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Diabetic Neuropathy



Neuropathy (ner – AH – puh – thee) is an abnormality of the nervous system. Diabetic neuropathy is nerve damage caused by diabetes. Peripheral refers to the edge of something, as opposed to it’s center. In the case of the human body, and particularly in the case of diabetic neuropathy, this term is referring to the hands and the feet.  Diabetic peripheral neuropathy is described as a loss of sensation that starts in the tips of the toes and gradually works its way up the legs. It is sometimes referred to as a stocking glove neuropathy because it progresses as if one was pulling a stocking up the leg.

Almost twenty-one million Americans have diabetes. About sixty to seventy percent of diabetics have some type of nerve damage and about 30% of diabetics over forty years of age have diabetic peripheral neuropathy (CDC, 2005). Five percent of diabetics will experience painful diabetic neuropathy and the incidence increases with age. Over 45% of individuals who have had diabetes for over twenty five years will experience some symptoms of painful diabetic neuropathy.

Symptoms : There are three types of nerves affected in diabetic peripheral neuropathy, sensory, motor and autonomic.

  • Sensory nerves allow people to feel sensation, like pain, hot or cold or touch. Burning, numbness, tingling, hot and cold sensations, leg discomfort, shooting and electrical pain are all sensory neuropathy sensations. A diabetic may feel one or all of the these symptoms.

  • Motor nerves control the muscles and allow movement. Muscle weakness, loss of balance and changes in foot shape are due to motor neuropathy. These changes are typically seen in a more advanced stage of diabetic neuropathy.

  • Autonomic nerves control bodily functions without our awareness or control. In the feet, an autonomic nervous response would be sweating. Dry feet and cracked skin are typical in all diabetics, but particularly those with diabetic autonomic neuropathy. Changes in foot shape can also be due to autonomic neuropathy.

Neuropathy can affect all of these nerve group types, but sensory nerves are typically the first and most often affected.

Causes : The exact cause of diabetic neuropathy is not clearly understood. Many theories exist: poor blood supply to the nerves, abnormal sugar metabolism within the nerve, increase in free radicals and hence oxidation and loss of enzyme function, all caused by high blood sugar and resulting in loss of nerve function. The general school of thought is that high blood sugar causes chemical changes in the nerves and also damages blood vessels carrying oxygen and nutrients to the nerves, impairing nerve function. A theory gaining in popularity is that diabetics are susceptible to nerve compression. The increased susceptibility is thought to be due to swelling of the nerves from the increased sugar and it’s conversion within the nerve. This increase in volume causes pressure on the nerves from the surrounding tissues and ligaments, resulting in a loss of function.

New research has found that high triglycerides predict the progression of peripheral neuropathy. More on triglycerides and neuropathy.

Complications: There is a long list of complications associated with diabetic neuropathy. As mentioned above, between 5% and 45% of diabetics will develop pain. Most diabetics with neuropathy will experience the exact opposite, numbness. This loss of sensation will result in painless injuries to the feet, which can go unnoticed. Small blisters, cuts and scrapes can turn into infections or lead to ulcerations when they are left untreated. An ulceration is a slow healing open sore on the foot. Over 2 million diabetics have ulcerations and one in four diabetics with an ulcer will have an amputation. These can be frightening statistics. Preventing diabetic ulcerations is of the utmost importance.

Treatments : Currently, there are no treatments to reverse diabetic neuropathy and there are no treatments that will eliminate the numbness. There are, however, many treatments which will decrease the symptoms associated with diabetic neuropathy, especially painful diabetic neuropathy.

The mainstay of medical treatment for diabetic peripheral neuropathy is to manage the symptoms with medications. For those individuals with painful diabetic neuropathy, prescription medications may be needed to manage the pain. Click here for a list of treatments for painful diabetic neuropathy.

Anodyne infrared therapy uses light energy to increase the circulation to the lower extremities. Diodes are fit into flexible pads which can be applied directly to the skin on multiple areas of the feet. The theory is that light energy helps to increase blood flow, which thereby restores function to injured nerves. Initially released in 1994, Anodyne was met with mixed reviews, but has gained in popularity in more recent years. Some studies have shown great results with reduction in pain and relief of overall symptoms of neuropathy. Anodyne has also been used for treatment of diabetic ulcers, with some great results.

Nerve decompression has been increasing in popularity in recent years as a treatment for diabetic peripheral neuropathy. This surgical treatment was initially not met with much enthusiasm. Earlier studies showed poor surgical results and many surgeons were hesitant to perform elective surgery on diabetics. A new surgical approach has been introduced and surgical success rates have improved dramatically. The theory that diabetics are more susceptible to nerve compression, may warrant decompression of those nerves to give relief of the symptoms associated with diabetic neuropathy.

Prevention : As with all diabetic complications, prevention is the best treatment. Keeping the blood sugar levels within a normal range is the most important tool in treating and preventing peripheral neuropathy. Even with tight control, most diabetics will still develop some level of neuropathy. Considering the severity of the complications associated with neuropathy (ulcers and amputations), the importance of blood sugar control cannot be understated. Diabetics with peripheral neuropathy can avoid many of the complications associated with neuropathy with proper foot care. It is recommended to talk with your physician and your podiatrist about all diabetic foot care, treatments and preventative measures.

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last updated 4/22/15

Disclaimer: The advice on this website is not intended to substitute for a visit to your health care provider. We will not be held liable for any diagnosis made or treatment recommended. Consult your doctor if you feel you have a medical problem.