Diabetic weak legs: Diabetic neuropathy – Symptoms and causes
When Diabetes Leads to Nerve Damage
Tingling, numbness, pain in the arms, legs, hands, or feet — these are all common signs of diabetic neuropathy, or nerve damage. Up to 70 percent of people with diabetes will develop some type of neuropathy, making it one of the most common side effects of this disease.
Diabetes: Understanding Neuropathy
Although tingling, numbness, or pain in the extremities are common signs of neuropathy, others may experience no symptoms at all. Nerve damage can also occur in internal organs, such as the heart or digestive tract. Diabetes-related neuropathy can affect muscle strength, sensation in various parts of the body, and even sexual function.
People who develop diabetic neuropathy are typically those who have trouble controlling their blood glucose levels, blood pressure, cholesterol, and body weight. Although researchers haven’t quite figured out exactly why this happens, they know that neuropathy can occur due to:
- Alcohol use and smoking
- Genetic predisposition
- Injuries such as carpal tunnel syndrome
- Nerves that become inflamed related to autoimmune conditions
- Neurovascular issues that damage the blood vessels responsible for bringing nutrients and oxygen to your nerves
Your risk also increases the older you get and the longer you have diabetes, with the highest rates of neuropathy occuring in people who have had diabetes for at least 25 years.
Diabetes: Where Neuropathy May Strike
Here are some of the specific types of neuropathy that occur in people with diabetes:
- Autonomic neuropathy impairs the functioning of the digestive system, resulting in diarrhea or constipation as well as impaired bladder function. This type of neuropathy also affects how you perspire and even your sexual response — men may have trouble getting an erection and women may experience vaginal dryness. This neuropathy also masks the symptoms of hypoglycemia (low blood glucose).
- Focal neuropathy can attack any nerve in the body and often causes sudden weakness.
- Peripheral neuropathy, the most common diabetic complication, can cause numbness or pain in the legs, feet, toes, arms, and hands.
- Proximal neuropathy may cause weakness in your legs and pain in your hips, buttocks, and thighs.
Because diabetes-related neuropathy can cause such a wide variety of symptoms, there is no single diagnostic test for the condition. Your doctor will rely heavily on a complete physical exam and your description of symptoms to diagnose this condition. In some cases, tools such as nerve conduction studies, a heart rate variability test, and ultrasound may be used to aid in the diagnosis.
Diabetes: Protect Your Feet
Peripheral neuropathy often occurs in the feet. If you start to lose feeling in your feet, you’re more likely to injure yourself, walk abnormally, and develop sores that won’t heal. These sores often become badly infected, which can lead to amputation of your feet or legs. That’s why it’s important for people with diabetes to keep a close eye on their feet.
Diabetes: Treatment Will Vary
Because each neuropathy is different, treatments vary widely and you’ll need to consult with your doctor to find the best solution for your individual condition. However, treatment for any neuropathy will start with bringing your blood glucose levels under control if they aren’t already.
Here are some treatment options that may be suggested:
- Various medications, including some antidepressants, can be used to treat nerve pain.
- If you have stomach problems, your doctor may suggest a change in your diet. If that doesn’t help, medications can be used to help control your digestive processes.
- If you experience bladder problems, you may need an antibiotic to clear up any infection that results. Incontinence treatment starts with remembering to urinate at regular intervals, since you may not realize when your bladder is full.
- Medications are available for men with erectile dysfunction, and there are mechanical options, such as vacuum devices, that can help with maintaining an erection. Women who experience vaginal dryness can try lubricants.
- For neuropathy that causes dizziness and weakness, usually related to blood pressure or circulation, your doctor may advise you to raise the head of your bed, and to sit up or stand slowly. Medication for high blood pressure may be prescribed; for some people an increased level of salt in the diet may be recommended.
Even though diabetic neuropathy will affect the majority of people who have diabetes, you can still work to prevent it, mostly by keeping your blood glucose level within your target range. This will help protect your nerves from damage.
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Diabetic Amyotrophy | Patient
In this series Diabetes (Diabetes Mellitus) Diabetes and High Blood Pressure Diabetes Foot Care Driving and Diabetes Diabetic Kidney Disease Diabetic Neuropathy Diabetic Retinopathy Diabetes and Illness Blood Sugar Tests
Diabetic amyotrophy is a nerve disorder complication of diabetes mellitus. It affects the thighs, hips, buttocks and legs, causing pain and muscle wasting.
In this article
- What is diabetic amyotrophy?
- What is diabetic amyotrophy like?
- What causes diabetic amyotrophy?
- How common is diabetic amyotrophy?
- How is diabetic amyotrophy diagnosed?
- How is diabetic amyotrophy treated?
- What is the outlook for patients with diabetic amyotrophy?
- How do I prevent diabetic amyotrophy?
What is diabetic amyotrophy?
Diabetic amyotrophy is a nerve disorder which is a complication of diabetes mellitus. It affects the thighs, hips, buttocks and legs, causing pain and muscle wasting. It is also called by several other names, including proximal diabetic neuropathy, lumbosacral radiculoplexus neurophagy and femoral neurophagy.
What is diabetic amyotrophy like?
The main features of diabetic amyotrophy are:
- Weakness of the lower legs, buttocks or hip.
- Muscle wasting, usually in the front of the thigh, which follows within weeks.
- Pain, sometimes severe, usually in the front of the thigh but sometimes in the hip, buttock or back.
Other features which occur in some (but not all) patients are:
- Altered sensation and tingling in the thigh, hip or buttock, which tends to be mild in comparison to the pain and weakness.
- About half of patients also have distal neuropathy, meaning that sensation in the nerves of the lower legs and feet may be separately affected by this condition (which is the most common form of diabetic neuropathy). See the separate leaflet called Diabetic Neuropathy.
- About half of people affected lose weight.
Symptoms generally begin on one side and then spread to the other in a stepwise progression. The condition may come on quickly or more slowly and usually remains asymmetrical (ie the two sides of the body are unequally affected) throughout its course. About half of patients also have distal symmetrical polyneuropathy, which means the sensation in their feet and toes on both sides is also affected.
The condition tends to go on for several months but can last up to three years. By the end of this time it usually recovers, although not always completely. During its course it may be severe enough to necessitate wheelchair use.
Pain subsides well before the muscular strength improves. This may take months and mild-to-moderate weakness may continue indefinitely. Some patients also develop associated pain or weakness in the arms, chest and upper back.
What causes diabetic amyotrophy?
Diabetic amyotrophy is thought to be caused by an abnormality of the immune system, which damages the tiny blood vessels which supply the nerves to the legs. This process is called microvasculitis. The likelihood of getting it does not seem to be related to how long you have diabetes, or how severely you are affected. However, it occurs only very rarely if you don’t have diabetes. It is therefore thought that although having raised blood sugar does not directly damage the nerves, it may contribute in some way to the process of damage.
How common is diabetic amyotrophy?
The condition affects around 1 in 100 people with type 2 diabetes and around 3 in 1,000 people with type 1 diabetes. This is uncommon by comparison to peripheral neuropathy, which 50% of people with diabetes experience to some degree.
You are more likely to develop diabetic amyotrophy if you are over 50, although younger patients can be affected. The condition can itself be the first sign that you have diabetes.
How is diabetic amyotrophy diagnosed?
If your doctor suspects that you have this condition, it is likely that they will refer you to a neurologist or diabetes specialist for further tests.
The doctor will examine you, looking for muscle weakness and wasting and for changes in your leg reflexes. He or she will check the sensation in your legs. If you also have peripheral neuropathy then this may be markedly reduced, although in pure diabetic amyotrophy it is often unchanged.
They will ask you to have some blood tests to check for vitamin deficiencies; also, your diabetic control will be reviewed. Other possible tests include:
- Lumbar puncture to look for signs of inflammation in the fluid around the spinal cord.
- Nerve conduction studies to check the workings of the nerves to your legs.
- An MRI scan of your lower back may be done to rule out compression of the nerves around the spine
How is diabetic amyotrophy treated?
Treatment mainly consists of maintaining the best possible control of your diabetes, together with a very active programme of physiotherapy. It is very important to keep muscles working as much as possible, to minimise wasting and improve the speed and degree of recovery.
Improving lifestyle habits, such as maintaining a good diet and avoiding smoking, is likely to be helpful.
Medications are prescribed by doctors for the pain of diabetic amyotrophy. This type of pain, which is referred to as neuropathic pain or nerve pain, often responds less well to conventional painkillers like paracetamol. Doctors often prescribe specialist nerve pain treatments, including amitriptyline, antidepressants and antiepileptic medicines.
Steroid medicines and immunosuppressant medicines have recently been used to help speed recovery. However, as yet there is not enough evidence to be certain that this treatment is always effective.
How long the treatment is prescribed for depends on the course of the condition and the amount of nerve damage.
What is the outlook for patients with diabetic amyotrophy?
The outlook (prognosis) is usually good. Most patients recover well, although some symptoms may remain. The chances of making a good recovery – and remaining well (as the condition can relapse) – are improved by maintaining good diabetes control.
How do I prevent diabetic amyotrophy?
The best way to reduce your risk of developing this condition, as for many of the complications of diabetes, is to:
- Avoid smoking.
- Eat well but sensibly.
- Maintain a healthy body weight.
- Most importantly, retain as tight a control of your diabetes as is possible.
- Attend regular check-ups to ensure the condition doesn’t worsen
Diabetic amyotrophy can still occur. However, it is likely that recovery will be faster and easier if these elements are already in control.
Dr Mary Lowth is an author or the original author of this leaflet.
Management of diabetes; Scottish Intercollegiate Guidelines Network – SIGN (March 2010 – updated November 2017)
Diabetes (type 1 and type 2) in children and young people: diagnosis and management; NICE Guidelines (Aug 2015 – updated May 2023)
Diabetic foot problems: prevention and management; NICE Guidelines (August 2015 – last updated January 2023)
Type 2 diabetes in adults: management; NICE Guidance (December 2015 – last updated June 2022)
Type 1 diabetes in adults: diagnosis and management; NICE Guidelines (August 2015 – last updated August 2022)
Chan YC, Lo YL, Chan ES; Immunotherapy for diabetic amyotrophy. Cochrane Database Syst Rev. 2017 Jul 267:CD006521. doi: 10.1002/14651858. CD006521.pub4.
Gylfadottir SS, Weeracharoenkul D, Andersen ST, et al; Painful and non-painful diabetic polyneuropathy: Clinical characteristics and diagnostic issues. J Diabetes Investig. 2019 Sep10(5):1148-1157. doi: 10.1111/jdi.13105. Epub 2019 Jul 29.
Foot injury due to diabetes mellitus
Diabetic foot disorders
Damage to the lower extremities in diabetes mellitus (DM) can be divided into several groups, however, as a rule, they occur in combination.
1. Peripheral neuropathy. Neuropathy is manifested by pain, a crawling sensation, cramps, a “burning” sensation in the feet, which are aggravated in the evening and at night.
At the same time, the nerve fibers responsible for temperature, pain, tactile and vibration sensitivity lose their sensitivity, which can lead to tragic consequences if proper foot care is not organized. This means that you may not feel an injury: for example, you may not notice a foreign object in a boot or a burn while warming your feet near a radiator or in a foot bath until a wound has already formed.
2. Deformity of the toes and arch of the foot. Damage to the nerve fibers can lead to deformity of the fingers and arch of the foot, which, in turn, can also result in foot ulcers. As a rule, deformations are a consequence of wearing improperly selected shoes, which can also lead to increased callus formation, the development of hyperkeratosis (skin disease associated with an increased rate of division of the stratum corneum cells and a violation of their desquamation process).
If you have any changes: bones, flat feet, toe deformity – ask your doctor where you can order or purchase orthopedic shoes. Wearing individual orthopedic shoes is a mandatory prevention of foot ulcers.
3. Reduced blood flow in the arteries of the lower extremities (atherosclerosis of the arteries of the lower extremities).
The main causes of atherosclerosis in diabetes are:
- poor blood sugar control;
- high blood pressure;
- increase or decrease in cholesterol levels;
The main symptom of atherosclerotic lesions of the arteries of the lower extremities is the occurrence of pain when walking – the so-called intermittent claudication.
If you are concerned about these symptoms, be sure to contact your doctor to find out the reasons.
To stop the progression of the atherosclerotic process, you must immediately quit smoking, control your blood pressure and take medications prescribed by your doctor regularly to maintain a normal level of blood pressure.
In some cases, drugs that improve peripheral blood flow may be effective. Often, with poor circulation, your feet can get cold.
Remember that you can’t warm your feet on a radiator, by an open fire, or soar in hot water – this can lead to burns and ulcers, since you can also have neuropathy, i.e. you won’t feel the heat. The best way to keep your feet warm is to wear warm socks.
Diabetic foot syndrome (DFS) is a combination of these complications of diabetes mellitus in the legs, which pose an immediate threat or the development of ulcerative necrotic processes and gangrene of the foot.
To prevent the development of SDS, several rules must be observed:
- adequate blood sugar control;
- control of blood pressure and taking antihypertensive drugs.
- foot care.
Let’s talk about the last point in more detail. The resulting ulcerative defects and wounds in patients with DM are treated for a long time and not always successfully, which is associated with the peculiarities of the course of DM. Therefore, the prevention of such conditions is extremely important.
What should be done?
- Check your feet daily, including the spaces between your toes, on your own or with family members.
- Tell your doctor immediately if you have abrasions, cuts, cracks, scratches, wounds or other skin damage.
- Wash your feet daily with warm water (temperature below 37 C, check the water with your hand, not with your foot), dry your feet gently, with a soft towel, blotting movements, not forgetting the spaces between the toes.
- If there is keratinized skin, treat these areas with a pumice stone or a special leather file (not metal). Do not use a blade or scissors for this purpose. And it is better to contact a specialist – a podologist who specializes in the treatment of feet in patients with diabetes.
- Do not use chemicals or patches to remove calluses and dead skin.
- If your feet are dry, after washing, apply a cream containing urea to them, except between the toes.
- Carefully file nails without rounding the corners, using a nail file (not metal).
- Use warm socks to keep your feet warm, not a heating pad or hot water, which can cause burns due to reduced sensation.
- Wear seamless (or seam-out) socks/tights made of cotton or other natural fabrics and change them daily.
- Do not walk barefoot indoors and outdoors, do not wear shoes on bare feet.
- Consult an orthopedic specialist if you need to wear preventive or complex orthopedic shoes.
- Inspect shoes daily for foreign objects and for curled insoles, as this can cause abrasions on the skin of the feet.
- If the skin is damaged (crack, scratch, cut), do not use alcohol-containing and coloring solutions. Use colorless aqueous antiseptic solutions for processing – Chlorhexidine, Dioxidine.
Take care of your feet and be healthy!
- “Algorithms of specialized medical care for patients with diabetes mellitus” Edited by I.I. Dedova, M.V. Shestakova, A.Yu. Mayorova 2019.
- Diabetic foot. A Guide for Physicians. Udovichenko O.V., Grekova N.M. M.: Practical medicine, 2010. – 272 p.
Diabetic foot – symptoms, causes and treatment
Diabetic foot syndrome (hereinafter referred to as DFS) is a complex of anatomical and functional changes in the lower extremities (legs) of a person with diabetes mellitus. That is, DDS is a collective concept, and is rarely used as an independent diagnosis. Most often, in the extract, doctors indicate the components of this syndrome – abscess, phlegmon, gangrene and others. They develop against the background of such complications of diabetes as diabetic neuropathy, micro- and macroangiopathies, osteoarthropathy and some others. And the most terrible consequence of these complications is amputation. Let’s figure out what you need to know and how to behave in everyday life in order to avoid this.
Causes of diabetic foot syndrome
Due to reduced blood flow in the legs and neurological disorders, a person with diabetes may develop wounds that do not heal for a long time, a progressive and untreated fungus, black spots on the skin (mainly of the toes), ulcers – These are all manifestations of SDS. Also, this syndrome can manifest itself as a deformity of the foot – for example, unnaturally curved toes, high arch and arched foot, etc.
Statistically, SDS is 10 times more common in people with type 2 diabetes. But, of course, this does not mean that people with type 1 diabetes can not be afraid of these complications. After all, the main cause of SDS is damage to the vessels in the legs. And the vessels in the legs are affected due to high sugars for a long time or due to sudden changes in blood sugar from low to high and back.
Diabetes decompensation (often high sugars or frequent sudden changes in sugars) of any type causes distal angiopathy – deterioration of blood flow in the lower extremities, and distal neuropathy – impaired sensitivity of nerve endings in the legs. Signs that you are at risk for developing SDS are:
- little or no pain in the feet when they are injured,
- insensitivity to high or low temperature,
- tingling sensation in the legs,
- burning or shooting pain when walking or even at rest,
- the legs stop sweating and the skin (especially the feet) becomes dry.
Dry feet in people with diabetes is quite common. To reduce this manifestation and its negative consequences, it is important to follow the rules of foot hygiene and regularly use moisturizing creams or even special foot care kits for diabetics.