From the Guidelines
Excess glucose causes neuropathy primarily through multiple biochemical pathways that damage nerves, and maintaining good blood glucose control is essential for preventing or slowing diabetic neuropathy progression. When blood glucose levels remain chronically elevated, glucose overloads normal metabolic pathways, leading to increased sorbitol production via the polyol pathway, which causes osmotic stress and depletes nerve cells of antioxidants 1. Additionally, excess glucose forms advanced glycation end products (AGEs) that damage nerve proteins and trigger inflammation. High glucose levels also increase oxidative stress by generating harmful free radicals while impairing the body's natural antioxidant defenses. The combination of these processes damages the small blood vessels supplying nerves (microvasculopathy), reducing oxygen and nutrient delivery to nerve tissues.
Some key points to consider in the management of diabetic neuropathy include:
- Optimizing glucose control to prevent or delay the development of neuropathy in patients with type 1 diabetes and to slow the progression of neuropathy in patients with type 2 diabetes 1
- Assessing and treating patients to reduce pain related to diabetic peripheral neuropathy and symptoms of autonomic neuropathy, and to improve quality of life 1
- Considering causes of neuropathy other than diabetes, including toxins, neurotoxic medications, vitamin B12 deficiency, hypothyroidism, renal disease, malignancies, infections, chronic inflammatory demyelinating neuropathy, inherited neuropathies, and vasculitis 1
Overall, the management of diabetic neuropathy should focus on maintaining good blood glucose control, addressing underlying biochemical mechanisms of nerve damage, and improving quality of life for patients with this condition. The most effective way to prevent or slow diabetic neuropathy progression is to maintain good blood glucose control through medication, diet, and exercise 1.
From the Research
Causes of Neuropathy
- Excess glucose can cause neuropathy due to prolonged exposure to high blood glucose levels, leading to nerve damage 2
- Hyperglycemia can impact nerve function, glucose metabolism, and lead to the formation of advanced glycation end products (AGEs), contributing to neuropathy 2
- Metabolic dysregulation, inflammatory, and immune-mediated processes also play a role in the development of diabetic neuropathy 2
Risk Factors
- Poor glycemic control is a significant risk factor for developing neuropathy 3, 4, 5
- Other risk factors include vitamin B12 deficiency, elevated blood pressure, and obesity 5
- Hyperlipidemia and hypertension can also contribute to the development of neuropathy 3
Pathophysiology
- Diabetic neuropathy is characterized by nerve damage resulting from prolonged exposure to high blood glucose levels 2
- The complex interplay between hyperglycemia, metabolic dysregulation, and nerve damage leads to the development of neuropathy 2
- Abnormalities in glucose metabolism and the role of advanced glycation end products (AGEs) also contribute to the pathophysiology of diabetic neuropathy 2