Nerve problems

Nerve damage and pain

Type 1 diabetes means you are more likely to get nerve damage, or neuropathy. Neuropathy can cause pain – this is called neuropathic pain.

If you have neuropathic pain you should be offered painkillers. If painkillers such as aspirin and paracetamol don't help, you should be offered stronger medicines to help with the pain. Your doctor or nurse should explain that you may need to take these for several weeks for them to have their full effect. In some cases the pain may improve over time, so you can reduce or stop taking the medicines.

NICE has produced separate guidance and information for the public on medicines for neuropathic pain – see other NICE guidance for more information.

Gastroparesis

Gastroparesis is a type of nerve problem that affects the stomach. It can make you feel full and bloated even after eating a small amount of food, and can cause vomiting. High blood glucose can cause a temporary form of gastroparesis, and will make existing gastroparesis worse.

If gastroparesis is making you vomit, you should be advised to eat mashed or pureed foods. You may be offered an insulin pump as an alternative to injecting insulin, to see if this helps with symptoms.

Your doctor may also offer you medicines to help with vomiting – if so, they should explain about the possible risks and benefits of taking these medicines.

If these treatments don't help or aren't suitable for you, you may be referred to a specialist.

At the time of publication, some medicines for treating gastroparesis may be recommended for 'off-label' use in this guideline. Your doctor should tell you this and explain what it means for you.

Questions to ask about gastroparesis

  • What causes gastroparesis?

  • What can I do to reduce or stop vomiting?

  • How might having an insulin pump help?

  • What medicines can I try? How will they help?

  • What are the side effects of these medicines? What should I do if I get any side effects?

Erection problems

Erection problems (also called 'erectile dysfunction') are quite common in men with type 1 diabetes. If you wish, your doctor or nurse should talk with you about this at your annual review. If you would like treatment you should be given medicine that can help, if this is suitable for you. If this doesn't work, your doctor may offer to refer you to a specialist clinic.

Other nerve‑related problems

Talk to your doctor or nurse if you have diarrhoea (particularly at night) or problems emptying your bladder fully. Also tell them if you are worried about other symptoms such as sweating a lot (especially when eating), or feeling light‑headed when you change position. These symptoms may be caused by nerve problems, and you might need further tests and treatment.

  • Information Standard