Diabetic Neuropathy

Diabetic neuropathy is nerve damage caused by long-standing diabetes mellitus.

Excess glucose inside nerve cells activates the polyol pathway, leading to the conversion of glucose into sorbitol and fructose.

Build-up of sorbitol and fructose causes cell swelling and triggers oxidative stress, disrupts nerve signaling, and weakens structural proteins.

At the same time, advanced glycation end products accumulate, further damaging proteins and lipids and reducing the nerves' ability to repair themselves.

Alongside these metabolic disturbances, diabetes also affects the small blood vessels that supply nerves. Thickened basement membranes and narrowed vessels reduce oxygen and nutrient flow, creating ischemia that worsens nerve injury.

As a result, nerves undergo demyelination and axonal loss. Long sensory nerves are most vulnerable, leading to numbness and pain in the hands and feet, known as glove and stocking distribution.

Motor and autonomic nerves are also affected, causing weakness, gastrointestinal disturbances, and bladder dysfunction.