Diabetic Nerve Problems

Diabetic neuropathy is nerve damage from long-standing high blood sugar — the commonest complication of diabetes and the leading cause of non-traumatic amputation in India. Controlling sugar well from the start prevents most diabetic nerve problems; once damage is established, it is partly but not fully reversible.

Types

• Peripheral (distal symmetric) polyneuropathy — commonest; numbness, tingling, burning in feet then hands ("glove-and-stocking").
• Autonomic neuropathy — dizziness on standing, stomach emptying problems (gastroparesis), bladder issues, erectile dysfunction, altered sweating.
• Mononeuropathy — a single nerve (e.g. 3rd cranial nerve → double vision), carpal tunnel.
• Diabetic amyotrophy — thigh weakness and wasting.

Consequences to prevent

• Foot ulcers and infections — painless injuries go unnoticed; can progress to amputation. See Diabetic Foot page for full care.
• Falls from balance loss.
• Cardiovascular events masked by loss of warning symptoms (silent heart attack).
• Severe pain — disabling sleep and life.

Management

• Tight, durable blood sugar control — with avoiding hypoglycaemia; HbA1c target per your Health Expert.
• BP, cholesterol, weight, no smoking, no excess alcohol — all reduce progression.
• Medicines for painful neuropathy — nerve-pain modulators, tricyclics, SNRIs; try and match.
• Foot care daily — inspect, moisturise, well-fitting footwear, never barefoot, prompt care of any cut/blister.
• Annual foot examination by a Health Expert; more often for established neuropathy.
• Address other drivers — B12 deficiency often coexists; correct.
• Physiotherapy for balance and strength.

Every diabetic adult should have a yearly comprehensive foot examination. Most amputations in India start with a small injury in a numb foot that went unnoticed — this is preventable.