Neuropathies related to diabetes can affect 60-70% of people with diabetes. Neuropathy associated with type 2 diabetes may be present at the time of diagnosing diabetes. Neuropathy associated with type 1 diabetes usually develops more than 10 years after the diagnosis of diabetes.
Diabetes is the most common cause of peripheral neuropathy in the world.
- Age over 40 years.
- History of periods of poor glycaemic control.
- Prevalence increases with increased duration of diabetes.
- People with signs of neuropathy are likely also to have evidence of diabetic nephropathy and diabetic retinopathy.
- Ischaemic heart disease.
Diabetic proximal neuropathy, or amyotrophy, is the muscle weakness and wasting caused by years of high blood sugar. But you can prevent and even reverse it.
Diabetic proximal neuropathy is only one of the diabetic neuropathies. Like all the others it is the result of long-term high blood sugar.
It is not as well known as the numbness and tingling of fingers and toes that nearly every type 2 diabetic deals with from the beginning of diabetes.
That’s because not everyone with type 2 diabetes has the symptoms of muscle wasting and weakness of diabetic proximal neuropathy.
Also called diabetic amyotrophy (myo- for muscles and -trophy for breaking down), this neuropathy arrives after years and years of too much glucose in your blood.
Diabetic peripheral neuropathy starts with pain in the muscles of your thighs, hips, buttocks or legs.
In rare cases it also affects your shoulders, too. But wherever it shows up, the pain is usually on only one side, or on one side more than the other.
Do not give up. Go to the home page for encouragement.
If the cause of the muscle wasting is diabetic nerve disease, it is always in older adults who have had diabetes for a while.
Type 2 diabetes has been damaging the blood vessels that supply nerves with oxygen, destroying the nerve pathways slowly over time.
The effect is weakness in your legs. You cannot stand up from a chair without help.
Your knee and ankle reflexes become weaker and disappear. That’s one reason doctors check your reflexes at each physical. They gently tap your knee and ankle joints with a small hammer as they measure your responses.
Extreme Weakness of Amyotrophy
If diabetic proximal neuropathy continues the result is quadriparesis, the medical term for extreme weakness in the arms and legs. That’s why it is called muscle wasting.
There are other causes for muscle wasting that need to be ruled out, such as Lou Gehrig’s disease or muscular dystrophy. But in type 2 diabetes the cause is peripheral nerve disease.
Insulin resistance in the cells leads to high blood sugar. Long term this weakens veins and arteries. Type 2 diabetics also have high insulin levels that lead to inflammatory symptoms.
For a long time those are hidden problems, but after a while the symptoms of pain and weakness rise up, and we are forced to face the amyotrophy of diabetic peripheral neuropathy.
How It Is Diagnosed
Doctors have tests available to them, like nerve conduction studies and needle electromyography, but usually those tests are not necessary.
It is easy for your doctor to diagnose the symptoms of amyotrophy with reflex tests and watching the way you stand and walk. Doctors see diabetic neuropathies every day.
What concerns them more is the treatment and prevention. It is good to know there are things that can be done.
Diabetic proximal neuropathy is halted and reversed by controlling your blood sugar. Good eating habits are the place to start.
Next is physical exercise that not only improves blood sugar control but strengthens muscles and stimulates nerve growth.
Medications for helping control blood sugar are available, but know the side effects of each diabetic medicine so you can weigh them carefully.
You can also ask for medications that fight the pain of diabetic proximal neuropathy. Most of them are the same things prescribed for depression, because they are effective against nerve pain.
Staying out of the depression that plagues diabetics will improve every complication. If you are not depressed, nerve pain will be less damaging.
Avoiding harmful habits like smoking, and lowering your level of chronic stress will also improve neuropathies. There are good ideas for that on the stress page of A Diabetic Life.
Management of painful neuropathy
May require a great deal of support for the depressing and disabling nature of the condition.
- Bed foot cradles for problems at night.
- Simple analgesia taken in advance of diurnal symptoms.
- Contact dressings.
- Drug treatments recommended by the National Institute for Health and Care Excellence (NICE)
- Offer a choice of amitriptyline, duloxetine, gabapentin or pregabalin as initial treatment for neuropathic pain.
- If the initial treatment is not effective or is not tolerated, offer one of the remaining three drugs, and consider switching again if the second and third drugs tried are also not effective or not tolerated.
- Consider tramadol only if acute rescue therapy is needed.
- Consider capsaicin cream for people with localised neuropathic pain who wish to avoid, or who cannot tolerate, oral treatments.
- Opioids other than tramadol should be avoided unless part of shared-care arrangements after specialist assessment.
Patients on drug treatment should be reviewed early when starting treatment for dosage titration, or when changing dose to monitor for adverse effects and tolerability.
Regular reviews (NICE does not specify a time interval) should also be arranged to check progress, adverse effects, mood, quality of sleep and any problems with daily activities.
Autonomic neuropathy is associated with a high mortality rate, mainly due to its association with chronic kidney disease, cardiopathy and hypotension.
Diabetic peripheral neuropathy is a major cause of morbidity and increased mortality and increases the risk of burns, injuries and foot ulceration.
People with diabetes are more likely to undergo lower limb amputation.
Tight glycaemic control has been clearly shown to reduce the risk of neuropathy.
Smoking avoidance or cessation.