There are many types of neuropathy that are extremely common among the population, but can diabetic neuropathy be reversed?
Diabetic neuropathy is the medical term for nerve damage caused by diabetes. One of the ways in which diabetes can attack the body is through the slow destruction of nerve cells. Studies suggest that about 15 percent of diabetic patients struggle with painful symptoms of diabetic neuropathy.
Many of diabetes’ central symptoms revolve around high blood sugar, as the body is incapable of producing or responding to insulin in order to process it. Diabetic neuropathy is thought to be caused by this high blood sugar level. Once blood sugar reaches a certain point, the excess glucose in the bloodstream can attack and damage the myelin sheathing of your nerve cells, causing them to become destroyed.
This doesn’t happen overnight, of course – it takes time for the effects to become noticeable. Depending on where the neuropathy begins, the symptoms can differ from person to person. Just as diabetes mostly affects the extremities first (gloves/socks and stockings), it’s more likely for the first symptoms of diabetic neuropathy to occur in the hands, feet, arms, and legs.
Can Diabetic Neuropathy Be Reversed?
The short answer, is most of the time, no. Diabetic neuropathy cannot be reversed. While diabetic neuropathy is a slow process, it is also generally an irreversible one, depending on the extent of the damage. Our nerve cells are slow to heal, and some nerve cells – especially the ones in our brain and spinal cord – cannot heal at all.
Some nerve damage can be repaired or may heal by itself if the nature and extent of the damage is minimal. Things like compressed or impinged nerves, severed peripheral nerves, or burned nerve endings can, through careful treatment, reach the point where a patient can regain mobility and feeling. But because diagnosed or clinical diabetic neuropathy tends to be more widespread, the damage already done usually cannot be undone.
What can be done is preventative care. Patients with diabetes can be informed of the dangers and likelihood of diabetic neuropathy and can take steps with their doctor to reduce it. Treatment can also involve improving quality of life through pain management and long-term care.
The Different Types of Diabetic Neuropathy
Diabetic neuropathy can affect the nervous system in different ways. It doesn’t always attack the same regions first or cause the same symptoms. The three major ways in which diabetic neuropathy can affect a patient are through their peripheral nervous system, through their autonomic nervous system, and through focal neuropathy.
1. Peripheral Neuropathy
The peripheral nervous system broadly describes any nerve that doesn’t belong to the central nervous system (the brain and spinal cord), but in this case we are specifically referring to the physical extremities, hips, thighs, and buttocks, all of which can be affected by diabetic neuropathy. Symptoms of peripheral nerve damage through diabetes include:
- Weakness and loss of mobility in the arms and legs
- Tingling or burning sensation
- Increased sensitivity to touch
- Muscle atrophy (significantly shrunken muscles)
- Difficulty standing up from a seated position
- Joint pain (especially knees and shoulders)
2. Autonomic Neuropathy
Where peripheral neuropathy describes pain and loss of function in the arms, legs, hips, and buttocks, autonomic neuropathy is a breakdown of the autonomic nervous system. This is the part of your nervous system that controls heartbeat, breathing, sweating, your bladder, hormone production, and digestion. When affecting the autonomic nervous system, diabetic neuropathy can cause:
- Loss of photosensitivity
- Nausea and vomiting from gastroparesis
- Loss of appetite
- Loss of hypoglycemic symptoms
- Crashing sex drive
3. Focal Neuropathy
Focal neuropathy, or mononeuropathy, is a degeneration of a single nerve. Common forms of focal neuropathy include:
- Loss of vision in one eye
- Partial paralysis of the face (Bell’s palsy)
- Tingling or loss of feeling in one finger or hand.
Stages of Diabetic Neuropathy
Blood sugar levels can begin to affect nerves and cause symptoms of neuropathy over multiple stages. These are the subclinical, clinical, and debilitating stages of diabetic neuropathy.
1. Subclinical Neuropathy
The only main difference between subclinical and clinical neuropathy is that a patient may exhibit symptoms of neuropathy via abnormal neurologic functioning tests (quantitative sensory tests, autonomic function tests, electrophysiologic tests), but without a diagnosis of clinical neuropathy (through other tests, like nerve conduction).
This may be because the neuropathy is in its early stages, or because diabetic neuropathy may not be the cause for these abnormal symptoms. Diabetic neuropathy is distinguished from other causes of nerve damage or related illnesses by first ruling those out. This can take time, and multiple different tests.
2. Clinical Neuropathy
Clinical diabetic neuropathy is diagnosed with a patient is exhibiting symptoms of nerve damage (motor, sensory, or autonomic) and other causes are ruled out. From there, the neuropathy is identified based on symptoms, areas affected, and different nerve conduction and physical tests.
Another common sign of advanced, debilitating diabetic neuropathy is the development of deformities in the feet.
As neuropathy causes muscle atrophy in the extremities, the flexor muscles of the foot become far weaker than the extensor muscles, causing the toes to curl inward painfully, while the fat pad under the ball of the foot is pulled under the toes. This increases risk for ulceration.
Treating Diabetic Peripheral Nerve Damage
While diabetic neuropathy usually cannot be reversed, it can be treated. Preventative care is important, and taking appropriate measures to slow the damage is critical.
In addition to careful monitoring of your blood sugar – even in the absence of hypoglycemic symptoms – some common preventative measures to reduce further nerve damage include:
- Increasing your physical activity as much as you can
- Working with your doctor to formulate a realistic and effective diabetes meal plan
- Avoiding (or quitting) smoking
- Reducing alcohol consumption
- Frequent foot care (orthopedic shoes, regular foot exams, checking and getting unusual spots or symptoms checked)
While damage to the motor and sensory nerves of the arms and legs is most common in patients with diabetic neuropathy, it can affect a person in unusual ways, from a crashing sex drive to loss of vision in one eye.
Diabetic Neuropathy Treatment Options
Pain management is central to long-term care for neuropathy. Medication, physical therapy, and non-surgical interventions such as targeted nerve blocks can help drastically reduce pain for short periods or modulate pain over longer periods.
Aggressive treatment halts the progress of the neuropathy, and gets it under control, avoiding worse symptoms. Without treatment, diabetic neuropathy can eventually cause heart damage and sudden death. Neuropathy treatment options include:
- Peripheral nerve stimulators (PNS)
- Nerve blocks
- Spinal cord stimulation
- Medication management
Diabetic neuropathy screenings are recommended by the American Diabetes Association once per year immediately after a diabetes type II diagnosis, and five years after a diabetes type I diagnosis. The best defense is early diagnosis and treatment.