Type 2 Diabetes Mellitus With Diabetic Polyneuropathy

Type 2 Diabetes Mellitus With Diabetic Polyneuropathy

Type 2 diabetes mellitus with diabetic polyneuropathy is commonly the first presentation when a person is diagnosed with diabetes.

The classical symptoms of diabetes such as polyurea, polydipsia, and polyphagia are rarely the presenting symptoms. 

Most patients visit the hospital with tingling and burning feet and they are diagnosed with diabetes.

I’ve observed individuals visiting our clinic with foot ulcers because they either forgot to wear slippers or unintentionally misplaced one, unknowingly walking barefoot.

Type 2 diabetes mellitus with Diabetic polyneuropathy raises the risk of lower limb amputation, diabetic foot ulcers, and other complications.

Moreover, the afflicted people’s quality of life may be negatively impacted when they develop diabetic polyneuropathy.

Most type 2 diabetes mellitus patients can not only identify the presence of diabetic polyneuropathy but also fail to report their symptoms to doctors or other healthcare professionals, despite its high prevalence and clinical significance.

Due to this, diabetic polyneuropathy is typically underdiagnosed and undertreated.

In T2DM patients, a thorough history, physical exam, neurologic examination, and fast therapy are required for early identification and adequate intervention for diabetic polyneuropathy.

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What is Diabetic Polyneuropathy?

Numerous motor and peripheral sensory nerves that exit the spinal cord and go to the arms, hands, legs, and feet are affected by diabetic polyneuropathy.

Usually, the longest nerves, those that go from the spine to the feet, are most severely impacted.

Following are the conditions that can be brought on by diabetic polyneuropathy

  • Hands, legs, and feet numb and in pain
  • Paresthesias are unusual sensations like tingling, burning, or prickling.
  • Muscular weakness in the hands and feet.
  • Insensitivity to temperature or discomfort fluctuations.
  • Cramping or sharp aches.
  • High sensitivity to touch.
  • Loss of coordination or balance, as well as having trouble walking on uneven ground.

Symptoms of Diabetic polyneuropathy depend on the type of nerve involvement. Here are the six common types of diabetic polyneuropathies:

Type of Diabetic Neuropathy


Peripheral NeuropathyAffects the peripheral nerves and causes symptoms such as numbness, tingling, and burning in the hands, arms, feet, and legs.
Autonomic NeuropathyAffects the nerves that control involuntary bodily functions such as digestion, heart rate, and blood pressure. Symptoms may include gastrointestinal problems, urinary incontinence, and sexual dysfunction.
Mononeuritis MultiplexAffects two or more nerves unrelated to each other (affects different parts of the body at the same time)
Cranial NeuropathyAffects the twelve cranial nerves originating directly from the brainstem.
Diabetic AmyotrophyAffects the nerves in the thighs and hips, causing pain, weakness, and muscle wasting.
MononeuropathyAffects a single nerve, usually in the face, torso, or leg. Symptoms may include sudden pain, weakness, or loss of sensation in the affected area.
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Symptoms of Diabetic Polyneuropathy in Type-2 Diabetics:

  • Dizziness when you stand up
  • Burning feelings in feet, especially at night
  • Bloating
  • Muscle weakness or wasting
  • Erectile dysfunction (ED)
  • Nausea, indigestion, or emesis
  • Diarrhea/constipation
  • Intense or decreased sweating
  • Vision issues, such as double vision
  • Vaginal dryness
  • Bladder problems, as well as incomplete bladder emptying
  • Inability to sense hypoglycemia
  • Increased heart rate
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Causes of Diabetic Polyneuropathy 

In type-2 diabetics, High blood sugar levels that are kept elevated for a long time are what cause diabetic neuropathy. Nerve injury may also result from other sources, such as:

  • Due to high blood cholesterol, which harms the arteries.
  • Mechanical damage, such as damage brought on by carpal tunnel syndrome
  • Alcoholism and smoking are examples of lifestyle choices

Neuropathy may result from inadequate vitamin B-12 levels. Low levels of vitamin B-12 can occur after taking the popular diabetic drug metformin (which is used to treat type-2 diabetes).

To determine whether you are deficient in any vitamins, contact your doctor for a quick blood test.

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Diagnosis of  Diabetic Polyneuropathy in Type-2 Diabetes

A doctor will ask you about your symptoms and medical history to start determining whether or not you have neuropathy. 

They will measure your heart rate, blood pressure, muscle tone, and degree of sensitivity to warmth and touch.

To determine how sensitive your feet are, your doctor could do a filament test. To do this, they’ll evaluate your limbs for any loss of feeling using a nylon fiber.

Moreover, the doctor evaluates your vibration with a tuning fork. Your ankle reflexes may also be evaluated by your doctor.

Although not usually required, NCS (nerve conduction studies) is the diagnostic test to confirm diabetic polyneuropathy and gauge its severity.

NCS may also differentiate from other forms of neuropathies such as CIDP (chronic inflammatory demyelinating polyneuropathy).

What is the treatment of Diabetic Polyneuropathy in Type-2 Diabetics?

Diabetic neuropathy is incurable, however, you can prevent it from progressing quickly.

The greatest method to reduce the risk of developing diabetic neuropathy or limit its progression is to maintain appropriate blood sugar levels with type-2 diabetes. Additionally, it helps with some symptoms.

Furthermore, a thorough treatment plan should also include regular exercise and quitting smoking.

Before starting a new workout regimen, always consult with your doctor or healthcare team. Lastly, inquire with your physician about supplementary therapies or neuropathy supplements.

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Pain Medicines for Diabetic Polyneuropathy:

Medications can help manage the discomfort. So, discuss the available drugs with your doctor, as well as any possible adverse effects. Several drugs can reduce symptoms of diabetic polyneuropathy.

Acupuncture is one alternative therapy that you might wish to take into account. According to some studies, Capsaicin is beneficial in treating diabetic polyneuropathy.

When combined with medicine, alternative therapies could offer more alleviation.

Here is a list of Medications used to treat diabetics with Diabetic Polyneuropathy:




GabapentinAnticonvulsantReduces pain and improves sleep by decreasing abnormal electrical activity in the nerves.
PregabalinAnticonvulsantSimilar to gabapentin, but may be more effective for some people.
DuloxetineAntidepressantIt acts by blocking serotonin and norepinephrine reuptake. It is very effective in diabetics with polyneuropathy and associated depression.
AmitriptylineAntidepressantHelps to reduce pain and improve sleep by increasing levels of certain neurotransmitters in the brain.
VenlafaxineAntidepressantMay be used for pain management in people who do not respond to other medications.
Capsaicin creamTopical analgesicDerived from chili peppers, this cream may help to reduce pain and improve sensation in the feet.
Lidocaine patchTopical analgesicContains a local anesthetic that can help to reduce pain in the feet.
OpioidsPain medicationMay be used in severe cases of diabetic neuropathy that do not respond to other treatments, but carries a risk of addiction and other side effects.
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Preventing Diabetic Polyneuropathy in Type 2 Diabetics:

If you watch your blood glucose levels closely then you can usually prevent developing diabetic neuropathy. Being consistent with:

  • Keeping an eye on your blood sugar levels
  • Controlling your nutrition, taking prescribed medications, and staying active

Working closely with your doctor and according to their suggestions will help delay the course of diabetic neuropathy if it does occur. Also, you may lessen the harm done to your nerves and prevent problems by taking the appropriate care.

Here’s a table summarizing some of the ways to prevent diabetic polyneuropathy:

Prevention Method


Maintaining good blood sugar controlcan help to prevent or delay the onset of diabetic polyneuropathy.
Exercise regularlyimprove circulation and nerve function.
Eat a healthy dietcan help to maintain good overall health and prevent complications of diabetes, including polyneuropathy.
Avoid smokingQuitting smoking can help prevent or delay the onset of diabetic polyneuropathy by reducing the risk of vascular damage.
Limiting alcohol consumptioncan help prevent or delay the onset of diabetic polyneuropathy by reducing the risk of nerve damage.
Regular check-ups with a healthcare professionalcan help monitor blood sugar levels and detect any complications of diabetes, including polyneuropathy, early on.
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Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

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