Reduce Your Risk of Nerve Pain and Damage From Diabetes

Reduce Your Risk of Nerve Pain and Damage From Diabetes

Edited By : Rebecca Taylor
Reviewed by :Brunilda Nazario, MD

If you have diabetes, chances are good that you already have some form of nerve pain or nerve damage, called diabetic neuropathy. "People with diabetes have about a 60% chance of getting neuropathy of any kind," says Dace L. Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle. "It's probably an equal risk of getting neuropathy with type 1 and type 2 diabetes."

You may have tingling, pain, or numbness in your feet and hands -- common signs of the diabetic nerve damage called peripheral neuropathy. Or you may have damage to the nerves that send signals to your heart, stomach, bladder, or sex organs, called autonomic neuropathy. Nerve damage can also be "silent," meaning you have no symptoms at all.

Sometimes, nerve damage starts even before a person is diagnosed with diabetes, Trance tells WebMD. "Even somebody with prediabetes may have neuropathy," she says. As many as 54 million Americans have prediabetes -- a condition where blood sugar levels are abnormally high, but not high enough to qualify as diabetes -- says the American Diabetes Association (ADA). Add to that the nearly 21 million Americans already coping with full diabetes, and you can see how common nerve pain may be.

The good news? Many of the risk factors for diabetic neuropathy are under your control. So while you may not be able to prevent nerve pain and damage completely, you may be able to help slow it down. You can reduce your risk of nerve damage and other diabetes complications by keeping your blood sugars under tight control, says the National Diabetes Information Clearinghouse (NDIC).

Trence agrees. "The better the blood sugar control," she says, "the less likely neuropathy is to progress." A healthy lifestyle helps lower your risk of heart disease, stroke, and other diabetes complications, as well. So know your risk for complications, and work to control the ones you can control.

Are You at Risk for Diabetic Neuropathy?

1. You Have High Blood Sugar.

The risk: Who are the people at highest risk of nerve pain and damage from diabetes? Those who have trouble controlling their blood sugar.
What you can do: Sometimes glucose control is about mind over matter: you may simply need a little help staying motivated, sticking to your exercise program, or learning how to prepare more varied, tasty, healthy meals. But if you're "doing everything right" and still have high glucose levels, you may need to change your plan and start medications to help better manage your blood sugars.

2. You've Had Diabetes for Many Years.

The risk: Nerve pain and damage is more common in people who have had diabetes for more than 25 years.
What you can do: Do your best to monitor your blood sugar at home as often as advised by your doctor. The NDIC also advises having the A1c test, a blood test that measures your average amount of blood glucose over the previous 2 to 3 months, at least twice a year. Trence advises taking the A1c more often as an extra measure of control. "I think most of us believe it should be done every 3 to 4 months," she says. "It can vary, but we need to keep on top of things, and it's such a powerful piece of information to have to complement the patient's own blood sugars."

3. You're Overweight.

The risk: Being overweight is double trouble for people with diabetes. It puts you at higher risk of diabetic nerve damage -- and higher risk of deadly diabetes complications like heart attack and stroke.
What you can do: Losing weight is hard for everyone, since meals are loaded with emotional meaning, well-being, satisfaction -- or frustration. So if you're overweight, be patient -- but consistent -- with yourself. Losing even a few extra pounds can be a big boost to your health, says the ADA. You really can control this risk with a balanced diet and exercise plan designed for slow, safe weight loss. And losing weight means less pressure on those tender feet if you already have diabetic nerve pain.

4. You're Over 40.

The risk: Diabetic nerve damage is more common in people over 40.
What you can do: While you can't turn back the clock, you can recommit to a healthy lifestyle each year. You might try one, fun new thing to help manage your diabetes each year, like finding a new diabetes cookbook or joining a walking or swimming group, to keep yourself motivated. If you're in a relationship, tell your partner or spouse that your diabetes-friendly lifestyle can help your sweetheart feel young, healthy, and energized, too. Every little bit helps when it comes to diet, exercise, and other lifestyle changes. "It's similar to the blood sugar situation," says Trence. "Wherever a person is at, we try to improve."

5. You're Off-Target With Your Blood Fats.

The risk: The wrong levels of fats in your blood put you at higher risk of diabetic neuropathy. Often, people with diabetes have too-low levels of HDL ("good cholesterol") and too-high levels of the blood fat called triglycerides, says the ADA. To make matters worse, their LDL ("bad cholesterol") makes them more likely to have a heart attack. A grim truth: 66% of people with diabetes will die of a heart attack or stroke, according the ADA.
What you can do: Find out your numbers, if you're not sure. Have your cholesterol checked at least once a year, and aim for these target levels, advises the ADA:
LDL cholesterol: below 100 mg/dL
HDL cholesterol: above 40 mg/dL for men

above 50 for women
Triglycerides: below 150 mg/dL

Keep in mind that these are general guidelines; check with your doctor to see if your target levels are different, given your medical condition.

6. You Have High Blood Pressure.

The risk: High blood pressure, or hypertension, increases your risk of diabetic neuropathy. As many as two out of three adults with diabetes have high blood pressure, increasing their risk of heart disease and stroke.
What you can do: Some people can manage high blood pressure with diet and exercise alone; others need medication. For everyone with diabetes, the ADA advises keeping your blood pressure lower than 130/80 ("130 over 80"). This goal is lower than for the general population, since diabetic people have a higher risk of heart disease and stroke. If you can't keep your blood pressure at this target with exercise and healthy eating, talk to your doctor about taking medications for better blood pressure control.

7. You Smoke.

The risk: Smokers are at greater risk of nerve damage from diabetes. And as you no doubt know, smoking has been linked to heart disease for years.
What you can do: You really can quit, even if you've been a longtime smoker. And it's never too late: Even if you've smoked for years, you'll do yourself a world a good if you quit. These days, you'll find smoking cessation classes, groups, and resources everywhere. Set a quit date, commit yourself, and ask your friends, family, colleagues, and your doctor for support.

8. You Drink a Lot of Alcohol.

The risk: Alcohol goes right into your bloodstream and can "spike" your blood sugar the same way high-sugar foods like desserts do. Drinking can also make you swerve off your meal plan and eat foods you know will wreck your blood sugars. Even more sobering? Alcohol blocks how well your liver clears fat from your blood and can raise your level of unhealthy blood fats called triglycerides - even with as little as two 4-ounce glasses a wine a week, says the ADA.
What you can do: The ADA and NDIC both advise cutting down on drinking to help prevent -- or at least try to control -- diabetic nerve damage. If you already have nerve pain, ask your doctor whether you should have any alcohol at all. There isn't any proven, "safe" amount to drink, so if you're living with diabetes, you may decide to cut out drinking entirely.

So, quick review: Your blood sugar, weight, blood fats like cholesterol, blood pressure, smoking, and drinking. That's six of the eight risk factors for diabetic neuropathy that are under your control. Not bad. Now if medicine can just come up with a "cure" for aging ...

Published July 5, 2007.
Medically reviewed June 2007.

5 Steps to Managing Diabetes Comlications

5 Steps to Managing Diabetes Comlications

Diabetes Complications

If not controlled, diabetes can cause a host of complications that can affect nearly every organ in the body. They include:

  • The heart and blood vessels
  • The eyes
  • The kidneys
  • The nerves
  • The gums and teeth

Heart Disease and Blood Vessel Disease

Heart disease and blood vessel disease are the biggest complications that people with uncontrolled diabetes face. Approximately 65% of death from diabetes is due to heart disease and stroke. Diabetes can also cause poor blood flow in the legs and feet (peripheral artery disease).

Many studies show that controlling diabetes can prevent or stop the progression of heart and blood vessel disease.

Learn more about heart and blood vessel disease in people with diabetes.

Blood vessel damage or nerve damage (see below) may also lead to foot problems that can lead to amputations. More than 60% of leg and foot amputations not related to an injury are due to diabetes.

Learn more about diabetes foot problems.

Diabetes and the Eyes

Diabetes is the leading cause of blindness in the U.S. It can cause a number of eye problems, some of which can lead to blindness if not addressed. They include:

  • Glaucoma
  • Cataracts
  • Diabetic retinopathy

Studies show that regular eye exams and timely treatment of diabetes-related eye problems could prevent up to 90% of diabetes-related blindness.

Learn more about diabetes-related eye disease.

Kidney Disease

Diabetes is the leading cause of kidney failure in adults in the U.S. Drugs that lower blood pressure (even if you don't have high blood pressure) can lower risk of kidney failure by 33%.

Learn more about diabetes-related kidney disease.

Diabetes and Your Nerves

Over time, high blood glucose levels can harm the nerves. This can lead to loss of sensation or feeling (usually starting in the toes) or pain and burning of the feet.

Diabetes related nerve damage can also cause pain in the legs, arms, and hands, and can cause problems with digestion, going to the bathroom, or having sex.

Learn more about diabetes-related nerve damage.

Your Teeth

People with diabetes are at high risk for gum disease. Keeping your diabetes under control, seeing your dentist regularly, and taking good daily care of your teeth can prevent gum disease and tooth loss.

Learn more about diabetes and your teeth and gums.

What Causes These Complications of Diabetes?

Diabetes complications are caused by damage to the blood vessels, nerves, or both.

What Are the Symptoms?

Symptoms vary depending on the diabetes complication that you have. You may have:

  • No symptoms if you have heart disease or atherosclerosis of a large blood vessel, unless you have a heart attack or stoke. Disease of the large blood vessels in your legs may cause problems with blood circulation, leading to leg cramps, changes in skin color, and decreased sensation.
  • Vision problems, vision loss, or pain in your eye if you have diabetic eye disease
  • No symptoms if you have early diabetes-related kidney disease. Swelling of the legs and feet occur in more advanced stages of kidney failure.
  • Tingling, numbness, burning, or shooting or stabbing pain in the feet, hands, or other parts of your body, if the nerves are affected by diabetes (peripheral diabetic neuropathy). If the nerves that control internal organs are damaged (autonomic neuropathy), you may have sexual problems, digestive problems (a condition called gastroparesis); difficulty sensing when your bladder is full; dizziness, fainting, or difficulty knowing when your blood sugar is low.

How Can I Prevent Myself From Having Complications From Diabetes?

When complications are found early, you might only have to take medication to prevent progression of the disease. Only minor lifestyle changes may be necessary. For example, if you have early diabetic nephropathy, you can take medication to prevent further damage. Early treatment for a complication and keeping your blood sugar levels within a safe range can help slow the progression of your complication and may prevent other complications from developing.

How Are Diabetes Complications Treated?

Treatment focuses on slowing the progression of the damage. That may include medication, surgery, or other treatment options.

But the most important treatment to slow the progression of diabetes complications is to keep your blood sugar levels tightly in control and to treat high blood pressure and high cholesterol.

Reviewed by Certified Diabetes Educators in the Department of Patient Education and Health Information and by physicians in the Department of Endocrinology at The Cleveland Clinic.

Edited by Brunilda Nazario, MD, October 2006.
Portions of this page © The Cleveland Clinic 2000-2003.

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