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Diabetic Neuropathy

Medical Director, Neurologist

Diabetes is the leading cause of peripheral polyneuropathy and consist of a variety of syndromes resulting from generalized, focal, or multifocal damage to peripheral (both motor and sensory) or cranial nerves. There is great variability in the reported prevalence ranging from 10% to 80% which reveals a problem with diagnostic accuracy. Symptoms are often insidious in onset and usually consist of a sensory complaint since sensorimotor polyneuropathy is the most frequently occurring diabetic neuropathy although diabetic autonomic neuropathy is also frequently encountered as the autonomic nerve fibers are invariably involved in chronic sensorimotor polyneuropathy. 

Peripheral nerve dysfunction can be the result of other causes of neuropathies, even in diabetics, which may require specific treatment.  Other common disorders that may cause peripheral neuropathy in diabetics include  vitamin B12 deficiency, alcoholic neuropathy, chronic inflammatory demyelinating polyneuropathy, and endocrine neuropathies.

Since optimal glucose management is the most single important approach to prevention and treatment of diabetic neuropathy it is crucial these patients are identified early for better prognosis. Additional known risk factors for the development of polyneuropathy are age and duration of diabetes so early identification is key. Appropriate dietary changes can balance glucose and insulin levels as well as treat diabetic neuropathy already established. Important supplements and herbs include benfotiamine, evening primrose oil, cinnamon, berberine, and lipoic acid, among others.

Diabetic polyneuropathy usually worsens slowly over the years. Diabetic autonomic neuropathy is considered a progressive disorder and a risk factor for renal failure and myocardial infarction. So clearly it is important to focus on treatment, if not prevention. Symptom control does not necessarily prevent progression so a multi-faceted approach is necessary. Optimal lifestyle choices have been shown to be effective to lower glucose levels, reduce risk factors, minimize symptoms, and prevent progression.

Diabetic neuropathy should be an early focus of prevention in all patients diagnosed with diabetes. Diabetes is a lifestyle disease for the most part and early nutritional and other lifestyle changes can have a profound and exponential impact on their health and well-being. Diabetic neuropathies can be debilitating and life-altering as well as increase risk factors for other complications. Pain is often associated with diabetic neuropathies and that should be acknowledged and managed appropriately to not only reduce suffering but to allow for continued motivation on the part of the patient to make better choices in their meal planning and level of exercise.