Diabetes can damage the nerves that transmit signals throughout your body. This nerve damage is known as diabetic neuropathy.
When you have diabetes, you are more likely to have high levels of glucose and triglycerides floating around in your bloodstream. Given enough time, these will damage the nerves that send pain signals to your brain and also the tiny blood vessels that supply the nerves with nutrients… causing neuropathy.
Obviously the best way to prevent or delay the onset of diabetic neuropathy is to control your blood glucose and blood pressure.
Four main types of diabetic neuropathy
The nerve damage caused by diabetes can manifest itself in various parts and functions of your body. Symptoms vary with the type of diabetic neuropathy you have.
There are four major types…
Autonomic neuropathy is a group of symptoms that occur when there is damage to the nerves that manage every day bodily functions, such as your blood pressure, heart rate, sweating, digestion and the emptying of your bowel and bladder emptying, and digestion. It causes major disruption to the functioning of your body.
Mononeuropathy or focal neuropathy is damage to a specific nerve in the face, torso (middle of the body) or leg. It’s most common in older adults. Mononeuropathy often strikes suddenly and can cause severe pain. However, it usually doesn’t result in any long-term problems.
Proximal neuropathy is a rare, disabling type of nerve damage in your hip, buttock, or thigh. This nerve damage typically affects one side of your body, making it hard to move, but seldom spreads to the other side.
Diabetic peripheral neuropathy (DPN) is the most common type of diabetic neuropathy and is the main subject of this essay.
DPN is damage to the nerves that enable you feel pain, heat and cold. It usually affects the feet and legs first, followed by the hands and arms.
Its symptoms can often be worse at night. These may include one or more of the following:
- numbness or reduced ability to feel pain or changes in temperature
- tingling or burning sensation, a bit like “pins and needles”
- “electrical” jolts running through your feet at random intervals (that can cause your feet or legs to jerk)
- sharp pains or cramps
- increased sensitivity to touch (even the weight of a bedsheet can be painful)
- muscle weakness
- loss of reflexes, especially in the ankle
- loss of balance and coordination
- serious foot problems, such as ulcers, infections, and bone and joint pain
If you experience any of there symptoms and the clinic you are attending for your diabetes has not yet checked you for diabetic peripheral neuropathy, you should insist on being tested asap.
However, you may have no symptoms even though your nerves are damages.
How common is diabetic neuropathy?
About half of the people in North America and Europe who have diabetes also have some kind of nerve damage. Indeed 2 out of 10 people already have diabetic peripheral neuropathy when they are first diagnosed with diabetes.
A person who has prediabetes, is obese or has metabolic syndrome (three out of four of high blood glucose, high blood pressure, high cholesterol and belly fat) has a much greater chance of getting DPN than a healthy person.
Thus, if you are diabetic, it is very important that your doctor checks you for DPN regularly… when you are diagnosed with diabetes and then at yearly intervals.
What are the checks for diabetic peripheral neuropathy?
Your doctor will perform a series of checks to see if you have DPN.
First he or she will visually check your feet and legs, looking for cuts, sores and problems with your circulation. Then he may watch you walk to check your balance.
After that he will probably want to find out how sensitive you are to changes in temperature… usually just by asking you.
He or she will also want to know how sensitive you are to light touches. The doctor may dangle a thin piece of string or thread over your foot, while you look away, touching your foot from time to time with the string to see if you notice. In another test he may use a tuning fork on your toes and feet to see how sensitive you are to vibrations.
Your doctor will also undertake some blood and urine tests. These help him or her to track your blood glucose and triglyceride levels.
These laboratory tests can also help rule out other causes of neuropathy such as thyroid problems, kidney disease, low levels of vitamin B12, infections, cancer, HIV and alcohol abuse… neuropathies arising from such causes may need to be treated differently.
The consequences of diabetic peripheral neuropathy
Some of the symptoms of DPN can be very painful, making walking and even sleeping comfortably at night very difficult.
In addition, DPN makes it more likely you could get a severe infection in one of your feet. This is because the reduced ability to feel pain associated with this type of neuropathy means that you may not notice minor cuts, blisters or other injuries to your feet because you cannot feel them.
Because diabetes reduces the efficiency of your immune system, minor cuts can take longer to heal… these wounds may become serious before you find them. Indeed they could become severely infected, meaning that if you don’t receive the proper care in a timely manner, you could lose a toe or a foot through amputation.
Charcot foot… is another threat arising from DPN. Severe neuropathy can weaken the bones of your foot. As a result, the bones can crack or break.
Because your feet lack feeling you could continue walking on your broken foot and so deform it… the arch, for example, could collapse and bulge down.
If it is caught early enough, and following a period of rest, a skilled doctor can treat Charcot foot with braces and special shoes. Serious cases, however, would need surgery.
How to care for your feet
Nothing can be done to reverse the damage caused to your feet by diabetic peripheral neuropathy.
However there are several things that can be done to help the pain and stop DPN from getting worse.
Painkillers… over-the-counter meds are not much good for treating the pain of peripheral neuropathy. Products you put on your skin to numb it, such as lidocaine, may help mask the pain. Drugs used to treat depression (eg, citalopram) and seizures (eg, gabapentin) can reduce the pain.
Personally, this writer has found Neurostil (gabapentin) very useful in deadening the pain in the soles of his feet due to DPN.
In addition, physical therapy in the form of special exercises designed to restore your sense of balance and the sensations in your feet can keep you moving (and improve your mood at the same time). Just Google “exercises for peripheral neuropathy in feet” for plenty of suggestions.
Caring for your feet… because your feet are insensitive, you may not notice minor injuries that can grow into major problems. So you should check your feet thoroughly every day… looking for sores, cuts or burns… without forgetting to check between your toes. You can use a mirror so see the undersides of your soles. If you discover any problems that do not clear up in a day or so, you should consult your doctor.
Keep your feet clean. You should wash them each evening in warm water, testing the water to make sure it is not too hot before you put your feet in. Make sure you dry them thoroughly afterwards.
When you are lying down, put your feet up (on pillows, say) to keep your circulation going. Wriggling your toes will also help to keep your feet healthy.
Appropriate footwear… splash out on good, comfortable shoes that breathe and have plenty of room for your toes. The width must be adequate for your feet. Make sure that the salesman goes to the trouble of measuring your feet properly. Various types of runners are best, especially those with gel or air-cushions in the soles. Consider using inserts or buy special shoes for diabetics.
Show your shoes to your doctor when you go for a check-up and ask for his opinion.