Diabetic polyneuropathy / nerve pain and numbness due to diabetes - symptoms

Diabetic polyneuropathy is a very common consequence of diabetes: almost one in three diabetics is affected by this nerve damage. Numbness, pain and other limitations are the consequence.
– dr. Tobias weigl

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This text has been prepared in accordance with medical literature, current guidelines and studies, and has been reviewed by a medical professional prior to publication.

Diabetic polyneuropathy is one of the more common secondary diseases of diabetes mellitus type 1 and type 2. The term describes the damage and subsequent functional limitation of peripheral nerves. Although the cause of the disease is still not fully understood, polyneuropathies are caused by disturbed metabolic processes as a result of elevated blood glucose levels.

Polyneuropathy is manifested by the fact that patients experience a loss of strength, or even pain. Even a paralysis of the muscles connected to the damaged nerves, a loss of sensation for pain or painful insensitivities. Symptoms depend on the nerves affected. As part of the treatment of diabetic polyneuropathy, four main aspects are pursued:

A causal therapy, i.e. a therapy that affects the causes of the disease
A pathogenetically justifiable therapy, i.e. a therapy that relates to the specific processes of the disease
A pain therapy as well as
The avoidance of risks.

What is diabetic polyneuropathy??

Jurgen could suffer from nerve damage as a result of his type 2 diabetes. The physician speaks then of a diabetic polyneuropathy (from greek. Poly ‘much’, greek. Neuron ‘nerve’ and altgr. Pathos ‘pain’, ‘suffering’). This is a secondary disease of the chronic metabolic disease diabetes mellitus. In the course of this disease, the metabolism of the nerve cells is affected by a high blood sugar level. As a result, oxygen deficiency occurs there, which damages the respective nerves.

In diabetic polyneuropathy, a distinction is made between sensorimotor and autonomic neuropathy.

The sensorimotor diabetic polyneuropathy is the most common manifestation of the disease and has a significant impact on the development of sensory disturbances, especially in the feet, and poorly healing wounds. It plays an important role in the development of the so-called diabetic foot. As the disease progresses, the symptoms associated with it also spread to the hands and legs – but in general, the progression of the disease is considered to be slow.

In the autonomic diabetic neuropathy it is a subjective disorder that can occur in any part of the autonomic nervous system, that is, the nervous system that we cannot consciously influence. As a result, symptoms such as impotence, cardiac arrhythmias, urinary problems, vomiting and diarrhea may occur.

More information about the consequences of diabetes in this video

What can be the consequences of diabetes? In this video dr explains. Dr. Tobias weigl, how diabetic polyneuropathy occurs and what other effects it can have, z. B. The diabetic foot.

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The symptoms: what are the symptoms of diabetic polyneuropathy??

diabetic polyneuropathy is usually symptom-free at first. However, it may be that those affected have a disturbed sensation with regard to vibration as well as HEAT and cold have. In general, the first symptoms are usually pain in the foot especially during the night, and it can lead to insensations come in the form of one feeling numb or furry as well as tingling can express. This can then already hands concern.

If the polyneuropathy is already more advanced, the freedom of movement the affected person may be limited. As a secondary disease, the so-called diabetic foot which is characterized by the fact that open wounds on the foot no longer close and therefore no longer heal. other classic complaints are gait unsteadiness, muscle weakness and a altered sensation of touch and pain.

an overview of the symptoms of diabetic polyneuropathy:

Initially symptom-free
disturbed sensation in relation to vibration, heat, cold
Pain in the foot
discomfort
feeling of numbness/pelpiness/tingling (also on the hands)
Limited freedom of movement
Non-healing, open wounds on the foot
gait insecurity
muscle weakness
Altered sensation of touch and pain

Who is affected?

diabetic polyneuropathy can generally affect any diabetic, and currently affects just under one in three people. it is the most common secondary disease of diabetes mellitus. About 10-20 percent of type 2 diabetics already have nerve damage at the time of diagnosis. The longer a patient has had diabetes, the more likely it is that his or her nerves will be damaged.

after only 10 years with diabetes, 50 percent of diabetics have symptoms that may be related to nerve damage. If a patient has been diabetic for 25 years, the probability of developing diabetic polyneuropathy is up to 50 percent. Constant vigilant blood glucose control is therefore indispensable. Risk factors that contribute to the development of this secondary disease are:

diabetes duration
Smoking and lack of physical activity
alcohol

What does the doctor do? Part 1: the diagnosis

At the beginning of every diagnosis there is the so called medical history, during which the doctor asks the patient about current complaints, asks about medications taken regularly and obtains information about any previous illnesses.

In the context of diabetic polyneuropathy, the most important thing in this conversation is that the patient is able to information about his existing diabetes if this has already been diagnosed. In addition, the doctor will ask specifically about sensory and motor symptoms and any deficits, i.e. pain, cramps or numbness and muscle weakness.

In the context of a clinical examination the doctor then first carries out a visual inspection by, thus examines bspw. skin color or injuries. This is followed by a palpation, For example. determine deformities. Furthermore some neurological examinations, where the doctor z. B. examines the patient’s reflexes with a reflex hammer, determines the vibration sensation with a graduated tuning fork, determines the touch or vibration sensation with a cotton ball and a pointed object. Testing pain sensation or using a cold object to determine temperature sensation. In addition, the doctor will evaluate the individual muscles examine in terms of their strength and mass. Equally important is a electrical examination of muscles and nerves by means of electromyograms and. Electroneurogram, in which their conduction velocity is tested.

The diagnosis is considered certain when a metabolic diabetic disorder is diagnosed and other possible causes, z. B. Inflammatory diseases, excessive alcohol consumption, malnutrition or other metabolic disorders, can be ruled out.

Fact box

Disturbed vibration sensation
Disturbed temperature sensation
Disturbed touch or sensation. Pain sensation
Pain in the foot
Sensory disturbances (numbness, tingling, furry sensations)
Gait Insecurity
Muscle weakness
Restricted mobility

What does the doctor do? Part 2: the treatment

In the context of the therapy of a diabetic polyneuropathy, the following four focal points should be in the focus:

Causal therapy
pathogenetically justifiable therapy
Pain therapy
Avoiding risks and complications.

The causal therapy aims to lower blood glucose levels in consultation with the family doctor, e.g. Via medication or a diet. The goal is normally a hba1c value of less than 6.5 percent. This value is also called blood glucose memory, because it reflects the average concentration of blood glucose over the past 6-8 weeks.

In the pathogenetically justifiable, the development of the disease in question, therapy attempts to switch off specific processes of the disease. The most important of these is the preparation alpha-lipoic acid which contains the only active ingredient that has been shown to be effective in studies.

What can be done against the pain?

The pain therapy can both Medication as well as non-medicinal take place. The drugs that the doctor can prescribe are basically divided into the three ranges antidepressants, opioids and anticonvulsants subdivided. They are also used for many other nerve diseases. The drugs mentioned here are particularly suitable for the treatment of diabetic polyneuropathy in that they affect neurons and nerve fibers that transmit pain. They affect the structures that are damaged in polyneuropathy.

More information on the use of antidepressants for pain management in this video!

In this video, dr explains. Weigl explains, among other things, the effects and side effects that antidepressants can have in the treatment of nerve pain, and the appropriate dosage of the medication.

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The non-drug measures should help to slowly lower the medication. This includes for example. TENS (transcutaneous electrical nerve stimulation), in which pain can be treated gently by means of small electric shocks. Furthermore, measures such as physiotherapy, baths, drinking cures and inhalations are suitable (so-called. balneotherapy’), relaxation therapy, acupuncture and a relatively new method called SFMS (‘small fiber matrix stimulation‘), in which damaged nerve fibers are stimulated and normalized.

The avoidance of risk factors and complications takes place e.g. by recommending the wearing of correct footwear and by examining the smallest injuries in detail.

When treating diabetic polyneuropathy, the following principles should always be considered:

There is no patent remedy for the treatment, which is usually very complex.
a combination therapy is advisable, different drugs of different classes should be used.
Each drug has a different effect on each patient.
Each medication must be dosed individually.
An assessment of the effect of a drug should only be made after a minimum of 2-4 weeks.

More information about the treatment of diabetic polyneuropathy can be found in this video

In this video dr. Weigl explains the principles of the treatment of diabetic polyneuropathy and explains how the therapy is optimally designed, which drugs can be used and what needs to be considered in the context of the therapy.

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Frequent patient questions

How can I prevent diabetic polyneuropathy??

Dr. T. Weigl:
for this, optimal blood sugar control is essential. as a diabetic you should also take care to reduce or even stop your alcohol and tobacco consumption. Because polyneuropathy can be triggered primarily by chronic alcohol consumption. Also recommended are regular doctor visits for blood tests and checkups, as well as medical foot care.

What is diabetic foot?

Dr. T. Weigl:
diabetic foot syndrome is a secondary disease of diabetes mellitus and a complication of diabetic polyneuropathy. This causes damage to blood vessels, as a result of which the feet are supplied with too little oxygen. Nerve cells in the feet are also affected, resulting in reduced pain sensation. This is dangerous because injuries or pressure points on the foot are no longer perceived, which very quickly leads to them getting worse. As a result, the tissue becomes inflamed and cells die off.