Diabetic nerve pain in neck and shoulder

By Lynn YoffeeMedically Reviewed by Lindsey Marcellin, MD, MPH

Reviewed: December 9, 2011

Tingling, numbness, pain in the arms, legs, hands, or feet — these are all common signs of diabetic neuropathy, or nerve damage. Up to 70 percent of people with diabetes will develop some type of neuropathy, making it one of the most common side effects of this disease.

Diabetes: Understanding Neuropathy

Although tingling, numbness, or pain in the extremities are common signs of neuropathy, others may experience no symptoms at all. Nerve damage can also occur in internal organs, such as the heart or digestive tract. Diabetes-related neuropathy can affect muscle strength, sensation in various parts of the body, and even sexual function.

People who develop diabetic neuropathy are typically those who have trouble controlling their blood glucose levels, blood pressure, cholesterol, and body weight. Although researchers haven't quite figured out exactly why this happens, they know that neuropathy can occur due to:

• Alcohol use and smoking
• Genetic predisposition
• Injuries such as carpal tunnel syndrome
• Nerves that become inflamed related to autoimmune conditions
• Neurovascular issues that damage the blood vessels responsible for bringing nutrients and oxygen to your nerves

Your risk also increases the older you get and the longer you have diabetes, with the highest rates of neuropathy occuring in people who have had diabetes for at least 25 years.

Diabetes: Where Neuropathy May Strike

Here are some of the specific types of neuropathy that occur in people with diabetes:

• Autonomic neuropathy impairs the functioning of the digestive system, resulting in diarrhea or constipation as well as impaired bladder function. This type of neuropathy also affects how you perspire and even your sexual response — men may have trouble getting an erection and women may experience vaginal dryness. This neuropathy also masks the symptoms of hypoglycemia (low blood glucose).
• Focal neuropathy can attack any nerve in the body and often causes sudden weakness.
• Peripheral neuropathy, the most common diabetic complication, can cause numbness or pain in the legs, feet, toes, arms, and hands.
• Proximal neuropathy may cause weakness in your legs and pain in your hips, buttocks, and thighs.

Because diabetes-related neuropathy can cause such a wide variety of symptoms, there is no single diagnostic test for the condition. Your doctor will rely heavily on a complete physical exam and your description of symptoms to diagnose this condition. In some cases, tools such as nerve conduction studies, a heart rate variability test, and ultrasound may be used to aid in the diagnosis.

Diabetes: Protect Your Feet

Peripheral neuropathy often occurs in the feet. If you start to lose feeling in your feet, you're more likely to injure yourself, walk abnormally, and develop sores that won't heal. These sores often become badly infected, which can lead to amputation of your feet or legs. That's why it's important for people with diabetes to keep a close eye on their feet.

Diabetes: Treatment Will Vary

Because each neuropathy is different, treatments vary widely and you'll need to consult with your doctor to find the best solution for your individual condition. However, treatment for any neuropathy will start with bringing your blood glucose levels under control if they aren't already.

Here are some treatment options that may be suggested:

• Various medications, including some antidepressants, can be used to treat nerve pain.
• If you have stomach problems, your doctor may suggest a change in your diet. If that doesn't help, medications can be used to help control your digestive processes.
• If you experience bladder problems, you may need an antibiotic to clear up any infection that results. Incontinence treatment starts with remembering to urinate at regular intervals, since you may not realize when your bladder is full.
• Medications are available for men with erectile dysfunction, and there are mechanical options, such as vacuum devices, that can help with maintaining an erection. Women who experience vaginal dryness can try lubricants.
• For neuropathy that causes dizziness and weakness, usually related to blood pressure or circulation, your doctor may advise you to raise the head of your bed, and to sit up or stand slowly. Medication for high blood pressure may be prescribed; for some people an increased level of salt in the diet may be recommended.

Even though diabetic neuropathy will affect the majority of people who have diabetes, you can still work to prevent it, mostly by keeping your blood glucose level within your target range. This will help protect your nerves from damage.

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