Diabetic Neuropathy

Diabetic neuropathy is a common and serious complication of diabetes, affecting many people across Singapore. It results from prolonged high blood sugar levels, which can damage the nerves, leading to a wide range of symptoms. If left untreated, diabetic neuropathy can significantly impact quality of life, making early diagnosis and treatment crucial.

What Is Diabetic Neuropathy? What Are the Types of Diabetic Neuropathy?

Diabetic neuropathy refers to nerve damage caused by diabetes. It occurs when prolonged high blood sugar levels damage nerves throughout the body. There are four main types of diabetic neuropathy:

1. Peripheral Neuropathy: The most common type, peripheral neuropathy, affects the legs, feet, arms, and hands. It can cause pain, tingling, and numbness in these areas, often starting in the feet and spreading upwards.
2. Autonomic Neuropathy: This type affects the autonomic nervous system, which controls involuntary body functions such as digestion, bladder control, and heart rate.
3. Proximal Neuropathy: Also called diabetic amyotrophy, this type affects the muscles in the thighs, hips, or buttocks, leading to weakness and pain.
4. Focal Neuropathy: Focal neuropathy occurs when there is damage to a specific nerve, often causing weakness or pain in one part of the body, such as the head, torso, or legs.

What Causes Diabetic Neuropathy?

Diabetic neuropathy is caused primarily by poorly controlled blood sugar levels over an extended period. Elevated blood sugar levels can damage the walls of blood vessels that supply the nerves with oxygen, leading to nerve damage. Other contributing factors include:

• Inflammation of the nerves: Diabetes can cause the immune system to attack nerve fibres, leading to inflammation and damage.
• High cholesterol and blood pressure: These conditions can affect blood flow to the nerves, worsening the damage.
• Lifestyle factors: Smoking, a sedentary lifestyle, and obesity increase the risk of nerve damage in people with diabetes.

What Are the Symptoms of Diabetic Neuropathy?

The symptoms of diabetic neuropathy vary depending on the type and the nerves affected. Common symptoms include:

• Numbness or tingling: Often starting in the toes or fingers, these sensations can spread upwards through the body.
• Sharp or burning pain: Many people experience intense pain, particularly in the legs and feet.
• Muscle weakness: Nerve damage can lead to weakness in the muscles, particularly in the thighs and hips.
• Digestive issues: Autonomic neuropathy may cause problems such as nausea, constipation, diarrhoea, or bloating.
• Bladder or sexual dysfunction: Problems with bladder control and sexual function are also common.
• Dizziness or fainting: Damage to the autonomic nerves can affect blood pressure regulation, causing dizziness when standing.

Is Diabetic Neuropathy Painful?

Yes, diabetic neuropathy can be very painful. The pain is often described as burning, stabbing, or sharp, and it may worsen at night. The discomfort can be debilitating and may interfere with sleep, mobility, and daily activities. For many, managing the pain is one of the most challenging aspects of living with diabetic neuropathy.

Who Is at Risk of Getting Diabetic Neuropathy in Singapore?

Several factors increase the risk of developing diabetic neuropathy, particularly among people with diabetes in Singapore:

• Duration of diabetes: The longer a person has diabetes, the higher the risk of developing neuropathy.
• Poor blood sugar control: People who struggle to maintain stable blood glucose levels are more likely to experience nerve damage.
• High blood pressure or cholesterol: These conditions further strain the blood vessels that supply the nerves, leading to increased risk.
• Age: Older individuals with diabetes are more susceptible to nerve damage.
• Lifestyle factors: Smoking, lack of physical activity, and being overweight can all exacerbate the risk of diabetic neuropathy.

How Is Diabetic Neuropathy Diagnosed?

Diagnosing diabetic neuropathy typically involves a combination of physical exams and diagnostic tests. During a consultation, your doctor will review your medical history and ask about your symptoms. Some diagnostic tests that may be used include:

• Nerve conduction studies [link to NCS]: These tests measure the speed of electrical signals as they travel through your nerves, helping to detect nerve damage.
• Electromyography (EMG) [link to EMG]: EMG measures the electrical activity in your muscles, helping to determine whether muscle weakness is due to nerve damage.
• Sensory testing: Your doctor may use tools such as a tuning fork or a pin to assess how well your nerves are responding to sensation.
• Blood tests: These may be performed to check blood sugar levels, cholesterol, and other markers that may indicate poor diabetes control or nerve damage.

What Are the Treatment Options for Diabetic Neuropathy in Singapore?

While there is no cure for diabetic neuropathy, treatment can help manage symptoms, slow the progression of the condition, and improve quality of life. In Singapore, treatment options for diabetic neuropathy include:

• Blood sugar management: Controlling blood sugar levels is the most critical factor in preventing further nerve damage. Doctors may adjust your diabetes treatment plan, including medications, to help stabilise your glucose levels.
• Medications for pain relief: Neuropathy pain can be treated with a variety of medications, including:
  • Antidepressants: Some types of antidepressants can help reduce nerve pain.
  • Anticonvulsants: These medications, often used to treat epilepsy, are also effective for nerve pain.
  • Topical treatments: Creams containing capsaicin or lidocaine may provide localised relief for neuropathic pain.
• Lifestyle modifications: Maintaining a healthy lifestyle can help slow the progression of diabetic neuropathy. This includes regular exercise, a balanced diet, quitting smoking, and maintaining a healthy weight.
• Physical therapy: For those with muscle weakness or balance issues, physical therapy can help improve strength and mobility.
• Advanced treatments: In severe cases, more advanced interventions such as nerve blocks [link to Nerve blocks], spinal cord stimulation, or other neuromodulation therapies may be recommended to help manage pain.

Diabetic neuropathy is a serious and common complication of diabetes, but with early diagnosis and proper management, its progression can be slowed, and symptoms can be effectively managed.

If you or a loved one is experiencing symptoms of diabetic neuropathy, schedule a consultation with Dr Charles Siow to discuss your symptoms and develop a personalised treatment plan.