Diabetic Neuropathy 101

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Not too long ago, diabetic neuropathy affected only a very small percentage of the population. Except for those directly affected, very few knew what it was.

Even those who did mostly thought it related only to nerve damage in the feet and legs, which is only one type of neuropathy which can affect diabetics.

Now unfortunately, type 2 diabetes is truly an epidemic; not contagious, but exploding at such a rate that it almost seems it must be.

Diabetic neuropathy is one of the more extreme symptoms of advanced diabetes. It is also one of the more apparent (to the sufferer) symptoms, as opposed to other damage which is occurring within the body.

As rates of diagnosed diabetes increases, so too do incidences of diabetic neuropathy.

Due to the massive rates of diabetes worldwide, more and more resources are being directed to research of the disease. Education programs are slowly creating a public awareness that type 2 diabetes is a lifestyle disease.

However, it is very confronting for a newly diagnosed type 2 diabetic to realize that their condition is a result of their past diet and exercise patterns.

The positive to take away from this is that a change in these behaviors can bring about changes in the disease; many people have successfully “reversed” diabetes.

This document gives some understanding of the cause and scope of diabetic neuropathy, as well as options for managing and overcoming symptoms.

There is also a strong focus on overcoming the underlying diabetic condition itself, which will help alleviate current symptoms, and prevent any further deterioration.

What Is Diabetic Neuropathy?

Type 2 Diabetes – a Simple Overview

Diabetes is a chronic disease which is unfortunately becoming more and more common. As human beings have turned away from natural foods and begun to eat predominantly processed foods and food-like items, diabetes (especially type 2 diabetes) and other disabling health conditions have become more commonplace.

A great many people are unaware that high blood sugar levels are extremely dangerous, or why.

Human bodies evolved with digesting proteins, fats and complex carbohydrates, which are digested and release energy fairly uniformly, at rates our body can use. Any excess not used was stored as fat, to be broken down for use when food was unavailable.

As many (or most) subject themselves to our modern western diet in the pursuit of taste, convenience or both, our digestive system is constantly overloaded with excessive sugar intake.

Every time there is an unnatural sugar overload (as simple as consuming a can of soft drink) the body releases hormones, notably insulin, to process the sugar. What the body does not use immediately for energy the body tries to store. Insulin is the primary hormonal trigger for removing the excess sugar from the blood.

When consumption of simple carbohydrates and sugar based foods and drinks are regular instead of occasional, insulin is also persistently present, instead of the occasional release our physiology was designed for. As a result, the system starts to become insensitive to insulin, and the person is pre-diabetic.

To try to overcome this the body releases insulin in increased amounts, causing the system to become more and more insulin resistant and the person is now a type 2 diabetic.

When the body does not respond appropriately to insulin, the blood continues to carry a high glucose load. This is extremely dangerous to many of the body’s systems, especially nerves.

Diabetic Neuropathy

Diabetic neuropathy is a condition where abnormally high blood sugar levels, sustained for long periods of time cause nerve damage. Approximately 60% to 70% of people with diabetes will suffer some type of nerve damage from the disease.

Pain can be severe and absolutely debilitating, or you may experience no pain at all. The nerve damage can affect your sexual performance, your vision, your mobility, and in dire instances even require the amputation of part of a limb.

While previously thought to be irreversible, research with diabetic mice in 2013 and 2014 seems to show diabetic neuropathy may be reversed in some instances. Further testing is needed, but this is incredibly good news for those who suffer from this painful condition.

There are 4 different main types of diabetic nerve damage, each with its own set of symptoms and treatments. They are – peripheral, autonomic, proximal and focal. Different symptoms occur because there are different types of nerves which can be affected negatively by diabetes.

 Peripheral Neuropathy

Sometimes called diabetic nerve pain or distal polyneuropathy, peripheral nerve damage related to diabetes is the most common type of neuropathy experienced by diabetics.

It is so named because it usually affects your peripheral body parts, most consistently your feet and legs. Peripheral neuropathy can develop in your arms and hands, though this is not as common as experiencing damage to the nerves in the legs or feet.

In some rare cases peripheral diabetic neuropathy may appear in the back or abdomen.

Symptoms of this type of nerve damage include a numbness or a loss of feeling in a body part, which unfortunately may become permanent. You may alternately experience a burning sensation, usually in the evening, physical pain or a tingling feeling.

The sufferer may find his or her muscles becoming weaker, cramping up, or twitching frequently. An insensitivity to extreme temperatures or pain may develop in the area where the nerves have been damaged.

Symptoms often get worse at night, and this condition can develop to the point where even the lightest touch is painful. Left untreated, frustrating and mildly disturbing symptoms can lead to infections and ulcers, foot deformities and ultimately even amputation.

Medications are available which help you manage peripheral neuropathy, and once experienced, you should check your feet and legs every day for symptoms. Apply a healthy, organic lotion if your feet become dry.

Don’t forget to take care of your toenails, and your doctor may recommend seeing a podiatrist. It is recommended that you wear a good pair of comfortable shoes for support.

Autonomic Neuropathy

Your autonomic nervous system helps control processes which happen automatically. You don’t have to physically do anything for your heart to pump blood or your lungs to circulate air. The same is true with the digestive process.

These and other systems have autonomic nerves which work without you thinking about the process, and that is why this group of nerves is sometimes called the automatic nervous system.

Your homeostasis, a balanced, normal state of being, is negatively affected by autonomic diabetic neuropathy. Since your symptoms are determined by which of your autonomic nerves are damaged, the signs of this condition are widespread.

If you experience nerve damage which affects your digestive system, blood vessels, sex organs or urinary system and you are diabetic, this is usually because of autonomic neuropathy.

Symptoms include constipation or diarrhea, heartburn and nausea, vomiting, bloating and feeling exceptionally full after even small meals or snacks. You may feel dizzy and experience a rapid heartbeat, or even black out if you stand up suddenly.

Men might experience problems keeping an erection, and both men and women with autonomic neuropathy in the urinary system could experience incontinence, multiple trips to the bathroom at night, or problems emptying the bladder.

There are medications and surgeries, as well as lifestyle changes, which can help you manage autonomic nerve damage caused by diabetes.

 Proximal Neuropathy

Proximal neuropathy is also known as diabetic amyotrophy, with “myo” referring to your muscle system. Accordingly, symptoms of proximal nerve damage in diabetics are usually related to weak muscles in the upper legs, hips or buttocks.

Nerve pain is sometimes associated with this problem, occurring in the lower back or upper leg (known as sciatica). This type of condition will almost always cause pain in just one side of the body.

You may experience a weakness in your legs, or physical pain in your hips, buttocks or thighs. A combination of medication and physical therapy usually works best to treat proximal neuropathy.

This is the second most common type of diabetic neuropathy, often resolving itself over time, and most commonly affecting older people.

Focal Neuropathy

Although the eyes may be the area affected, it is not called focal neuropathy for this reason. Focal neuropathy affects only one nerve rather than a whole region, so focal here refers to focus (as in targeted) rather than vision.

Focal neuropathy generally strikes without warning. Unlike the other 3 types of diabetic neuropathy just discussed, it affects one specific type of nerve.

This condition is called focal because it focuses on a single nerve, usually affecting nerves in your head.

Symptoms of this condition include double vision or pain in the eyes, or a paralysis of one side of the face (a condition called Bell’s palsy). You may less commonly experience serious pain in a different specific area, generally the lower back or one of your legs.

Focal neuropathy is sometimes misdiagnosed, because you can develop a pain in your chest or stomach which resembles the symptoms of heart attack or appendicitis.

Focal neuropathy is unpredictable and excessively painful, and can appear out of the blue.
Left alone the problem generally takes care of itself over time, but if you are diabetic you should always tell your doctor if you experience any of the above symptoms as they can be managed with medication, diet and lifestyle practices, as is the case with every form of diabetic neuropathy.

Can Diabetic Neuropathy Be Reversed?

Nerve damage caused by continually high blood sugar levels in diabetics cannot currently be reversed, as of 2017. Management practices include medication, lifestyle practices, exercise and diet.

There are different types of diabetic neuropathy, so this condition can affect different parts of the body. As many as 7 out of 10 people that develop diabetes will also experience nerve damage from the disease.

Reversing Peripheral Neuropathy in Mice
While the condition is not currently reversible in humans, there is some promising research which has been conducted on diabetic mice that shows a reversal in the future maybe possible.

Researchers at the University of Virginia (UVA) School of Medicine have successfully reversed peripheral diabetic neuropathy that was previously present in mice. Peripheral neuropathy is just 1 of 4 different types of this condition, which also include focal, proximal and autonomic neuropathy.

Since peripheral nerve damage is the most common type of neuropathy experienced by diabetics, the ability of the UVA researchers to reverse this sometimes extremely painful condition is hopeful news for diabetics that suffer from this problem.

Doctors Slobodan Todorovic and Vesna Jevtoviv-Todorovic discovered that high glucose levels which are present in diabetic neuropathy cause some of the symptoms they do because of the way they change how your body absorbs calcium.

In a healthy human, “just right” levels of calcium move through channels which allow absorption into your nerve cells. In peripheral neuropathy, those channels are negatively affected. They allow for too much calcium to enter your cells.

This overload of calcium makes the affected cells “hyperactive”, and this is what often leads to the slight tingling sensations that are a common symptom of peripheral neuropathy. This over-absorption of calcium is also thought to create the excruciating pain which is sometimes encountered by diabetics who develop nerve damage associated with the disease.

The researchers were able to reverse peripheral nerve damage in diabetic mice using a naturally occurring substance that is present in animals and human beings.

It should be noted that human trials have not begun, and a lot of research still needs to be performed to see if this will be an effective way to treat and reverse this diabetic issue in the future.

The Problem with Current Diabetic Neuropathy Treatments

The symptoms which accompany diabetic nerve damage can be treated and managed. There is, however, a problem. Many of the medications which effectively reduce or eliminate symptoms from diabetic nerve damage create problems with addiction in some patients.

Also, some patients prefer to deal with the pain that arises from diabetic neuropathy rather than feel tired, sleepy and without energy all day, another side-effect of a few of the treatment drugs commonly prescribed.

In summary, the fact that this condition in mice has been reversed when the problem was previously considered a lifetime condition is very welcome news. Mice are often used in lab experiments because many of their internal processes are similar to ours.

Hopefully, in the future this will lead to a successful reversal of peripheral neuropathy in people. Currently though, diabetics are reliant on the treatments currently available which help diabetics manage this and other forms of diabetes-related nerve damage.

Does Diabetic Neuropathy Ever Go Away?

The nerve damage which occurs with diabetic neuropathy is long-term. It happens because of a constantly elevated level of blood sugar. One of the most common symptoms of diabetic nerve damage is a lack of sensation in the feet, or a tingling feeling.

This lack of ability to feel in the feet can lead to physical injuries that come from something as simple as walking. Left untreated it often causes the development of ulcers and infections, and can even lead to the amputation of the foot or lower leg.

The long-term effect of high blood sugar which causes nerve damage in diabetics does not usually present itself for several years, sometimes as many as 20 years after a diabetic diagnosis has been received. Pain can be so excruciating that it means absolute immobility.

With many of the symptoms which accompany diabetic neuropathy, there is no pain. Double vision may occur from focal diabetic neuropathy, or you may experience nausea, an upset stomach, or other digestive problems if you have autonomic neuropathy. In both of those cases, pain may be nonexistent.

Long-Term, Irreversible Diabetic Neuropathy is Treatable
Diabetic nerve damage, and the many symptoms that accompany it, is irreversible at this time. While there is some research which shows the condition can be reversed in mice, that is only in the case of peripheral neuropathy. Focal, proximal and autonomic forms of diabetic nerve damage have never been reversed in mice or other lab animals.

In all 4 types of diabetes-related neuropathy, effective treatment, but no reversal, has been achieved in humans. The condition does not simply go away, but the symptoms can sometimes be managed to a point where they themselves are no longer a problem.
Managing your glucose can prevent further damage to your nerves, and a combination of diet, medication and exercise can limit symptoms. Your neuropathy may be acute or chronic, meaning symptoms vanish when your diabetes is under control, or persist and recur for a long time.

Treatment Protocols

Just because diabetic neuropathy is irreversible does not mean it isn’t treatable. The diabetes condition is reversible in some cases, and managing your blood sugar level works wonders for treating both diabetes and the nerve damage which accompanies up to 70% of diabetes sufferers.

Opioids may be prescribed if other treatment protocols are not effective. Unfortunately, many of the drugs prescribed for treating diabetic neuropathy cause side-effects that can detract from quality of life.

Addiction is always a consideration when pain-relief medications are taken. Some of the drugs just mentioned caused severe fatigue and a constant feeling of weakness and lack of energy.

When pain and other symptoms of diabetic neuropathy are minor, patients sometimes decide to deal with the symptoms, rather than feeling run down and tired all day long.

Enjoying a healthy diet, exercising regularly, drinking lots of water throughout the day and getting plenty of rest is one treatment method that leads to a lot of health rewards, including efficient management of your neuropathy symptoms.

In some cases, a mild painkiller such as aspirin or paracetamol is all that is needed for symptom relief. Antidepressant drugs may be prescribed by your doctor to lessen physical pain, and nerve pain can be treated with duloxetine, pregabalin, gabapentin and other drugs.

Diabetic Neuropathy and Diet

What Foods Should Be Avoided?

We all have a food or foods that we avoid, for reasons other than taste. We do so because of uncomfortable or painful repercussions that accompany eating that food. Tomatoes and tomato-based products cause anxiety in some people, and not others.

You probably know someone who can wolf down anything and everything in sight, and not gain a pound. While on the other hand, you may gain weight if you don’t strictly follow a regimented diet plan.

There are plenty of ways that your diet can positively and negatively affect your health, and this is true with diabetic neuropathy.
When it comes to hat is good or bad in food, it is too easy to generalize. However, what is good for one person may be toxic for another.

Our genetics and environment conspire to make us all individuals, including our reactions to foods and food types.

If you are allergic to peanuts, you can’t blame the little legume for the things that happen to you if you knowingly or unwittingly eat peanuts. Your body has simply developed a reaction to that particular type of food, so you avoid eating peanuts.

For someone who is diagnosed with diabetic neuropathy, there are also foods which should be avoided. This is certainly a situation where you should not leave your treatment solely to your doctor.

Wise choices and actions you take will possibly have the biggest positive impact on your condition and the resultant symptoms.

If your diabetes has been accompanied with nerve damage, try not to eat or drink the following foods and liquids, or you could worsen an already bad situation.

Monosodium Glutamate (MSG)
MSG is a dangerous flavor enhancer found in many foods. It is used commonly in Chinese and other Asian foods, soups, frozen dinners, processed meats and canned vegetables.

It begins life as a salt, something that most people already get too much of, and moves through a process that turns it into a flavor which is desirable to your taste buds.

Monosodium glutamate has been linked to obesity, nerve damage in the brain, autoimmune diseases, diabetes, and inflammation. Inflammation is the basis for most chronic diseases.

As it turns out, MSG is also extremely bad for diabetes sufferers with neuropathy. MSG intensifies pain levels and damages your nerves, something a person with a compromised nervous system due to diabetic neuropathy obviously doesn’t want to experience.

Food manufacturers hide MSG under the names sodium caseinate, glutamic acid, yeast extract, hydrolyzed vegetable protein, textured whey protein, and textured soy protein.

Beer, wine and alcohol should be limited or avoided entirely if you have diabetic neuropathy. This is because excessive alcohol consumption can cause nerve damage. If you already have a condition which has damaged a part of your nervous system, there is no need to make the situation worse by damaging or killing off more nerves.

Man-Made Sugar
The natural sugars found in fruits and some vegetables are good for you. They are accompanied with wonderfully healthy nutrients, minerals, vitamins and essential elements for well-being.
However, table sugar, refined sugar and added sugars can trigger pain if you have diabetic neuropathy.

Unfortunately, sugar is often labeled under more than 100 names other than sugar, like corn sweetener, dextrose, fructose, fruit juice concentrates, glucose, high-fructose corn syrup, and any other ingredient which ends in -ose.

Found as an artificial sweetener in processed foods, diet sodas, some yogurts and candies, this additive heightens your sensitivity to pain, just like MSG does.

Doctors and researchers have found that when diet soda is eliminated from the diets of people complaining of chronic pain, the symptoms are reduced, and often eliminated entirely.

Foods to Eat if Suffering from Diabetic Neuropathy

What you eat is the biggest factor contributing to whether your glucose level is high, low or normal. Accordingly, some foods can help you better manage diabetic neuropathy.

Just as eating a banana can help you relieve stress and anxiety, avoiding foods which spike your blood sugar is an effective way you can manage diabetic neuropathy with your diet.

Since high glucose causes most of the damage in this type of neuropathy, you need to eat more foods which are slowly absorbed into your bloodstream. These are those foods which have a low glycemic index, or G.I.

That means eating more fresh fruits and vegetables, raw or lightly steamed, boiled or broiled, whenever you can. Those foods are dense in nutrients and low in calories and carbohydrates. They take longer for your digestion to process and they release glucose into the bloodstream in a controlled manner.

This is because the carbohydrates which are present in fruits and vegetables are known as complex carbohydrates. Their complexity lies in how they are constructed. Broccoli and other cruciferous vegetables are complex carbohydrates.

Sugar is the King of the simple carbs, and is almost immediately absorbed into your bloodstream, in one go, instead of in a steady and sustainable release.

Not only do fiber-rich foods like broccoli take a long time to chew, they also make you feel full longer after a meal than when you predominantly eat simple carbohydrates. If you sprinkle a little sugar on your tongue, it only takes a few seconds for it to be processed.

Complex carbohydrates take much longer for your body to digest them. This means you don’t get a rapid hike in your blood sugar level, and you help control your diabetic neuropathy symptoms.

Some high-fiber foods include split peas and lentils, black beans and figs. Lima beans, artichokes, avocados and Asian pears are also high in fiber, as are chickpeas, nuts, okra, raspberries and blackberries, Brussel sprouts and oatmeal.

The complete line of B vitamins is good for your nerves, so eat more foods like eggs and liver. The lentils, split peas and black beans mentioned earlier are also full of B vitamins. Add spinach, mushrooms, salmon and pine nuts to ensure you get the full range of 8 different B vitamins.

Fighting inflammation is also crucial for managing diabetic neuropathy. Inflammation is the cornerstone of most chronic diseases, and when you have nerves which have been damaged by high glucose levels, they are more susceptible to inflammation.

Foods with omega-3 essential fatty acids actually cool down inflammation, so get plenty of oily fish like salmon or tuna, flax-seeds or flax-seed oil, or eat 3 ounces of walnuts daily.

Ginger, thyme and turmeric spices are helpful for fighting inflammation and reducing pain signals, as are coffee (sugar-free), olive oil and the chemical resveratrol, found in red grapes.

If you eat wild caught fish 3 or 4 times a week, as well as plenty of healthy fruits, vegetables and nuts, you can dramatically impact your diabetic neuropathy in a positive manner.

As a smart complement to any healthy diet, you should be drinking plenty of water, getting lots of rest and exercising regularly to get the most health benefits out of the foods just mentioned.

What Vitamins are Good for Diabetic Neuropathy?

There are natural ways to manage diabetic neuropathy. Just as dietary changes are recommended to prevent and reverse a diabetes diagnosis, the foods you put into your body can go a long way to minimizing the effect of nerve damage caused by elevated glucose levels in your blood.

There are additionally certain vitamins which have proven effective for reducing the symptoms and pain associated with this type of nerve damage. The RDI or recommended daily intake of vitamins are prescribed for a healthy person.

When a person has diabetes their vitamin requirements will be increased to help combat their condition. Additionally, many of the medications for diabetes and its symptoms either deplete vitamins from the body or adversely affect the absorption of them.

For those suffering with diabetic neuropathy the effect is compounded. Medications such as antidepressants which may be prescribed for general pain relief are some of the worst for interfering with vitamin uptake. Ask your doctor if vitamin supplementation is appropriate in your case.

The following vitamins can slow down and stop the progression of neuropathy caused by high blood sugar. When taken with a healthy diet consisting of a wide range of fruits, vegetables, nuts and berries, these vitamins lead to other health benefits as well.

Remember to drink plenty of water every day to help transport these essential nutrients to where they are needed. It will also aid in the cleansing of impurities, waste and toxins from your body, which will limit inflammation causing more nerve damage.

B Vitamins
The B group of vitamins are essential for proper nerve function and a lack of any will exacerbate any nerve-related condition such as diabetic neuropathy.

Thiamine is also known as vitamin B1. The lack of this important vitamin in your body can directly cause neuropathy, and on the flip-side of that coin, thiamine (thiamin) can effectively treat the pain that accompanies some types of diabetic neuropathy.

Thiamine can be used to create a fat-soluble derivative called benfotiamine. This B-1 derivative is absorbed easily by your digestive system. It goes to work repairing and protecting pathways that lead to diabetic neuropathy. Doctors believe it also helps relieve neuropathy symptoms such as pain, particularly when given in doses ranging from 300 to 600 mg each day.

One of the main jobs of vitamin B12 is to promote a healthy nervous system, and a lack will contribute to nerve damage. Many of the medications prescribed to diabetics prevent efficient absorption of vitamin B12 even if consumption is the recommended daily intake, so supplementation is often necessary.

Homocysteine is found in high levels in some people with diabetic neuropathy, and is not usually found when vitamin B12 is in a healthy supply. A particular form of vitamin B12 known as methylcobalamin promotes healthy nerve tissue, and can reduce the amount of damage done by diabetic neuropathy.

Folic acid is also known as folate or vitamin B9. Just like it’s big brother B12, folic acid is vital for healthy nerve functioning. Vitamin B6 improves the health of blood vessels which supply your nerves. Because of this, and the importance of B12 to a healthy nervous system, experiments combining B12, B6 and folic acid have shown promising results in treating diabetic neuropathy.

Vitamin C
Vitamin C is found in low level in diabetics. Doctors believe this is not because those individuals were not taking in enough vitamin C. In diabetics, proper vitamin C consumption can occur, but the way that diabetes works seems to negate many health properties vitamin C offers.

Vitamin C is essential for supporting the immune system and the nervous system, both of which are compromised if a person has diabetes. Take extra care to ensure intake of natural sources such as fruits and vegetables. If this is not possible, supplementation will be necessary.

Vitamin E
Vitamin E is important for many reasons. As with all other essential minerals and nutrients, there are some health conditions which naturally lead to lower levels of this vitamin. One such condition is diabetes. A daily supplementation of vitamin E has accordingly proven effective in improving nerve conduction in those diagnosed with type 2 diabetes, and also for reducing symptoms of peripheral neuropathy.


Unfortunately, even if the underlying diabetic condition is successfully reversed or reduced, some of the effects it has caused cannot be undone. Advanced diabetes can cause profound damage to nerves, which then affect surrounding tissue in muscles and organs.

This does not mean that the symptoms and effects of this neuropathy cannot be managed or minimized. Natural and pharmaceutical options are available to help deal with and reduce both incidence and intensity of symptoms.
Research is ongoing to find improved methods of overcoming existing damage.
For now, the most enduring cure for diabetic neuropathy symptoms is the same as for the diabetic condition which caused it – make better, healthier choices regarding diet and exercise.

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