Diabetic neuropathy occurs when nerves become damaged due to impaired blood flow secondary to uncontrolled high blood sugars in people with diabetes. Elevated blood sugars can damage nerves anywhere in the body but most commonly impact peripheral nerves in the legs, feet, toes, fingers, and hands (peripheral neuropathy).
This damage results in pain, numbness, weakness, and balance issues in the affected areas which can be debilitating in some cases. Diabetic neuropathy can also cause problems with the digestive system, urinary tract, blood vessels, and heart.
As many as 50% of people with diabetes experience diabetic neuropathy. Fortunately, a functional medicine approach can help prevent diabetic neuropathy or slow its progress by implementing lifestyle and other measures to keep blood sugars within a consistently healthy range.
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What is Diabetic Neuropathy?
Diabetic neuropathy is nerve damage due to impaired blood flow secondary to uncontrolled high blood sugars in people with diabetes. Elevated blood sugars can damage nerves anywhere in the body.
There are four major types of diabetic neuropathy, depending on which nerves are impacted.
Peripheral neuropathy or distal symmetric peripheral neuropathy is the most common type of diabetic neuropathy. It usually impacts the toes, feet, and legs first, followed by the fingers, hands, and arms.
Autonomic neuropathy impacts nerves in the autonomic nervous system that control functions like blood pressure, heart rate, sweating, pupillary constriction, bladder contraction, digestive system movement, and sex organ function.
Proximal neuropathy or diabetic polyradiculopathy most commonly affects nerves in the thighs, hips, buttocks, or legs and can also affect nerves in the abdomen and chest.
Mononeuropathy or focal neuropathy occurs with damage to a single, specific nerve in the face, torso, arm, or leg.
Diabetic Neuropathy Symptoms
The symptoms of diabetic neuropathy depend on the type and location of the nerves that are damaged. Symptoms often develop gradually and may not be noticed until considerable nerve damage occurs.
Signs and symptoms of peripheral neuropathy are often worse at night and include the following:
- numbness
- a reduced ability to feel pain or changes in temperature
- burning or tingling
- sharp pains
- muscle weakness
- muscle cramps
- sensitivity to even light touch
- complications over time due to a lack of sensation and blood vessel damage, including ulcers, infections, and bone and joint damage
Autonomic neuropathy can result in symptoms all over the body, such as:
- hypoglycemia unawareness or a lack of awareness that blood sugar levels have dropped too low
- orthostatic hypotension or drops in blood pressure when rising from sitting or lying down that may cause dizziness or fainting
- bladder issues
- difficulty swallowing
- bowel problems
- gastroparesis or slow stomach emptying causing nausea, vomiting, fullness, and loss of appetite
- issues in the way the eyes adjust from light to dark or far to near
- too much or too little sweating
- problems with sexual response
Proximal neuropathy usually causes symptoms that are mainly on one side of the body but may eventually spread to the other side, such as:
- severe pain in the buttock, hip, or thigh
- weak leg muscles with difficulty rising from a sitting position
- atrophy (shrinking) of thigh muscles
- chest or abdominal wall pain
Mononeuropathy causes symptoms like:
- paralysis or the loss of the ability to move a part of the body such as one side of the face
- double vision
- numbness or tingling in the hand or fingers
- weakness in the hand or fingers that may result in clumsiness or dropping things
- pain in the shin or foot
- weakness causing difficulty lifting the front part of the foot resulting in foot drop and difficulty walking
- pain in the front of the thigh
What Causes Diabetic Neuropathy?
When blood sugar levels are not controlled in someone with diabetes, diabetic neuropathy can develop over time. When blood sugar is repeatedly high, it can damage nerves and interfere with their ability to send nerve signals. Elevated blood sugars can also weaken the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients, contributing to the damage.
Neuropathy can develop in anyone with uncontrolled high blood sugars. Some risk factors make nerve damage more likely:
- The longer blood sugars are elevated and poorly controlled within a healthy range, the higher the likelihood that nerves will be damaged. This can occur the longer you have had diabetes and/or the more poor your blood sugar is controlled.
- When the kidneys are damaged from diabetes, more toxins can build up in the blood and can contribute to nerve damage.
- Being overweight or obese may increase the risk of diabetic neuropathy.
- Smoking damages blood vessels and reduces blood flow, especially to the legs and feet, which damages the peripheral nerves.
Functional Medicine Labs to Test for Root Cause of Diabetic Neuropathy
Labs can help practitioners narrow down the root cause of diabetic neuropathy while also providing practitioners with the tools to individualize a treatment plan. The following are some of the most common labs ran for patients suffering from diabetic neuropathy:
Blood Sugar and Metabolism Markers
Several tests can evaluate blood sugar balance and insulin function to evaluate how well diabetes is controlled:
- fasting glucose
- hemoglobin A1c measures the average blood sugar level over the previous six weeks
- fasting insulin
- C-peptide, a marker that the body is producing insulin
Together, these can identify insulin resistance when sugars remain in the blood, causing inflammation and damage to blood vessels and nerves, which leads to diabetic neuropathy.
One test that looks at many of these metabolic markers of glucose balance and insulin function is the Metabolomic Profile.
The NutraEval FMV also provides insights into cellular health, toxin exposure, and how the body handles oxidative stress, which can all impact general nerve health.
Lipids
Imbalances in lipids are common in metabolic syndrome and type 2 diabetes and can contribute to the inflammation and cellular damage that occurs in diabetic neuropathy. To evaluate the balance of fats in the blood, a lipid profile including total cholesterol, HDL (“good” cholesterol), LDL (“bad” cholesterol), and triglycerides can be measured. In addition, lipoprotein(a), LDL particle number, and ApoB-containing lipoproteins (ApoB) can provide a more specific risk assessment.
Inflammation Markers
High-sensitivity CRP is made by the liver in response to inflammation and can be used over time to track trends in inflammation within the body that contribute to and result from the metabolic imbalances involved in diabetic neuropathy.
Testing to Rule Out Other Causes of Neuropathy
Vitamin B12 deficiency is another cause of neuropathy that can be assessed with blood testing.
Toxins, like heavy metals, can also damage nerves and contribute to neuropathy. A heavy metals profile measures any heavy metals that have accumulated in the body and may be contributing to nerve damage and inflammation.
Conventional Treatment for Diabetic Neuropathy
Treatment of diabetic neuropathy aims to relieve pain and other symptoms, slow the progression of the damage, and manage complications.
Blood Sugar Management for Diabetic Neuropathy
One key component of preventing further nerve damage is consistently keeping blood sugar within an individualized target range. While many factors influence optimal blood sugar for an individual, the American Diabetes Association (ADA) states that most people with diabetes should maintain blood sugars between 80 and 130 mg/dL (4.4 and 7.2 mmol/L) before meals and less than 180 mg/dL (10.0 mmol/L) two hours after meals with a hemoglobin A1C of 7.0% or lower.
Blood sugar management involves a balanced diet focusing on low-glycemic carbohydrates, fiber, protein, and healthy fats, along with maintaining a healthy weight and getting regular physical activity.
Take Care of Your Feet
Since the feet and toes are frequently impacted by diabetic neuropathy and can develop serious complications like ulcers and bone infections, taking care of the feet is especially important in people suffering from diabetic neuropathy. Assess your feet daily for cuts, blisters, or redness, and keep your feet clean and dry.
Pain Management
Conventional prescription medications are sometimes used to manage the pain of diabetic neuropathy. For example, anti-seizure medications like pregabalin (Lyrica) or gabapentin (Gralise, Neurontin) may be used. However, they can cause side effects including drowsiness, dizziness, and swelling in the hands and feet. Tricyclic antidepressants such as amitriptyline, nortriptyline (Pamelor), and desipramine (Norpramin) can also be used to reduce nerve pain but have the risk of side effects including dry mouth, constipation, drowsiness, difficulty concentrating, and dizziness when changing position (orthostatic hypotension). Other antidepressant drugs in the serotonin and norepinephrine reuptake inhibitor (SNRI) family, like duloxetine (Cymbalta, Drizalma Sprinkle) and venlafaxine (Effexor XR), may also help with nerve pain with fewer side effects.
Integrative Medicine Treatment for Diabetic Neuropathy
A lifestyle and functional medicine approach can help prevent or delay the progression of diabetic neuropathy and its complications. This focuses on a balanced anti-inflammatory diet, nourishing the gut microbiome, exercising regularly, taking targeted supplements that help maintain blood sugar levels within a consistently healthy range, and taking good care of the feet and body overall.
Nutrition for Diabetic Neuropathy
Plant-based diets rich in fiber, vegetables, legumes, and other high-quality proteins like wild fish and grass-fed meats help keep blood sugars balanced and reduce inflammation. This approach focuses on high-fiber and complex carbohydrates and avoids processed and added sugars to keep blood sugars consistently in a healthy range.
For example, a Mediterranean diet, emphasizing citrus fruits, vegetables, legumes, and complex carbohydrates with moderate fish and olive oil, helps improve blood sugar, insulin, and cholesterol. This way of eating balances inflammation and promotes gut health. It has wide-reaching benefits throughout the body, including improving some of the risk factors for diabetic neuropathy.
Polyunsaturated omega-3 fatty acids in foods like salmon and walnuts are especially helpful for improving blood pressure, insulin, blood sugar, and triglycerides to help keep blood vessels and nerves healthy.
A gluten-free diet may also improve many aspects of diabetes or metabolic syndrome, such as balancing blood sugar and reducing triglyceride levels to prevent diabetic neuropathy.
The microbiome plays a key role in blood sugar balance. A diverse plant-focused diet rich in dietary fiber supports balanced gut bacteria that promote a healthy gut lining and proper digestion, weight, and blood sugar balance. These types of diets are naturally rich in polyphenols and long-chain omega-3 polyunsaturated fatty acids, which significantly increase gut microbial diversity and the ratio of Firmicutes/Bacteroidetes to positively impact glucose and lipid metabolism, improving the management and prevention of diabetic neuropathy. Prebiotic foods like garlic, bananas, and asparagus feed healthy gut bacteria, while probiotics in naturally fermented foods like sauerkraut and miso promote microbial diversity to help regulate insulin sensitivity, cholesterol, and weight.
Exercise for Diabetic Neuropathy
Studies show a strong association between physical inactivity and obesity with metabolic dysfunction with improvements in nerve damage with exercise. Incorporate regular consistent exercise to improve the body’s ability to handle sugars and reduce nerve damage.
Supplements for Diabetic Neuropathy
Alpha-lipoic acid (ALA) is an antioxidant that helps relieve the symptoms of diabetic neuropathy, reducing pain and/or preventing progression.
Nicotinamide riboside and nicotinamide mononucleotide are precursors that can be taken as supplements to help raise levels of nicotinamide adenine dinucleotide (NAD+), a critical metabolite in energy metabolism within the mitochondria. Studies show that NAD+ levels are reduced in nerves in people with diabetes, with NAD+ helping to prevent oxidative injury in nerve cells.
Acupuncture for Diabetic Neuropathy
Acupuncture has been shown to significantly relieve diabetic neuropathy. Acupuncture works by stimulating blood flow, relaxing muscle, and stimulating the central nervous system. This, in turn, releases chemicals into the muscles, spinal cord, and brain to help with pain management.
Summary
Diabetes is a major cause of nerve damage or neuropathy. Uncontrolled elevated blood sugars can damage blood vessels and nerves, resulting in pain, numbness, tingling, and tissue damage. Nerves in the autonomic nervous system may also become damaged, causing problems with blood pressure, digestion, bladder contractions, and sexual function.
Functional medicine testing can evaluate how well blood sugars are controlled. Testing can also help assess inflammation and the balance of lipids in the blood, factors that contribute to nerve damage. In addition, blood testing can help to rule out other causes of neuropathy, like toxins and vitamin B12 deficiency.
Lifestyle and dietary factors can prevent diabetic neuropathy and its consequences. A balanced gluten-free plant-based diet with plenty of omega-3 fats and fiber regulates blood sugars and balances inflammation. Supplements like alpha lipoic acid and the NAD+ precursors nicotinamide riboside and nicotinamide mononucleotide can prevent and even improve nerve damage. Regular exercise and foot care also help prevent complications of diabetic neuropathy like ulcers and bone infections.
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