Diabetic nerve damage: Diabetic amyotrophy

 

What is diabetic amyotrophy?

Diabetic amyotrophy is a type of diabetic neuropathy – or diabetic nerve damage – that’s also called proximal neuropathy (it has several other names too, including lumbosacral radiculoplexus neuropathy, femoral neuropathy, diabetic polyradiculoneuropathy and Bruns-Garland syndrome, among others).
 
Compared to the main type of diabetic nerve problem – that is, peripheral neuropathy, – diabetic amyotrophy isn’t that common, affecting around one in 100 people with type 2 diabetes and three in 1,000 people with type 1 diabetes (i). Indeed peripheral neuropathy affects far more people, with about 50 per cent of people with diabetes thought to experience it to some degree (i).
 
As well as being more common in people with type 2 rather than type 1 diabetes, diabetic amyotrophy affects more men than women, and is also most likely to develop in those aged 50 or older (ii).
 
Diabetic amyotrophy was first recognised in the late 19th century when the German neurologist Ludwig Bruns called it diabetic lumbosacral radiculoplexus neuropathy (DLRPN). Then much later in the 1950s, the British neurologist Hugh Garland co-authored a paper that gave the condition the name we most often associate with it today – diabetic amyotrophy.
 
This condition acts differently to peripheral neuropathy, which causes symptoms such as tingling, numbness and pain typically in the hands and feet. Instead, diabetic amyotrophy affects different nerves and therefore different parts of the body, most often the hips, buttocks, legs and thighs, and sometimes also the chest and abdomen.
 

What are the symptoms of diabetic amyotroph?

The first symptom most people with diabetic amyotrophy notice is pain in the front of the thigh – though some get pain in their hip, buttock or back. This pain – which usually starts on one side – often comes on suddenly and can be severe, excruciating even, sometimes spreading gradually to the other side of the body too.
 
Besides pain the other main symptoms include:
 

• Muscle weakness in the lower legs, buttock or hip (though sometimes the arms, chest and upper back can be affected) – for instance, this can make it difficult for you to stand up from sitting in a chair unassisted or you may even find it difficult to walk without crutches or a walking stick

• Muscle wasting (atrophy or loss of muscle tissue), usually in the front of the thigh (this typically starts within weeks of the initial pain symptoms)

Some people can also experience additional symptoms, including:

• Tingling and other altered sensations in the thigh, hip or buttock

• Loss of reflexes (for instance, the knee reflex – when a doctor taps your leg just below your knee cap)

• Muscle twitching

• Unintentional weight loss

• Sensation problems in the lower legs and feet, caused by a separate condition called distal neuropathy (around half of those who have diabetic amyotrophy also experience distal  neuropathy) (i)

• Foot drop (when the front part of the foot drags on the ground when you walk) 

• Severe stomach pain

 

Can diabetic amyotrophy be cured?

The symptoms of diabetic amyotrophy can become so bad you may need to use a wheelchair. The good news is that, while the symptoms typically get worse at the beginning, they then gradually improve and the condition tends to pass in time, with most cases resolving within several months (though some people may be affected for up to two or three years).
 
The initial symptom – pain – is the first to subside, though muscle weakness can take longer to improve. However, most people will eventually make a full recovery from diabetic amyotrophy. 
 

What causes diabetic amyotrophy?

The reason diabetic amyotrophy has so many alternative names is that there’s a variety of opinions regarding what exactly causes the condition. The fact that it rarely affects people who don’t have diabetes has led many experts to conclude that the nerve damage of diabetic amyotrophy is caused by the same thing as that of other types of diabetic neuropathies – namely having persistently high blood sugar levels.
 
Indeed, many believe having uncontrolled high blood sugar damages nerves, which affects their ability to send signals to the brain (iii). Having persistent high blood sugar levels may also weaken the walls of the capillaries – small blood vessels – that transport oxygen and nutrients to the nerves, which means the nerves become starved of the nutrients they need to stay healthy, and eventually die.
 
Experts elsewhere have suggested diabetic amyotrophy may be triggered by a problem with the immune system called microvasculitis (i), and that having diabetes is a risk factor rather than the primary cause of the condition (iv). With microvasculitis – an autoimmune disease – the blood vessels that supply the nerves to the legs become inflamed and damaged. In fact, some researchers think peripheral neuropathy may be related to autoimmunity too (v).
 

How is diabetic amyotrophy treated?

Diabetic amyotrophy can be tricky to diagnose as it shares symptoms with other conditions. Some of the other things your GP may want to test for alongside diabetic amyotrophy, for instance, include conditions such as degenerative spine disease, diabetic muscle infarction and meralgia paresthetica – all of which can cause symptoms like pain, burning, tingling and swelling in the thigh.
 
Several tests, however, can help confirm a diagnosis of diabetic amyotrophy, including blood tests to check for diabetes (according to Patient UK, the symptoms of diabetic amyotrophy can sometimes be the first sign that you have diabetes (i)). Other tests have to be carried out at a hospital, including:
 

• Lumbar puncture (to check for signs of inflammation) 

• Electromyography and nerve conduction studies (to check the health of your nerves)

• X-rays, CT scans and MRI scans

 
If you’re diagnosed with diabetic amyotrophy, the main treatment – for the vast majority of cases that also have diabetes – includes making sure your blood sugar levels are tightly under control. Managing your weight, blood pressure and cholesterol levels is also thought to be very helpful. It’s also likely that you’ll be offered a course of physiotherapy treatment to help keep your muscles working as well as possible and to limit the effects of muscle wasting. If you need help with carrying out your daily activities, your GP or specialist may also refer you to an occupational therapist.
 
Medicines are available to help with pain relief, though you’ll usually be given prescription medication, since ordinary over-the-counter painkillers such as paracetamol and ibuprofen aren’t considered effective for nerve pain. These medicines include antidepressants (though in this instance they’re used to control pain rather than treat the signs of depression), as well as other medicines normally used for other conditions including those taken for epilepsy and anxiety, and medicines usually prescribed for bladder problems.
 
Steroid medicines and immunosuppressant medicines are also sometimes used, though specialists don’t always prescribe them as there’s still not enough evidence to show they’re effective for diabetic amyotrophy symptoms (i).
 
Meanwhile, if you’ve been diagnosed with diabetic amyotrophy, your GP or specialist may also advise you to make some lifestyle changes, including avoiding smoking, staying physically active, maintaining good mental health and eating a healthy, balanced diet.
 

Natural support for living with diabetic amyotrophy

While nutritional supplements should never be used as an alternative to conventional diabetes medicines or medical care, certain supplements may be helpful if you take them alongside the treatments your GP has prescribed for you. Some, for instance, are thought to help with blood sugar control, which may help prevent diabetic amyotrophy symptoms caused by high blood sugar or help reduce symptoms if they’ve already developed.

• If you have diabetes always check with your GP before taking these or any other supplements, as having blood sugar levels that are too low can put you at risk of a serious complication called hypoglycaemia (hypo).

Find out more about hypos in our guide to diabetes. 

If you want to consider taking a supplement, a multivitamin and mineral product is a great place to start, as it can make sure you have all the nutrients your body needs for overall health. This can be particularly useful if your diet isn’t always as healthy as it should be. Discover further details about multivitamin supplements including which one may be the most suitable for you by reading our guide to multivitamins and daily requirements. 

Meanwhile other supplements you may want to consider include:
 

Cinnamon  

 
Cinnamon is one of the oldest remedies used in traditional Chinese medicine. It’s also often recommended by natural practitioners for people with type 2 diabetes, as there’s some evidence it may help improve blood sugar levels (vi).
 

Alpha lipoic acid

 
A powerful antioxidant, alpha lipoic acid is a fatty acid that may help control blood sugar levels (vii) as well as improve insulin sensitivity in people with type 2 diabetes (viii). Indeed alpha lipoic acid supplements have been used widely in Germany to treat diabetic neuropathy, and at least one study suggests it may well be effective (ix). However, if you have diabetes always consult your GP before taking alpha lipoic acid as it may enhance insulin activity.
 

Magnesium

 
Some experts believe people who have diabetes also have low magnesium levels (x), possibly because diabetes or some of the medicines used to treat it may cause magnesium deficiency. Elsewhere researchers have discovered magnesium may help with blood sugar control (xi).
 

Turmeric

 
The curry spice turmeric contains a compound called curcumin that has several potential health benefits, including the ability to reduce blood sugar levels – though to date most studies have been carried out in animals rather than humans, which means the available evidence is weak. However, some researchers studying the effects of taking curcumin in people with diabetic foot ulcers found those taking curcumin supplements experienced improved blood sugar level control, though they didn’t notice any significant improvement in wound healing (xii).
 

High-strength fish oils

 
Omega-3 fatty acids – particularly EPA and DHA, two omega-3s found in oily fish such as salmon, trout, sardines and mackerel, as well as fish oil supplements – are widely considered helpful for general health and wellbeing. There’s also some evidence they may help reduce levels of triglycerides in the blood, which is thought to be a risk factor for nerve damage (xiii). Fish oil supplements are widely available, but vegetarians and vegans can get these beneficial omega-3 fats too by taking supplements that contain omega-3 oils derived from marine algae.
 

Fenugreek

 
Fenugreek seeds have been used traditionally as a medicine for centuries in some parts of the world (in Ayurvedic medicine, for instance). These days, herbal practitioners recommend fenugreek seeds to people with diabetes, as the seeds may help increase the body produce insulin. There is also some evidence fenugreek seeds may be helpful in controlling type 2 diabetes and reducing insulin resistance, though supporting studies to date are small in scale (xiv). However, don’t take fenugreek if you’re pregnant or breastfeeding.
 

Vitamin D

 
Best known for helping the body absorb calcium, vitamin D – and particularly having low levels of it – is increasingly being linked with type 2 diabetes (xv). Researchers are also examining the association between vitamin D deficiency and diabetic neuropathy, with one small-scale study finding that people with type 2 diabetes and peripheral neuropathy have significantly lower levels of vitamin D than those who don’t have neuropathy or diabetes (xvi).
 
Meanwhile, taking vitamin D may also be useful since there is some evidence that deficiency may be linked with increased autoimmunity (xvii). Vitamin D deficiency is also thought to lead to muscle atrophy (xviii).

Unfortunately, vitamin D deficiency is thought to be common in some countries including the UK, which explains why Public Health England advises adults and children over the age of one-year-old to consider taking a daily supplement containing 10mcg of vitamin D, particularly during autumn and winter (xix). However if your skin is rarely exposed to the sun – if you spend most of your time indoors, for instance, or if your skin is always covered when you’re out and about – you may need to take vitamin D throughout the year. People with dark skin from African, Afro-Caribbean and South Asian backgrounds should consider taking vitamin D all year round too, PHE advises.

The recommended form of vitamin D is vitamin D3 or cholecalciferol, as it’s the natural form of vitamin D that the body makes when it’s exposed to sunlight. Vitamin D3 supplements are available in tablet form, and now you can get them in veggie-friendly drops too. However, most vitamin D3 supplements are made from the fat of lamb’s wool, which means they’re unsuitable for vegans. The good news is that vegan vitamin D3 supplements sourced from lichen are now more widely available.
 

High-strength anthocyanidins

 
Found in dark-skinned fruits such as blueberries, cranberries, raspberries, blackberries and red grapes – as well as vegetables such as red cabbage, red onions and aubergines –  anthocyanidins and their derivatives anthocyanins are potent antioxidant compounds. They may be useful for people with diabetes and diabetic neuropathy as they may help strengthen and repair the walls of veins and capillaries by protecting collagen in the body (collagen being the structural protein that gives blood vessels their strength).
 
Anthocyanidins are also available in supplement form (choose a product that combines anthocyanidins with vitamin C, as vitamin C supports the body’s ability to produce collagen).
 
Diabetic amyotrophy may be less common than peripheral neuropathy – the main type of diabetic nerve damage – but it can often be far more disabling for those who are affected. However, as with several types of neuropathy, if you have diabetes your risk of developing diabetic amyotrophy is higher than that of someone who doesn’t have diabetes. This guide aims to show you the symptoms to look out for, as well as the steps you can take to prevent diabetic amyotrophy or recover from it more effectively. For more information on a range of health and wellbeing issues, visit our pharmacy health library.

 

References:

(i) Available online: https://patient.info/diabetes/diabetes-mellitus-leaflet/diabetic-amyotrophy
 
(ii) https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/proximal-neuropathy
 
(iii) Available online: https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580
 
(iv) Diaz LA, Gupta V. Diabetic Amyotrophy. Available online: https://www.ncbi.nlm.nih.gov/books/NBK560491/
 
(v) Janahi NM et al. Diabetic peripheral neuropathy, is it an autoimmune disease? Immunol Lett 2015 Nov;168(1):73-9. Available online: https://www.sciencedirect.com/science/article/abs/pii/S016524781530033X?via%3Dihub
 
(vi) Mang. B, Wolters. M, Schmitt. B, et al. Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2. Eur J Clin Invest. 2006;36:340-344. Available online: https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2362.2006.01629.x

Akilen. R, Tsiami. A ,Devendra. D, Robinson. N, et al. Glycated haemoglobin and blood pressure-lowering effect of cinnamon in multi-ethnic Type 2 diabetic patients in the UK: a randomized, placebo-controlled, double-blind clinical trial. Diabet Med. 2010;27(10):1159-1167. Available online: https://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2010.03079.x

Pham. AQ, Kourias. H, Pham. DQ. Cinnamon supplementation in patients with type 2 diabetes mellitus. Pharmacotherapy. 2007 Apr;27(4):595-9.Available online: https://accpjournals.onlinelibrary.wiley.com/doi/abs/10.1592/phco.27.4.595

Kirkham S, Akilen R, Sharma S, Tsiami A. The potential of cinnamon to reduce blood glucose levels in patients with type 2 diabetes and insulin resistance. Diabetes Obs Metab. 2009 Dec;11(12):1100-13. Available online: https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/j.1463-1326.2009.01094.x
 
(vii) Poh. ZX., Goh KP., A current update on the use of alpha lipoic acid in the management of type 2 diabetes mellitus. Endocr Metab Immune Disord Drug Targets. 2009 Dec;9(4):392-8. Available online: https://www.eurekaselect.com/article/30245
 
(viii) Evans JL, Goldfine ID. Alpha-lipoic acid: a multifunctional antioxidant that improves insulin sensitivity in patients with type 2 diabetes. Diabetes Technol ther. Autumn 2000;2(3):401-13. Available online: https://www.liebertpub.com/doi/10.1089/15209150050194279
 
(ix) Ziegler. D, Ametov. A, Barinov. A, et al. Oral treatment with {alpha}-lipoic acid improves symptomatic diabetic polyneuropathy: The SYDNEY 2 trial. Diabetes Care. 2006;29:2365-2370. Available online: https://care.diabetesjournals.org/content/29/11/2365
 
(x) Elamin. A, Tuvemo. T. Magnesium and insulin-dependent diabetes mellitus. Diabetes Res Clin Pract. 1990;10:203-209. available online: https://www.diabetesresearchclinicalpractice.com/article/0168-8227(90)90062-X/pdf.

Barbagallow M, Dominguez LJ. Magnesium and type 2 diabetes. World J Diabetes 2015 Aug 25; 6(10):1152-57. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549665/
 
(xi) Song. Y, He. K, Levitan. EB. Effects of oral magnesium supplementation on glycaemic control in Type 2 diabetes: a meta-analysis of randomized double-blind controlled trials. Diabet Med. 2006;23:1050-1056. Available online: https://onlinelibrary.wiley.com/doi/10.1111/j.1464-5491.2006.01852.x
 
(xii) Mokhtari M., Razzaghi R, Momen-Heravi M. The effects of curcumin intake on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial. Phytother Research: PTR (2020) 35(4):2099–107. Available online: https://onlinelibrary.wiley.com/doi/10.1002/ptr.6957
 
(xiii) Cbauhan S et al. Role of Omega-3 Fatty Acids on Lipid Profile in Diabetic Dyslipidaemia: Single Blind, Randomised Clinical Trial. J Clin Diagn Res. 2017 Mar; 11(3): OC13–OC16. Available online:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427353/
 
(xiv) Yilmaz Z et al. Supplements for Diabetes Mellitus: A Review of the Literature. Pharm Pract 2017 Dec;30(6):631-638. Available online: https://journals.sagepub.com/doi/10.1177/0897190016663070.

Kassaian N et al. Effect of fenugreek seeds on blood glucose and lipid profiles in type 2 diabetic patients. J Vitam Nutr Res 2009 Jan;79(1):34-9. Available online: https://econtent.hogrefe.com/doi/10.1024/0300-9831.79.1.34 .

Gupta A, Gupta R, Lal B. Effect of Trigonella foenum-graecum (fenugreek) seeds on glycaemic control and insulin resistance in type 2 diabetes mellitus: a double blind placebo controlled study. Physicians India 2001 Nov;49:1057-61. Available online: https://pubmed.ncbi.nlm.nih.gov/11868855/
 
(xv) Berridge MJ. Vitamin D deficiency and diabetes. Biochem J. 2017 Mar 24;474(8):1321-1322. Available online: https://portlandpress.com/biochemj/article-abstract/474/8/1321/49583/Vitamin-D-deficiency-and-diabetes?redirectedFrom=fulltext
 
(xvi) Shillo P et al. Reduced vitamin D levels in painful diabetic peripheral neuropathy,
Available online: https://onlinelibrary.wiley.com/doi/full/10.1111/dme.13798
 
(xvii) Aranow C. Vitamin D and the Immune System. J Investig Med. 2011 Aug;59(6):881-886.Available online: https://jim.bmj.com/content/59/6/881.long
 
(xviii) Dzik KP et al. Vitamin D Deficiency Is Associated with Muscle Atrophy and Reduced Mitochondrial Function in Patients with Chronic Low Back Pain. Oxid Med Cell Longev 2019 Jun 2;2019:6835341. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6589343/
(xix) Available online: https://www.gov.uk/government/news/phe-publishes-new-advice-on-vitamin-d

 

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Disclaimer: The information presented by Nature's Best is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications.

 

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