Everything you need to know about diabetic neuropathy

What is diabetic neuropathy?

Diabetic neuropathy is any involvement of the nerves in someone with diabetes, where the cause cannot be attributed to any other reason. Essentially diabetic neuropathy often is a diagnosis of exclusion.

It is the most common form of neuropathy worldwide, except for in certain countries where alcohol-related neuropathy is predominant.

Any nerve can be affected by the impact of diabetes so it can present in many different ways.

What are the different types of diabetic neuropathy?

The diiferent types of diabetic neuropathy depend on the nerves involved. Typically diabetic neuropathy affects the extremeties- this is the most common presentation.

Patients get a stocking type neuropathy which starts in the tips of the toes and progresses up almost like a stocking. Additionally, the hands may also be affected. Patients can get what they typically used to call a glove and stocking involvment.

However, no nerve is safe from the impact of diabetes. Depending on where the nerves are involved, there can be different presentations of diabetic neuropathy.

What doctors call diabetic neuropathy however, is the classical stocking type neuropathy, which is the most common presentation. This neuropathy increases the risk of getting diabetic foot ulcers, increases the risk of developing pain and of course can lead to other foot problems such as charcot arthropathy.

You can get neuropathy in different regions of the body. It can affect the nerves that run the heart and the nerves in the gut, therefore you get different presentations, depending on the region that is predominantly involved.

Can you recover from diabetic neuropathy?

Diabetic neuropathy happens over a period of time, often years to decades. It does not happen overnight and recovery from such damage depends on where the patient is in the scheme of the damage.

There are nerves that mediate our sensory responses and there are nerves that mediate our motor and more complex sensory responses. Some of these nerves, if caught early, may recover in time but if the damage is extensive, such as if someone’s come to a light late into the illness and where there is true loss of sensation, that cannot often be reversed.

In summary, some of the sensory perceptions can be reversed, if picked up early but the motor components or changes that happen because of advanced nerve loss can often be very difficult to reverse or are never reversed.

Why is diabetic neuropathy worse at night?

Diabetic neuropathy, on its own, does not change whether it’s day or night.

What changes is the discomfort or the symptoms patients experience and typically this is worse at night. This is because at that time the brain does not have multiple sensory involvement.

Therefore it is focusing on resting and then the pain experience is heightened, whereas during the day, your brain is involved with multiple other things; you have the same symptoms but because the brain is busy processing other things, you don’t experience the pain to the same amount as at night, when the rest of the applications are on silent mode.

It is not that the neuropathy is worse, it is that the discomfort, the symptom component is worse at night.