Diabetic neuropathy

 

What is diabetic neuropathy?

Diabetic neuropathy is the term for nerve problems that develop as a result of having diabetes. In fact, it’s one of the most common long-term complications of having diabetes, and is thought to affect up to 70 per cent of people living with the condition (i).
 
Most types of diabetic neuropathy don’t usually appear suddenly. Instead, they tend to develop slowly over a long period of time – so the longer you have diabetes, the more likely you are to be affected by diabetic neuropathy.
 
According to Diabetes UK, having high blood sugar levels for a long time can damage the small blood vessels that supply your nerves (ii). As a result, essential nutrients carried via the bloodstream fail to reach the nerves. When that happens the nerves become damaged and, in time, they may disappear entirely.
 
Besides high blood sugar levels, other things that may affect the health of your nerves include:

• Smoking

• Drinking excessive amounts of alcohol

• High cholesterol and/or triglyceride levels

• Injury (for instance, carpal tunnel syndrome) 

• Vitamin B12 deficiency (iii)

If you have diabetes you may also be more likely to develop nerve damage if you’re overweight or have high blood pressure, if you have advanced kidney disease or if you have coronary heart disease. There’s also some evidence that some people may be more susceptible to developing diabetic neuropathy if they have certain genes (iv).
 

How your nerves work

Your nerves send electrical signals to your brain from the rest of your body and vice versa. There are many different kinds of nerves, each of which belongs either to the central nervous system (the brain and spinal cord) or the peripheral nervous system (these branch out from the central nervous system to every part of the body).
 
Part of your peripheral nervous system consists of a network of peripheral nerves that relays signals from your central nervous system to your feet, legs, hands and arms. Other nerves within the peripheral nervous system supply your internal organs, such as your gut, bladder and heart. All of these nerves have a variety of functions:
 

• Your sensory nerves allow you to feel sensations such as touch, pain, heat and cold.

• Motor nerves travel to and from your brain to your muscles, allowing your muscles to move.

• Autonomic nerves control involuntary actions such as breathing, heart rate, digestion, blood pressure, sweating and sexual arousal.

 
Any of these nerves can become damaged in people who have diabetes, though the most commonly affected are the peripheral nerves, particularly those found in the legs and feet – this condition is called peripheral neuropathy. Other types of diabetic neuropathy include proximal neuropathy (also called diabetic amyotrophy), autonomic neuropathy and focal neuropathy.
 

What are the symptoms of diabetic neuropathy?

If you have diabetic neuropathy you may have one or more of a wide range of symptoms, such as pain and numbness in your feet and legs or problems with your internal organs. The exact symptoms you’ll experience will depend on which nerves have been damaged.
 

Peripheral neuropathy

If your peripheral nerves have become damaged, the condition is known as peripheral neuropathy (this is also sometimes known by other names including peripheral diabetic nerve pain or distal polyneuropathy).  Peripheral neuropathy is the most common type of neuropathy caused by diabetes, affecting around half of those who’ve had diabetes for 25 years or longer (v).
 

Peripheral neuropathy symptoms:

 

• Numbness and tingling sensations in the hands or feet that can continue up the legs and arms

• Burning, stabbing or shooting pains in the hands, feet, legs or arms

• Muscle weakness in the hands and feet

• Balance and co-ordination problems 

• Loss of sensation in the hands or feet (for instance, not being able to feel pain from a cut or other injury, or not being able to feel cold or heat) 

One of the main complications of peripheral neuropathy that affects the feet is an increased risk of developing diabetic foot ulcers. If left untreated, foot ulcers can become infected and – in the most severe cases – can even lead to amputation.
 
Find out more about peripheral neuropathy and how it is treated by reading our guide. 
 

Proximal neuropathy

Also known as diabetic amyotrophy, proximal neuropathy affects the muscles in the upper part of your legs, buttocks and hips. 
 

Proximal neuropathy symptoms

 

• Main symptoms are a weakness of the lower legs, buttocks or hips

• Muscle wasting, typically affecting the muscle in the front of the thigh

• Sudden pain in the front of the thigh, often severe, and also sometimes in other areas such as the hips, buttocks or back

Proximal neuropathy can also cause tingling in the affected area, as well as weight loss. The condition usually starts on one side of the body and spreads slowly to the other, though most people who are affected find that one side is usually more affected than the other. The good news is that, for most people, the condition clears up within time (sometimes months but sometimes years), though it can often be so severe that those affected need to use a wheelchair for a period of time.
 
Find out more about this condition, including how to reduce your risk of developing it, by reading our guide to diabetic amyotrophy
 

Autonomic neuropathy

This affects your involuntary body functions such as your heart rate, breathing, digestion and many others – that is, the functions controlled by your autonomic nervous system. The autonomic nervous system is important as it helps keep your body working as it should. But if your autonomic nerves are damaged by the effects of diabetes, it can cause a range of problems. such as:
 

Autonomic neuropathy symptoms

• Digestive issues such as constipation, diarrhoea, bloating, nausea or vomiting

• Problems with your blood pressure

• Irregular heartbeats (including palpitations)

• Dizziness when standing up

• Not being able to sweat (or sweating too much)

• Vision problems such as your eyes not responding to changes in light levels very quickly

• Incontinence and other problems with urination

• Inability to feel low blood sugar level symptoms (hypoglycaemia unawareness)

• Erectile dysfunction problems in men

 

Focal neuropathy

Also sometimes called mononeuropathy, this is when just one specific nerve or group of nerves becomes damaged, most often in the hands, head, torso or legs. Carpal tunnel syndrome is a common type of focal neuropathy, affecting the median nerve in the wrist and hand.
 
Unlike other types of diabetic neuropathy, a focal neuropathy can appear suddenly. But like proximal neuropathy, the symptoms of most focal neuropathies disappear in time – usually over the course of a few weeks. 
 

Focal neuropathy symptoms

 

• Numbness and tingling in the affected area

• Pain in areas such as the lower back, chest, stomach, side, pelvis, foot, shin or thigh

• Double vision 

• Aching behind the eye

• Problems with vision focusing

• Bell’s palsy (sudden paralysis of one side of the face)

 

Can you recover from diabetic neuropathy?

There is currently no cure for diabetic neuropathy, though treatments are available that may help relieve some of the symptoms such as pain (your GP or a member of your diabetes care team can advise you about the type of pain relief medicine that would suit you, as common painkillers such as ibuprofen and paracetamol aren’t usually effective for nerve pain), digestive problems and other symptoms such as erectile dysfunction and muscle weakness. 
 

How is diabetic neuropathy treated?

In addition to GP-recommended pain relief medication, you may also be advised to have vitamin B12 injections or take tablets if you’ve been diagnosed with B12 deficiency, or antibiotics if you have a foot ulcer that has become infected.
 
Less commonly, other medicines may be prescribed for certain symptoms of diabetic neuropathy including steroids (anti-inflammatory medicines), immunosuppressants (drugs that reduce the activity of the immune system) and immunoglobin injections (immunoglobin is a mixture of antibodies made by the immune system).
 
Living with diabetic neuropathy can also be difficult to live with, and many people affected by it have a higher-than-average risk of experiencing depression. If you have any of the symptoms of depression – including feeling low in spirits all the time, not having any pleasure in life, feeling hopeless or not having any energy – your GP can advise you about the various treatments that are available to you.
 
Meanwhile, there are also a few things you could do to help prevent the symptoms of diabetic neuropathy as well as stop any symptoms you’re already experiencing getting any worse. These include:
 

• Keeping your blood sugar levels under control (this includes taking your diabetes medication as prescribed and having as healthy a lifestyle as possible – read our guide to diabetes causes and treatments for more details)

• Losing weight or maintaining a healthy weight 

• Maintaining a healthy blood pressure 

• Giving up smoking

• Looking after your feet 

• Cutting down on alcohol if you need to 

• Getting plenty of good-quality sleep  

• Staying as physically active as you can (aim for 150 minutes of moderate exercise every week – build-up to this goal slowly if you haven’t been very active lately)

• Eating a healthy, nutritious diet 

 

Nutritional supplements for diabetic neuropathy

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 neuropathy or stop any existing symptoms from getting worse.
 

• If you have diabetes 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 therapists for those with type 2 diabetes, as there is 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 even 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. Some researchers, however, have studied the effects of taking curcumin in people with diabetic foot ulcers (xii). They found those taking the curcumin supplements experienced improved blood sugar level control, though they didn’t notice any significant improvement in wound healing.
 

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 is 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’s ability to 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 people with type 2 diabetes and peripheral neuropathy have significantly lower levels of vitamin D than those who don’t have neuropathy and those who don’t have diabetes (xvi).

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 (xvii). 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 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 neuropathy affects many people, especially those who have lived with diabetes for many years. There’s no cure, but treatments can help relieve the symptoms. Most importantly there are several things you can do yourself to reduce your symptoms or even help prevent diabetic neuropathy from developing in the first place. For more information on a range of health and wellbeing issues, visit our pharmacy health library. 

 

References:

(i) Available online: https://patient.info/doctor/diabetic-neuropathy-pro
 
(ii) Available online: https://www.diabetes.org.uk/guide-to-diabetes/complications/nerves_neuropathy
 
(iii) Serin HM, Arslan EA. Neurological symptoms of vitamin B12 deficiency: analysis of pediatric patients* Acta Clin Croat. 2019 Jun; 58(2):295-302. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6884369/
 
(iv) Witzel I et al. Identifying Common Genetic Risk Factors of Diabetic Neuropathies. Front Endorcrinol (Lausanne). 2015; 6: 88. Available online: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4447004/
 
(v) Available online: https://patient.info/brain-nerves/peripheral-neuropathy-leaflet
 
(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) 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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