Diabetic neuropathy

Alternative Names

Nerve damage - diabetic; autonomic neuropathy; peripheral neuropathy; gastroparesis

Symptoms

Digestive tract:

• Constipation
• Diarrhea
• Nausea and vomiting
• Swallowing difficulty

Legs and arms:

• Deep pain, most commonly in the feet and legs
• Loss of the sense of warm or cold
• Muscle cramps
• Numbness (if the nerves are severely damaged, you may be unaware that a blister or minor wound has become infected)
• Tingling or burning sensation in the extremities, particularly the feet
• Weakness

Other symptoms:

• Dizziness
• Drooping eyelid
• Drooping face
• Drooping mouth
• Impotence
• Light-headedness when standing up (orthostatic hypotension)
• Loss of bladder control
• Rapid heart rate
• Speech impairment
• Vision changes

Note: Symptoms vary depending on the nerve(s) affected, and may include symptoms other than those listed. Symptoms usually develop gradually over years.

Exams and Tests

Physical examination, including nervous system (neurological) and sensory tests, may diagnose neuropathies. A common early finding is the absence of ankle reflexes.

Health care providers often test for loss of sensation in the feet with a brush-like instrument called a monofilament.

Electrodiagnostic testing may be done.

References

Vinik AI. Diabetic neuropathies. Med Clin North Am. 2004; 88(4): 947-99.

Vardi M, Nini A. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus. Cochrane Database Syst Rev. 2007; Jan 24(1):CD002187.

Wong MC, Chung JW, Wong TK. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ. 2007; 335:87.

Hunt D. American Diabetes Association (ADA). Standards of medical care in diabetes--2008. Diabetes Care. 2008;31:S12-S54.