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Diabetic Neuropathies; Types, Causes, Symptom, Diagnosis, Treatment

Diabetic neuropathies are nerve damaging disorders associated with diabetes mellitus. These conditions are thought to result from diabetic microvascular injury involving small blood vessels that supply nerves (vasa nervorum) in addition to macrovascular conditions that can culminate in diabetic neuropathy. Relatively common conditions which may be associated with diabetic neuropathy include third nerve palsy; mononeuropathy; mononeuropathy multiplex; diabetic amyotrophy; a painful polyneuropathy; autonomic neuropathy; and thoracoabdominal neuropathy.

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Alternative Names

Diabetic neuropathy; Diabetes – neuropathy; Diabetes – peripheral neuropathy

Epidemiology

Neuropathies related to diabetes can affect 60-70% of people with diabetes. Neuropathy associated with type 2 diabetes may be present at the time of diagnosing diabetes. Neuropathy associated with type 1 diabetes usually develops more than 10 years after the diagnosis of diabetes. Diabetes is the most common cause of peripheral neuropathy in the world

Risk factors

Smoking.
Age over 40 years.
History of periods of poor glycaemic control.
Prevalence increases with increased duration of diabetes.
People with signs of neuropathy are likely also to have evidence of diabetic nephropathy and diabetic retinopathy.
Hypertension.
Coronary heart disease.

Types of Neuropathies and affected areas of the body
Peripheral neuropathy affects	Autonomic neuropathy affects	Proximal neuropathy affects	Focal neuropathy affects
Toes	Heart and blood vessels	Thighs	Eyes
Feet	Digestive system	Hips	Facial muscles
Legs	Urinary tract	Buttocks	Ears
Hands	Sex organs	Legs	Pelvis and lower back
Arms	Sweat glands		Chest
	Eyes		Abdomen
	Lungs		Thighs
			Legs
			Feet

Source: http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/#what

Causes of diabetic neuropathy

Diabetic neuropathy is caused by high blood sugar levels sustained over a long period of time. Other factors can lead to nerve damage, such as:

damage to the blood vessels, such as damage done by high cholesterol levels
mechanical injury, such as injuries caused by carpal tunnel syndrome
lifestyle factors, such as smoking or alcohol use
metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin
neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves
autoimmune factors that cause inflammation in nerves
mechanical injury to nerves, such as carpal tunnel syndrome
inherited traits that increase susceptibility to nerve disease
lifestyle factors, such as smoking or alcohol use

Low levels of vitamin B-12 can also lead to neuropathy. Metformin (Glucophage), a common medicine used to manage the symptoms of diabetes, can cause lower levels of vitamin B-12.

Classification

Diabetic neuropathy encompasses a series of different neuropathic syndromes which can be schematized in the following way

Focal and multifocal neuropathies

Mononeuropathy
Amyotrophy, radiculopathy
Multiple lesions “mononeuritis multiplex”
Entrapment (e.g. median, ulnar, peroneal)

Symmetrical neuropathies:

Acute sensory
Autonomic
Distal symmetrical polyneuropathy (DSPN), the diabetic type of which is also known as diabetic peripheral neuropathy (DPN) (most common presentation)

Sign symptoms

1.Peripheral neuropathy

Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include:

Numbness or reduced ability to feel pain or temperature changes
A tingling or burning sensation
Sharp pains or cramps
Increased sensitivity to touch — for some people, even the weight of a bed sheet can be agonizing
Muscle weakness
Loss of reflexes, especially in the ankle
Loss of balance and coordination
Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain

Sensory neuropathy

Sensory neuropathy affects the nerves that carry messages of touch, temperature, pain and other sensations from the skin, bones and muscles to the brain. It mainly affects the nerves in the feet and the legs, but people can also develop this type of neuropathy in their arms and hands.

Symptoms can include:

Tingling and numbness
Loss of ability to feel pain
Loss of ability to detect changes in temperature
Loss of coordination – when you lose your joint position sense
Burning or shooting pains – these may be worse at night time.

The main danger of sensory neuropathy for someone with diabetes is loss of feeling in the feet, especially if you don’t realise that this has happened. This is dangerous because you may not notice minor injuries caused by:

Walking around barefoot
Sharp objects in shoes
Friction from badly fitting shoes
Burns from radiators of hot water bottles.

If ignored, minor injuries may develop into infections or ulcers. People with diabetes are more likely to be admitted to hospital with a foot ulcer than with any other diabetes complication. Related image

Autonomic neuropathy

Autonomic neuropathy affects nerves that carry information to your organs and glands. They help to control some functions without you consciously directing them, such as stomach emptying, bowel control, heart beating and sexual organs working.

Damage to these nerves can result in

Risk factors include hypertension and dyslipidaemia. It is more common in females.

Cardiac autonomic neuropathy, which has been linked to:

Resting tachycardia, postural hypotension, orthostatic bradycardia and orthostatic tachycardia.
Exercise intolerance.
Decreased hypoxia-induced respiratory drive.
Loss of baroreceptor sensitivity, increased intra-operative or peri-operative cardiovascular lability.
Increased incidence of asymptomatic myocardial ischaemia, myocardial infarction, decreased rate of survival after myocardial infarction.
Congestive heart failure.

Genitourinary:

Impotence, retrograde ejaculation, urinary hesitancy, overflow incontinence.
At least 25% of men with diabetes have problems with sexual function.
There is often no association with glycaemic control or with duration or severity of diabetes.
Risk factors for erectile dysfunction include increasing age, alcohol, initial glycaemic control, intermittent claudication and retinopathy.

Gastrointestinal:

Nausea and vomiting.
Abdominal distension.
Dysphagia.
Diarrhoea.

Gustatory sweating, anhidrosis.

Tends to be associated with peripheral neuropathy.
People with both types 1 and 2 are affected.
High mortality rate (50% within three years) mainly due to chronic kidney disease but there is often no obvious cause.
Tight glycaemic control reduces the risk.

Symptoms include also include according to who

Bloating
Heartburn and bloating
Nausea, constipation or diarrhea
Not feeling low blood sugar levels (hypoglycemic unawareness)
Difficulty speaking or swallowing
Feeling full when eating small amounts of food
Vomiting a few hours after eating
Orthostatic hypotension, or feeling light-headed and dizzy when standing up
Faster heart rate than normal
Excessive sweating, even when temperature is cool or the individual is at rest
Bladder problems, for example, difficulty in emptying the bladder completely when urinating, leading to incontinence
Sexual dysfunction in men
Sexual problems in women with vaginal dryness and inability to experience orgasm
Dysesthesia, when the patient’s sense of touch is distorted
Significant drooping of the face and eyelids
Muscle contractions and weakness.

Motor neuropathy

Motor neuropathy affects the nerves which control movement. Damage to these nerves leads to weakness and wasting of the muscles that receive messages from the affected nerves. This can lead to problems such as:

muscle weakness, which could cause falls or problems with tasks such as fastening buttons.
muscle wasting, where muscle tissue is lost due to lack of activity
muscle twitching and cramps.

Focal neuropathy

Focal neuropathy appears suddenly and affects specific nerves, most often in the head, torso, or leg. Focal neuropathy may cause

inability to focus the eye
double vision
aching behind one eye
paralysis on one side of the face, called Bell’s palsy
severe pain in the lower back or pelvis
pain in the front of a thigh
pain in the chest, stomach, or side
pain on the outside of the shin or inside of the foot
chest or abdominal pain that is sometimes mistaken for heart disease, a heart attack, or appendicitis

Focal neuropathy is painful and unpredictable and occurs most often in older adults with diabetes. However, it tends to improve by itself over weeks or months and does not cause long-term damage.

Radiculoplexus neuropathy (diabetic amyotrophy)

Radiculoplexus neuropathy affects nerves in the thighs, hips, buttocks or legs. Also called diabetic amyotrophy, femoral neuropathy or proximal neuropathy, this condition is more common in people with type 2 diabetes and older adults.

Symptoms are usually on one side of the body, though in some cases symptoms may spread to the other side. Most people improve at least partially over time, though symptoms may worsen before they get better. This condition is often marked by:

Sudden, severe pain in your hip and thigh or buttock
Eventual weak and atrophied thigh muscles
Difficulty rising from a sitting position
Abdominal swelling, if the abdomen is affected
Weight loss

Mononeuropathy

Mononeuropathy involves damage to a specific nerve. The nerve may be in the face, torso or leg. Mononeuropathy, also called focal neuropathy, often comes on suddenly. It’s most common in older adults.

Although mononeuropathy can cause severe pain, it usually doesn’t cause any long-term problems. Symptoms usually diminish and disappear on their own over a few weeks or months. Signs and symptoms depend on which nerve is involved and may include:

Difficulty focusing your eyes, double vision or aching behind one eye
Paralysis on one side of your face (Bell’s palsy)
Pain in your shin or foot
Pain in your lower back or pelvis
Pain in the front of your thigh
Pain in your chest or abdomen

Sometimes mononeuropathy occurs when a nerve is compressed. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes.

Signs and symptoms of carpal tunnel syndrome include:

Numbness or tingling in your fingers or hand, especially in your thumb, index finger, middle finger and ring finger
A sense of weakness in your hand and a tendency to drop things

Silent diabetic peripheral neuropathy.

Up to 50% of people with peripheral neuropathy have no painand may not realize their feet are numb.This boosts the risk for foot ulcers (if you don’t notice cuts or blisters, for example) and increases the risk for amputations 2.5-fold.

Diagnosing diabetic neuropathy

A physician will carry out a physical exam and do a foot exam to check for

Pinprick test – Light touches with a pin-like device on parts of the feet and toes will show whether nerves are still sensitive to pain.

Ankle reflex – The test is performed at both ankles. With the patient sitting or lying, the examiner dorsiflexes the foot and gently strikes the Achilles tendon with the reflex hammer.

Vibration perception – The doctor may use a tuning fork on your feet to test your ability to feel the vibration from the tuning fork. If you cannot feel the vibration, that may indicate diabetic neuropathy.

Pressure sensation – Your doctor may use flexible nylon filaments to help determine how much pressure you can feel. He or she will use different sizes of filaments; each requires a different amount of pressure to make it bend. If you cannot feel the pressure of the filament, that may indicate diabetic neuropathy. ⁷ Some doctors will lightly touch your toes with a finger (as you close your eyes or look away) to check for pressure sensation instead.

Loss of sensation
Changes in skin texture
Changes in skin color
Loss of the ability to sense movement of your joints (proprioception)
Drop in blood pressure when you stand up after sitting or lying down
No reflexes or weak reflexes in the ankle
Loss of feeling in the feet (this is checked with a brush-like instrument called a monofilament
Changes in the skin, including dry skin and thick or discolored nails
Electromyogram (EMG), a recording of electrical activity in muscles
Nerve conduction velocity tests (NCV), a recording of the speed at which signals travel along nerves
Gastric emptying study to check how fast food leaves the stomach and enters the small intestine
Tilt table study to check if the nervous system is properly controlling blood pressure
Full assessment of diabetes and blood pressure control. Assessment of other possible causes – eg, TFTs, B12.
May require nerve conduction studies and electromyography.

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Treatments

Pain Relief

Doctors usually treat painful diabetic neuropathy with oral medications, although other types of treatments may help some people. People with severe nerve pain may benefit from a combination of medications or treatments and should consider talking with a health care provider about treatment options.

Medications used to help relieve diabetic nerve pain include

Acetaminophen: This is a painkiller, also known as an analgesic. Tylenol is an example of acetaminophen, and it works by blocking pain messages to the brain. In essence, acetaminophen makes it harder for the “pain” signal to travel through the nerves and to the brain, and therefore, the brain doesn’t know that it should be feeling pain.
Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs have a two-fold effect—they work as painkillers and they fight inflammation. They work by blocking the body from creating prostaglandins, which are chemicals that cause inflammation and pain. By taking an NSAID, you prevent your body from making as many prostaglandins, thereby decreasing inflammation and pain.
Topical Medication: There are several medications available that you apply directly to your skin; these are called topical medications.One option is capsaicin cream. Capsaicin is what makes chili peppers hot, and it can also relieve your pain. It just temporarily reduces your pain, though, so you’ll need to keep re-applying.
Anticonvulsants- Such as pregabalin (Lyrica), gabapentin (Gabarone, Neurontin), carbamazepine, and lamotrigine (Lamictal)

Anti-depressants: It’s not required to be depressed in order to take an anti-depressant. Anti-depressants work by blocking pain messages on their way to the brain, and it’s also thought that anti-depressants stimulate the release of endorphins, which are the body’s natural painkillers.

There are several types of anti-depressants available to treat diabetic neuropathy:

Tricyclic anti-depressants: By raising levels of calming neurotransmitters in your brain, tricyclic anti-depressants can, most importantly, reduce pain. They can also improve your mood and help you deal with sleep issues (it can be difficult to sleep when you have severe nerve pain).For diabetic nerve pain, amitriptyline (eg, Elavil, Tryptanol), desipramine (eg, Norpramin and Pertofrane), and imipramine (eg, Antideprin and Deprinol) are commonly prescribed. They’re called “first line” medications because they are among the first medications doctors will try to relieve neuropathy because they are usually effective and safe.
Serotonin-norepinephrine reuptake inhibitors (SNRIs): Commonly called SNRIs, these anti-depressants increase how much serotonin and norepinephrine you have in your system. They do this by blocking them from being reabsorbed by brain cells; they inhibit their reuptake. With more serotonin and norepinephrine, you should have better mental balance and reduced pain.
Selective serotonin reuptake inhibitors (SSRIs): Selective serotonin reuptake inhibitors—abbreviated to SSRI—increase how much serotonin you have. They are different from SNRIs in that they focus on serotonin. SSRIs block serotonin reuptake so that your serotonin level is increased. If you have more serotonin, you have less pain perception.

Anti-seizures (also called anti-convulsants or anti-epileptics): As the name implies, these medications were—and still are—used to treat seizures. They work on diabetic neuropathy by slowing down nerve signals so that the pain message isn’t transmitted as effectively.
Anti-Seizure Drugs-Drugs used to prevent epileptic seizures can also help with nerve pain. These drugs include pregabalin (Lyrica), gabapentin (Gabarone, Neurontin), phenytoin (Dilantin), and carbamazepine (Carbatrol, Tegretol). Pregabalin can also improve your sleep. Side effects include drowsiness, swelling, and dizziness.
Some examples of anti-seizures and anti-convulsants are: pregabalin (Lyrica) and gabapentin (Gabarone and Neurontin). Lyrica is FDA-approved to treat diabetic neuropathy.
Opioids (Narcotics) – Opioids, also called narcotics, are very serious, heavy-duty painkillers. They can be used to provide immediate relief for severe pain, but because they can be addictive, you must exercise extreme caution and prudence when using them; use them only under a doctor’s careful supervision.Tramadol (Ultram or Ultracet) is an example of an opioid. Oxycodone (OxyContin) is another example that has proven useful in relieving diabetic neuropathy pain.
Topical Medication – In addition to capsaicin cream, which is available without a prescription, another topical medication is a lidocaine patch. You must have a prescription to use a lidocaine patch. Lidoderm is an example of a lidocaine patch.
Other types of antidepressants – such as duloxetine (Cymbalta), venlafaxine, bupropion (Wellbutrin), paroxetine (Paxil), and citalopram (Celexa)
opioids and opioidlike drugs, such as controlled-release oxycodone, an opioid; and tramadol (Ultram), an opioid that also acts as an antidepressant

Duloxetine and pregabalin are approved by the U.S. Food and Drug Administration specifically for treating painful diabetic peripheral neuropathy.

Drug treatments recommended by the National Institute for Health and Care Excellence (NICE)

Offer a choice of amitriptyline, duloxetine, gabapentin or pregabalin as initial treatment for neuropathic pain.
If the initial treatment is not effective or is not tolerated, offer one of the remaining three drugs; consider switching again if the second and third drugs tried are also not effective or not tolerated.
Consider tramadol only if acute rescue therapy is needed.
Consider capsaicin cream for people with localised neuropathic pain who wish to avoid, or who cannot tolerate, oral treatments.
Opioids other than tramadol should be avoided unless they are part of shared-care arrangements after specialist assessment.
Patients on drug treatment should be reviewed early when starting treatment for dosage titration, or when changing dose to monitor for adverse effects and tolerability.
Regular reviews (NICE does not specify a time interval) should also be arranged to check progress, adverse effects, mood, quality of sleep and any problems with daily activities.

**Management of autonomic neuropathy

Cardiovascular effects – various cardio-active drugs are being used to reverse the effects on the cardiovascular system, including angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, diuretics and digoxin.
Erectile dysfunction: see separate Erectile Dysfunction article.

Gastroparesis:

Investigation using radiological or radioisotope methods may help in the diagnosis.
Investigation of cardiovascular autonomic neuropathy may help in the diagnosis.
Metoclopramide and domperidone are worth a trial.

Diabetic nocturnal diarrhoea:

Investigation must exclude other causes of intestinal upset.
May be helped by high doses of codeine, loperamide or diphenoxylate, or by erythromycin or tetracycline.

Gustatory sweating:

Explanation and counselling are often required.
Topical or oral anticholinergic agents (eg, poldine methylsulfate) may be effective.

Postural hypotension:
- May respond to fludrocortisone.

NICE recommends

Consider the possibility of contributory sympathetic nervous system damage for adults with diabetes who lose the warning signs of hypoglycaemia.
In adults with type 1 diabetes who have unexplained diarrhoea, particularly at night, the possibility of autonomic neuropathy affecting the gut should be
considered.
Take care when prescribing antihypertensive medicines or tricyclic antidepressants not to expose people to the risks of orthostatic hypotension as a result of the combined effects of sympathetic autonomic neuropathy and blood pressure-lowering medicines.
In adults with diabetes who have bladder emptying problems, investigate the possibility of autonomic neuropathy affecting the bladder, unless other
explanations are adequate.
When managing the symptoms of autonomic neuropathy, include standard interventions for the manifestations encountered (eg, abnormal sweating and postural hypotension).

Acute painful neuropathy of rapid improvement of blood glucose control

Acute painful neuropathy resulting from rapid improvement of blood glucose control is a self-limiting condition that improves symptomatically over time.
The specific treatments for acute painful neuropathy resulting from rapid improvement of blood glucose control aim to make the symptoms tolerable until the condition resolves; they may not relieve pain immediately and may need to be taken regularly for several weeks to be effective.
Use of simple analgesics (paracetamol, aspirin) and local measures (bed cradles) are recommended as a first step; however, if trials of these measures are ineffective, they should be stopped and other measures tried.
Diabetes control should not be relaxed to address acute painful neuropathy resulting from rapid improvement of blood glucose control in adults with type 1 diabetes.
If simple analgesia does not provide sufficient pain relief for adults with type 1 diabetes who have acute painful neuropathy resulting from rapid improvement
of blood glucose control, treatments for neuropathic pain should be offered .

Physical Therapy

Some physical therapy treatments, such as swimming, can help treat diabetic neuropathy. Low-impact exercises are the most effective, as high-impact exercises can quickly cause nerves to go numb.

Be sure to choose a trusted physical therapist who understands neuropathy, diabetic or otherwise, to help you work through physical therapy methods in order to prevent further nerve damage. Proper attention to physical activity by an expert can prevent any further issues from occurring. Keep in mind, too, that physical therapy can soothe diabetic nerve pain, but not cure it.

Capsaicin – Capsaicin cream, applied topically to the skin, can reduce pain sensations in some people. Just be careful of side effects such as a burning feeling and skin irritation.

Acupuncture – The traditional Chinese therapy of inserting fine needles into points on the skin may help relieve the pain of neuropathy, and generally doesn’t have any side effects. It promotes the body’s own healing.

Transcutaneous electrical nerve stimulation (TENS) – This therapy may help prevent pain signals from reaching your brain. TENS delivers electrical impulses to specific nerve pathways through small electrodes placed on your skin. It’s considered safe and painless, but may not work on all types of pain.

Keep your blood pressure under control – People with diabetes are more likely to have high blood pressure. When have both, however, your risk of complications jumps – both damage your blood vessels and reduce blood flow. Try to keep your blood pressure in the range your doctor recommends, and be sure to have it checked regularly.

Gait training – Means relearning how to walk. It helps to prevent and stabilize foot complications, such as ulcers. Gait training is crucial for people who are using a prosthesis because they have lost limbs due to diabetic neuropathy. A good physical therapist will ensure that exercises for patients with diabetic neuropathy do not hurt their feet, which are usually sensitive..

A chiropractor – massage therapist, or osteopath can carry out regular massages or manual therapy to stretch the muscles. Massage can inhibit muscle contractures, spasms, and atrophy due to poor blood supply. Specific exercises, such as swimming or aerobics can develop and maintain muscle strength and reduce muscle mass reduction.

Therapeutic ultrasound – Uses very high-frequency sound waves to stimulate the tissue beneath the skin’s surface. This can help some patients to regain sensitivity in their feet.

Harbal ,Ayurvadic& home Treatments

Monitor Your Blood Glucose Levels

The first among home remedies for neuropathy that I want you to keep your head on is that you should monitor your blood sugar levels (glucose).

If you have diabetes, you will need to monitor your blood glucose levels to improve your neuropathy as your blood glucose levels are under control. This is extremely necessary thing to do so that it is listed on top of the list of home remedies for neuropathy I release today.

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Eat Healthy Meals

Following a healthy diet is very important to ensure that you get enough the vitamins and minerals which are essential for your body and overall health. Remember to add more dairy products and low-fat meats to your daily diet and consume a lot of vegetables, fruits, and whole grains in a regular basis to reduce the risk and influences of neuropathy. This is one of the best home remedies for neuropathy that people should not miss out!

Quit Smoking

Smoking cigarette can influence the circulation, raising the risks of foot health problems and other neuropathy related issues. Therefore, people with neuropathy should quit smoking if they want to live healthy.

Vitamin B6

Vitamin B6 is known as pyridoxine, which helps to reduce neuropathic hip pain, the tingling and numbness in the sciatic nerve; helps to repair the damage of the sciatic nerve, which acts to support the red blood cell production, synthesize protein, and increase the dopamine and serotonin production – the neurotransmitter substances that support the central nervous system of human beings.

Foods rich in vitamin B6 include – bananas, garbanzo beans, peanut butter, tomato juice, spinach, soybeans, sunflower seeds, walnuts, poultry, and wheat bran.

Vitamin B9

Vitamin B9 is also called folic acid. It can help to increase the production of red blood cells, aid in cell regeneration, support DNA synthesis, and reduce sciatic nerve pain in the back and limbs. It is also used to improve muscle coordination, protecting your sciatic nerve when it gets hurt, effectively support the embryonic neural development, and assist in the formation of the neural tube, which eventually becomes the central nervous system in a developing fetus.

Foods rich in vitamin B-9 include asparagus, beans, peas, lima beans, corn, mushrooms, liver, broccoli, orange juice, avocado, and green turnip.

Vitamin C

Vitamin C can help to strengthen your immune system and protect your sciatic nerve. Vitamin C can help to reduce the sciatic nerve pain, repair nerve damage, accelerate the healing process, improve nervous system function, and reduce the inflammation of the nerves.

Foods rich in vitamin C include oranges, grapefruit, pineapple, tomato, spinach, mustard greens, spinach, strawberries, cherries, cantaloupe, and cabbage. Consuming more foods which are rich in vitamin C is also among the best natural home remedies for people living with neuropathy and get pains in feet and hands.

Lean Protein

In fact, protein contributes to tissue repair and also allows the body to build lean muscle tissue. A lot of health and neuropathy experts suggest that people should eat more lean-protein foods, such as low-fat dairy products and poultry as important elements of a healthy daily meal plan that is necessary for those people who are suffering from peripheral neuropathy and other forms of neuropathy. Foods that are high in trans and saturated fats, such as highly processed foods, cheeses, butter, whole milk, and deep-fried or fatty meat, will be able to increase risk of diabetes, heart disease, and other conditions that should be avoided.

Fruit And Veggies

This is also one of the best home remedies for neuropathy that I want you to focus on.

Vegetables and fruits provide us with a valuable source of antioxidants, dietary fiber, minerals, and vitamins – the essential nutrients that are known for supporting and boosting a healthy immune system, as well as preventing diseases and infections. The experts recommend people following a daily diet that is high in nutritious vegetables and fruits for those people who are suffering from neuropathy. Vegetables and fruits may have a reducing effect on the blood sugar levels as well, which is especially useful for those people who are suffering or who are at risk of diabetes.

B Vitamins – Rich Foods

B vitamins are water-soluble vitamins that support in the breakdown of foods during digestion. According to health expert, B vitamins are necessary for healthy nerve functions and may help people who are living with developing neuropathy that is unassociated with a specific disease, such as diabetes. You can find valuable rich sources of vitamin B in whole grain cereals and protein-rich foods, such as meats, poultry, fish, brewer’s yeast, milk, eggs, legumes, potatoes and peanuts.

Vitamin B12

Vitamin B-12, which also known as cobalamin, is a crucial water-soluble vitamin. Vitamin B-12 is very necessary for the red blood cells formation. Vitamin B-12 can be obtained easily from animal-based food sources, such as meat and fish. This nutrient is also required for nerve functions and healthy brain. According to health experts, even a mid vitamin B-12 deficiency can cause peripheral neuropathy even though deficiencies are unusual, and they usually happen in elderly and vegans individuals.

Hot Pepper

Hot peppers include capsaicin – an important chemical compound with both analgesic and irritant properties – as well as carotenoid plant pigments, the flavonoid glycosides apiin and luteolin, and steroid saponins. The antioxidant vitamins A and vitamin C are also present, as are the compounds: violaxanthine, alpha-carotin, and capsanthin. Capsaicin and antioxidant will actually give people an effective and quick relief.

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Do Not Eat Too Much Saturated Fat

Saturated fat is a fat form prevalent in dairy products and fatty meats, which may led to an increased risk of heart disease, obesity, type-2 diabetes, and inflammation. For reducing the risk of neuropathy, the University of Virginia Health System suggests that you should follow a nutritious daily diet that is low in saturated fats. The richest sources of saturated fat are full-fat ice cream and cheeses, whole milk, butter, fried foods, dark-meat poultry, lamb, pork, beef, heavy cream and organ meats.

Do Not Consume Too Much Added Sugar

Added sugars, such as honey corn, syrup, and cane sugar, add to foods sweet flavor, but few nutrients, in fact. Similar to refined grains, added sugars are high-glycemic and they may interfere with blood sugar control. You should consume nutritious foods, such as whole grains, vegetables, and fruits, instead of sugary fare most often. You should also avoid common sources of added sugars, such as commercially pies, pastries, cookies, and baked cakes, jellies, frozen desserts milk chocolate, pancake syrup, sugary cereals, candy, and regular soft drinks.

Refined Grains

Refined grains are very rich in glycemic, meaning that they can leave an extremely dramatic impact on your blood sugar levels. According to the Neuropathy Association, glycemic management is the number one strategy that people should implement to prevent the development of neuropathy related to diabetes, which is one of the most common causes of diabetic neuropathy.

Consuming Less Gluten – Rich Foods

The last home remedies for neuropathy that I want to share is that you should consume less gluten – rich foods.

Foods, in fact, can be influential to people who are living with neuropathy differently. If you get a gluten allergy, which is also known as celiac disease, you should not consume gluten as it can trigger and worsen your condition. 50 % of adults who are suffering from celiac disease experience no gastrointestinal symptoms. In these cases, may be numbness and tingling are your only notable symptoms. Gluten is a storage protein that is contained in rye, barley, and wheat.

Walking

Exercising helps improve blood flow to your foot nerves and leg and nourish the damaged nerves back to normal condition. A study indicated that a regular walking program prevented neuropathy in diabetes patients during that course. The findings of study showed that walking slow the process of neuropathy in people who had already had neuropathic condition.

Exercising also helps lower blood sugars, increases your tolerance levels for the nerve pain and keeps your diabetes in control.

Warm Water Treatment

As one of easy natural home remedies for neuropathy, you can take warm bath to relieve mild nerve pain. In fact, warm water helps boost your blood flow to leg skin so it makes you get rid of stress and feel relaxed. Check out the water temperature before you step in. It should not be too hot or too cold.

Drinking Less Alcohol

A drink of proper alcohol daily can give you health benefits, but drink toomuch alcohol is associated with diabetic neuropathy. In fact, a high dose of alcohol is toxic to our nerves. The best solution for you is to reduce amounts of alcohol you consume. According to doctor, you should limit drinking over 4 drinks of alcohol per week and avoid drinking strong alcohol.

Taking Evening Primrose Oil

Evening primrose plant is high in omega-6 fatty acids, important structural components of your cell walls. Scientifically, supplementing your diet with evening primrose oil is available in medication and it is proven to enhance the regrowth of your damaged nerves cells.

Taking Botanical Oils

Studies have indicated that botanical oils like geranium oil can ease postherpetic neuralgia pain. Other botanical oils like lavender oil can help relax the body and take mind off nerve sore and pain.

Taking Alpha-Lipoic Acid

Alpha-lipoic acid is a potent antioxidant that can clear so-called free radicals out of the body and reduce nerve damage. In Germany, this acid is applied to ease nerve pain from diabetes.

How to end chronic peripheral neuropathy & diabetic nerve pain naturally without drugs or surgery?

Taking Magnesium

The body uses magnesium for new cell creation, fatty acid formation, clotting blood, nerve function supporting muscle and energy boosting. According to a study from the University of Florida, diabetic peripheral neuropathy was worsened as the neuropathic patients in the study had the magnesium deficiency. The scientists suggested that the recommended dose of magnesium is about 400mg. Take it twice a day.

Chiropractic Massage

The Medical News Today reported that many people with neuropathy benefited from chiropractic massage. Actually, massage can help loosen tight muscles as well as aid with the nerve connection and circulation, and relax the body. Make sure to choose right massage therapist, and ask the doctor to know what massages are for neuropathy.

All of the 18 natural home remedies for neuropathy pain in feet and hands above are proven to work effectively for a lot of neuropathy patients. I have studied them for a long time, and now, I am glad to share them with anyone who desires to get rid of the neuropathy condition within a short time.

Homeopathy Treatments

Following homeopathic remedies are used to treat diabetes neuropathy

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Aconite
Belladonna
Phosphorus
Allium cepa
Antimonium crudum
Arsenicum album
Coctus grandifolia
Cedron
Cicuta virosa
Coca
Gelsenium sempervirens
Hypericum
Ipecacuanha
Kalmia latifolia
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All about diabetic neuropathy - Dr. Axe

Urinary and Sexual Problems Care

To clear up a urinary tract infection, the doctor will probably prescribe an antibiotic. Drinking plenty of fluids will help prevent another infection. People who have incontinence should try to urinate at regular intervals—every 3 hours, for example—because they may not be able to tell when the bladder is full.

To treat erectile dysfunction in men, the doctor will first do tests to rule out a hormonal cause. Several methods are available to treat erectile dysfunction caused by neuropathy. Medicines are available to help men have and maintain erections by increasing blood flow to the penis. Some are oral medications and others are injected into the penis or inserted into the urethra at the tip of the penis. Mechanical vacuum devices can also increase blood flow to the penis. Another option is to surgically implant an inflatable or semirigid device in the penis.

Vaginal lubricants may be useful for women when neuropathy causes vaginal dryness. To treat problems with arousal and orgasm, the doctor may refer women to a gynecologist.

Foot Care

People with neuropathy need to take special care of their feet. The nerves to the feet are the longest in the body and are the ones most often affected by neuropathy. Loss of sensation in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers. Smoking increases the risk of foot problems and amputation. A health care provider may be able to provide help with quitting smoking.

More than 60 percent of all nontraumatic lower-limb amputations in the United States occur in people with diabetes. Nontraumatic amputations are those not caused by trauma such as severe injuries from an accident. In 2004, about 71,000 nontraumatic amputations were performed in people with diabetes. Comprehensive foot care programs can reduce amputation rates by 45 to 85 percent.

Careful foot care involves

cleaning the feet daily using warm—not hot—water and a mild soap. Soaking the feet should be avoided. A soft towel can be used to dry the feet and between the toes.
inspecting the feet and toes every day for cuts, blisters, redness, swelling, calluses, or other problems. Using a mirror—handheld or placed on the floor—may be helpful in checking the bottoms of the feet, or another person can help check the feet. A health care provider should be notified of any problems.
using lotion to moisturize the feet. Getting lotion between the toes should be avoided.
filing corns and calluses gently with a pumice stone after a bath or shower.
cutting toenails to the shape of the toes and filing the edges with an emery board each week or when needed.
always wearing shoes or slippers to protect feet from injuries. Wearing thick, soft, seamless socks can prevent skin irritation.
wearing shoes that fit well and allow the toes to move. New shoes can be broken in gradually by first wearing them for only an hour at a time.
looking shoes over carefully before putting them on and feeling the insides to make sure the shoes are free of tears, sharp edges, or objects that might injure the feet.

Points to Remember

Diabetic neuropathies are nerve disorders caused by many of the abnormalities common to diabetes, such as high blood glucose.
Neuropathy can affect nerves throughout the body, causing numbness and sometimes pain in the hands, arms, feet, or legs, and problems with the digestive tract, heart, sex organs, and other body systems.
Treatment first involves bringing blood glucose levels within the normal range. Good blood glucose control may help prevent or delay the onset of further problems.
Foot care is an important part of treatment. People with neuropathy need to inspect their feet daily for any injuries. Untreated injuries increase the risk of infected foot sores and amputation.
Treatment also includes pain relief and other medications as needed, depending on the type of nerve damage.
Smoking increases the risk of foot problems and amputation. A health care provider may be able to provide help with quitting.

Complications

Diabetic neuropathy can cause a number of serious complications, including

Loss of a limb – Because nerve damage can cause a lack of feeling in your feet, cuts and sores may go unnoticed and eventually become severely infected or ulcerated — a condition in which the skin and soft tissues break down. The risk of infection is high because diabetes reduces blood flow to your feet. Infections that spread to the bone and cause tissue death (gangrene) may be impossible to treat and require amputation of a toe, foot or even the lower leg.
Charcot joint – This occurs when a joint, usually in the foot, deteriorates because of nerve damage. Charcot joint is marked by loss of sensation, as well as swelling, instability and sometimes deformity in the joint itself. Early treatment can promote healing and prevent further damage.
Urinary tract infections and urinary incontinence – Damage to the nerves that control your bladder can prevent it from emptying completely. This allows bacteria to multiply in your bladder and kidneys, leading to urinary tract infections. Nerve damage can also affect your ability to feel when you need to urinate or to control the muscles that release urine.
Hypoglycemia unawareness – Normally, when your blood sugar drops too low — below 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L) — you develop symptoms such as shakiness, sweating and a fast heartbeat. Autonomic neuropathy can interfere with your ability to notice these symptoms.
Low blood pressure – Damage to the nerves that control circulation can affect your body’s ability to adjust blood pressure. This can cause a sharp drop in pressure when you stand after sitting (orthostatic hypotension), which may lead to dizziness and fainting.
Digestive problems – Nerve damage in the digestive system can cause constipation or diarrhea — or alternating bouts of constipation and diarrhea — as well as nausea, vomiting, bloating and loss of appetite. It can also cause gastroparesis, a condition in which the stomach empties too slowly or not at all. This can interfere with digestion and cause nausea, vomiting and bloating, and severely affect blood sugar levels and nutrition.
Sexual dysfunction. Autonomic neuropathy often damages the nerves that affect the sex organs, leading to erectile dysfunction in men and problems with lubrication and arousal in women.
Increased or decreased sweating. When the sweat glands don’t function normally, your body isn’t able to regulate its temperature properly. A reduced or complete lack of perspiration (anhidrosis) can be life-threatening. Autonomic neuropathy may also cause excessive sweating, particularly at night or while eating

Prevention of diabetic neuropathy

Be guided by your doctor, but general suggestions to reduce the risk of diabetic neuropathy include:

Maintain blood glucose levels within the target ranges.
Exercise regularly.
Maintain a healthy weight for your height.
Stop smoking.
Reduce your blood pressure and lipid (fat) levels through diet and lifestyle changes, and medication where appropriate
Consult your doctor promptly if you have symptoms including pain, numbness or tingling in your hands or feet.
Have your feet checked at least yearly by your doctor, podiatrist or diabetes educator, or more often if you have signs of problems with your feet or other complications of your diabetes.

Referances

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Forbes, JM; Coughlan MT; Cooper ME (June 2008). “Oxidative stress as a major culprit in kidney disease in diabetes”. Diabetes. 57 (6): 1446–1454. PMID 18511445. doi:10.2337/db08-0057.

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Mayo Clinic Staff. (2015, February 24). Diabetic neuropathy: Causes. Retrieved from http://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/basics/causes/con-20033336

Mayo Clinic Staff. (2015, February 24). Diabetic neuropathy: Symptoms. Retrieved from http://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/basics/symptoms/con-20033336

Nerve damage (diabetic neuropathies). (2013, November). Retrieved from https://www.niddk.nih.gov/health-information/diabetes/preventing-diabetes-problems/nerve-damage-diabetic-neuropathies

Peripheral neuropathy. (2013, December 5). Retrieved from http://www.diabetes.org/living-with-diabetes/complications/neuropathy/peripheral-neuropathy.html

Peripheral neuropathy [Fact sheet]. (2016, March 9). Retrieved from http://www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm

Symptoms of peripheral neuropathy. (n.d.). Retrieved from https://www.foundationforpn.org/livingwithperipheralneuropathy/symptomsperipheralneuropathy.cfm

Urine Analysis / Urinalysis