The following steps may help to prevent or slow the worsening of diabetic neuropathy.
      • Control diabetes. Try to keep blood sugar at a normal level.
      • Maintain normal blood pressure.
      • Exercise regularly, according to the healthcare provider's recommendation.
      • Stop smoking.
      • Limit the amount of alcohol intake because excessive alcohol also can cause neuropathy or make it worse.
      • Eat a healthy diet.
      • Keep follow-up appointments with the healthcare provider.
  • How is diabetic neuropathy treated? 
    • No treatment is available to reverse neuropathy. The best approach is to control the diabetes.
    • Muscle weakness is treated with support, such as braces. Physical therapy and regular exercise may help patients maintain the muscle strength they have.
    • Pain-killing drugs or medications applied to the skin may help make pain more tolerable.
    • Medications can be used to treat nausea, vomiting, and diarrhea.
    • Men who have trouble having erections because of neuropathy should talk to their healthcare providers. Prosthetic devices can be put in the penis and medications can help a man achieve and maintain an erection
    • Preventing injuries such as burns, cuts, or broken bones is especially important, because patients with neuropathy have more complications from simple injuries and may not heal as quickly as healthy individuals.
  • How can I take care of myself?
    • Work with primary care physicians and endocrinologists to control glucose levels.
    • Look for injuries on the skin of feet and lower legs regularly.
    • See a healthcare provider promptly for calluses, sores on the skin, or other potential problems so they can be treated properly.
    • Wear good-fitting, comfortable shoes that protect the feet.
  • How long will the problem last?
    • Once a patient has neuropathy, the symptoms will persist indefinitely.
    • Patients may be able to stop neuropathy from worsening by keeping blood sugar under good control.

For excellent patient education resources, visit eMedicine's Diabetes Center and Erectile Dysfunction Center. Also, see eMedicine's patient education articles, Diabetes, Impotence/Erectile Dysfunction, Erectile Dysfunction FAQs, and Nonsurgical Treatment of Erectile Dysfunction.

Miscellaneous

Medicolegal Pitfalls

Management of diabetic neuropathy should begin at the initial diagnosis of diabetes. The primary care physician is responsible for educating patients about the acute and chronic complications of diabetes.

  • Failure to diagnose diabetic polyneuropathy can lead to serious consequences, including disability and amputation.
  • Addressing the psychological impact of sexual dysfunction in both men and women is also a responsibility of the primary care giver.
  • The importance of involving a neurologist (preferably with expertise in peripheral neuropathy) in the treatment of patients with diabetic neuropathy cannot be overemphasized.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Emad Soliman, MD and Charles Gellido, MD to the development and writing of this article.



More on Diabetic Neuropathy

Overview: Diabetic Neuropathy
Differential Diagnoses & Workup: Diabetic Neuropathy
Treatment & Medication: Diabetic Neuropathy
Follow-up: Diabetic Neuropathy
References
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Further Reading

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Keywords

diabetic polyneuropathy, diabetic amyotrophy, proximal diabetic neuropathy, mononeuropathy multiplex, diabetic autonomic neuropathy, distal symmetric sensorimotor polyneuropathy, painful diabetic neuropathy, generalized sensorimotor polyneuropathy of diabetes mellitus, diabetic peripheral neuropathy, peripheral neuropathies, chronic hyperglycemia, entrapment neuropathies, diabetic neuropathy, carpal tunnel syndrome, numbness, feeling of wearing gloves, lossof balance, electric shocklike feelings, hypersensitivity to touch, foot slapping, toe scuffing, postural lightheadedness, fainting, urinary urgency, urinary dribbling, urinary incontinence, nocturnal diarrhea, constipation

erectile impotence, ejaculatory failure, nighttime painful paresthesias, impaired proprioception, impaired vibratory perception, sensory ataxia, anhidrosis, bladder atony, unreactive pupils, painless electric tingling, snug bandlike sensation around ankles, snug bandlike sensation around feet, absent ankle jerk reflexes, proprioceptive sensory impairment, gait instability, orthostatic hypotension, resting tachycardia, loss of sinus arrhythmia, sluggish light reflex

diabetic neuropathic cachexia, median neuropathy of the wrist, MNW, ulnar neuropathy of the elbow, UNE, single somatic mononeuropathies, multiple somatic mononeuropathies, single monoradiculopathies, multiple monoradiculopathies, diabetic lumbosacral radiculoplexoneuropathy, DLSRPN, diabetic thoracolumbar radiculoneuropathy, DTLRN, diabetic autonomia, cranial mononeuropathy, anterior ischemic optic neuropathy, diabetic oculomotor cranial mononeuropathies, acute periorbital pain, facial neuropathy, mononeuritis multiplex

diabetic polyradiculopathy, thoracoabdominal neuropathy, lumbosacral radiculoplexopathy, thoracolumbar neuropathy, thoracoabdominal radiculopathy, thoracic radiculopathy, truncal neuropathy, asymmetric proximal motorneuropathy, diabetic femoral neuropathy, femorosciatic neuropathy, diabetic myelopathy, Bruhn-Garland syndrome, poorly controlled diabetes, acute painful neuropathy, chronic inflammatory demyelinating polyneuropathy, CIDP, diabetes mellitus-CIDP, demyelinating neuropathy, diabetic neuropathy

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Contributor Information and Disclosures

Author

Dianna Quan, MD, Associate Professor of Neurology, Director, Electromyography Laboratory, University of Colorado Health Sciences Center
Dianna Quan, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Phi Beta Kappa
Disclosure: e-medicine Honoraria Other

Medical Editor

Milind J Kothari, DO, Professor and Vice-Chair, Department of Neurology, Pennsylvania State University College of Medicine; Consulting Staff, Department of Neurology, Penn State Milton S Hershey Medical Center
Milind J Kothari, DO is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Neurological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Neil A Busis, MD, Chief, Division of Neurology, Department of Medicine, Head, Clinical Neurophysiology Laboratory, University of Pittsburgh Medical Center-Shadyside
Neil A Busis, MD is a member of the following medical societies: American Academy of Neurology and American Association of Neuromuscular and Electrodiagnostic Medicine
Disclosure: Nothing to disclose.

CME Editor

Selim R Benbadis, MD, Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, University of South Florida School of Medicine, Tampa General Hospital
Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Nicholas Lorenzo, MD, Chief Editor, eMedicine Neurology; Consulting Staff, Neurology Specialists and Consultants
Nicholas Lorenzo, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Neurology
Disclosure: Nothing to disclose.

 
 
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