The toes burn and tingle and sharp pains shoot into the legs. The bed sheets feel uncomfortable on your feet and you toss and turn, hoping to drift away into a pleasant slumber. But, the “fire-like” sensation in your toes keeps you awake. You switch positions, wiggle the toes, prop a pillow under the legs, but nothing seems to help. You can only lie in bed and watch the hours on the clock pass by.
Burning, numbness, tingling, hot and cold sensations, shooting and electrical pain are common sensations felt in the feet in individuals with painful diabetic peripheral neuropathy (PDN). Neuropathy is an abnormality of the nervous system. Diabetic neuropathy is nerve damage caused by diabetes and is described as a loss of sensation that starts in the tips of the toes and gradually works its way up the legs. Diabetic neuropathy is sometimes referred to as a stocking glove neuropathy because it progresses as if one was pulling on a stocking. Diabetic neuropathy can affect both the hands and the feet.
Almost twenty-one million Americans have diabetes. About sixty to seventy percent of diabetics have some type of nerve damage and about thirty percent 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 forty five percent of individuals who have had diabetes for over twenty five years will experience some symptoms of PDN.
The exact cause of diabetic neuropathy is not clearly understood. Many theories exist, but the general school of thought is that high blood sugar causes chemical changes in the nerves and damages blood vessels carrying oxygen and nutrients to the nerves, impairing nerve function. A not so new theory, which is gaining in popularity is the idea that diabetics are susceptible to nerve compression. The susceptibility is thought to be due to the increased volume of the nerve from the abnormal glucose metabolism within the nerve. In layman’s terms this is as if the nerve is swelling and the surrounding tissues and ligaments are pressing on the nerves, resulting in a loss of function.
Currently, there are no treatments to reverse diabetic neuropathy and there are no treatments that will eliminate the numbness. There are, however, many treatments to decrease the symptoms associated with PDN.There was hope of reversing or significantly improving neuropathy with medications like aldose reductase inhibitors, myoinositol, protein kinase C inhibitors, C-peptide, vasodilators and nerve growth factors. Unfortunately, the research did not show consistent or effective results.
Medications: The mainstay of medical treatment for PDN is to manage the symptoms with medications. For those individuals with painful diabetic neuropathy, prescription medications may be needed to manage the pain.
Therapy: Anodyne infrared therapy was initially released in 1994, and was met with mixed reviews, but has gained in popularity in more recent years.
Surgical: Nerve decompression has been increasing in popularity in recent years as a treatment for diabetic peripheral neuropathy.
Natural Alternatives: There are numerous natural alternative treatment options for diabetic neuropathy. Many diabetics have had success with their use, but studies have not given consistent results showing their effectiveness.
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 develop some level of neuropathy. Considering the severity of the complications associated with neuropathy (ulcers, infections and amputations), the associated pain in PDN, tight blood sugar control is of the utmost importance. Along with a healthy diet, exercising for 30 minutes each day will also help to increase circulation and stimulate the growth of new vessels, which may help slow the progression of neuropathy.
Treating painful diabetic peripheral neuropathy is very difficult and many of the above mentioned therapies should be tried and combined. Don't expect any "cures" and make sure you give each therapy a chance to work. It is recommended to talk with your physician or podiatrist to discuss these treatment options.
last updated 4/22/15
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