Ask The Expert
Complications

According to the National Diabetes Information Clearinghouse, about 60 to 70 percent of people with diabetes have some form of neuropathy, but often the symptoms can be subtle or even absent. Although there are several different types of neuropathy in diabetes, I will concentrate in this answer only on peripheral neuropathy, which affects the feet and legs, and less commonly the hands.

Your brain controls your ability not only to think but also to feel, breathe, and move. It does this by sending messages through your spinal cord through a network of nerve cells; think of your nerves as being like wires that transmit electrical impulses.

What causes neuropathy?

The cause of the damage to nerves is still not fully understood, but some possibilities are:

• Too much glucose in the blood may interfere with blood circulation so that the nerves are unable to get the nutrients they need.
• Proteins coated with glucose might directly harm the nerve cells.

Research is still ongoing to fully determine the cause and treatment of neuropathy. However, keep in mind that numerous studies have already proven that controlling diabetes can reduce the risk of neuropathy by up to 60 percent.

What are the symptoms of peripheral neuropathy?

• Pins and needles, or a tingling or burning sensation, of the legs and feet (or arms), usually worse at night.
• Loss of sensitivity to heat or cold.
• Numbness or loss of feeling in your extremities.
• Cold hands or feet.
• There are more, but these are the most common.
  

Why is neuropathy a problem?

• While some people find these symptoms only mildly annoying, others experience severe debilitating pain, which interferes with their sleep and/or their ability to work and play.
• If you lose sensation, you could injure your foot and not even know it. Couple this with a decrease in circulation which could be present in your feet, along with elevated glucose levels, and you will have a much longer and more difficult time healing.
• According to the American Podiatric Medical Association, a lower-limb amputation occurs every 30 seconds due to diabetes. The good news is that following a comprehensive foot care program can reduce amputation risk by 45 to 85%.
• Another consideration is alcohol intake: although social drinking is accepted as part of a normal meal plan for people with diabetes, be aware that excess alcohol intake can cause or aggravate neuropathy. Be sure to review your alcohol intake with your physician.
• Also, it will be no surprise to learn that smoking can also aggravate nerve damage.
• Finally, another frustrating realization is that type 2 diabetes is usually present in most people for an average of 6 years before the diabetes is diagnosed. This means that the elevated glucose levels were slowly causing damage to the nerves.
  

How is neuropathy diagnosed?

• Your doctor will check your reflexes, as well as your ability to feel vibration and fine sensation (by using a monofilament wire to see if you can detect the sensation of touch).
• Your doctor might refer you to a neurologist for more complete testing if this is indicated.

How is it treated and will it ever go away?

• First of all, it is important to achieve and maintain the best control of your blood glucose as possible. Many people find that over time, their symptoms will disappear, although it may take 6-18 months. Others never regain their sensation, but may be able to preserve their existing nerve function with meticulous control of their diabetes.
• As already noted: stop smoking, and discuss your alcohol intake with your physician.
• There are various medications that are used, many of which affect nerve conduction:
  • Anticonvulsive agents (such as Dilantin® Neurontin®).
  • Antidepressants (Elavil®, for example).
  • A newer drug called Cymbalta®
  • Capsaicin ointment (derived from chili peppers), which is applied directly to the skin.
  • A TENS unit (transcutaneous electrical nerve stimulation) is sometimes used to block transmission of pain messages for people with severe pain.
  • Note that many of these treatments may take 4 to 6 weeks to get the full effect.
  • Research is ongoing to develop drugs that not only relieve the pain, but also better yet, can prevent the damage from occurring. Some of these drugs are currently in clinical trials.

• Meanwhile, be sure to take good care of your feet to protect them from injury. Hopefully you have learned about foot care in your diabetes education class, but here are some tips:
  • Don't walk barefoot, even indoors, where most injuries occur.
  • Inspect and feel your feet every day; if possible, ask your significant other to assist you, especially checking the bottom of your feet.
  • Shake out your shoes before putting them on.
  • Keep your feet clean and moisturized - dry, cracked skin can be an entryway for germs. Apply lotion daily, except between the toes, where extra moisture can cause breakdown of the skin or encourage athletes' foot.
  • Cut toenails straight across, and not too short. If this is too difficult to do, due to thickened nails or due to decreased vision, ask your doctor to refer you to a podiatrist (foot doctor).
  • Never buy tight shoes, and preferably choose leather shoes with low heels.
  • Maintain good circulation by exercising regularly, and elevating your feet when sitting.
  • Be sure to review all these tips with your healthcare team.

For further information, you may want to read the American Diabetes Association's The Diabetes Problem Solver, as well as back issues of Diabetes Forecast or Diabetes Self-Management, which were the references used for this answer.