Diabetes can lead to nerve damage (diabetic neuropathy) throughout the body over time. The risk of diabetic neuropathy increases with age, obesity, longer duration of diabetes and poor control of blood sugar.
The exact cause of diabetic neuropathy is not known. Nerve damage probably occurs due to a combination of factors such as:
- Metabolic causes: Such as elevated blood glucose, duration of diabetes, abnormal blood cholesterol and other lipid levels, and probably low levels of insulin.
- Neurovascular cause: Damage to the blood vessels that supply oxygen and other nutrients to nerves.
- Mechanical factors can lead to injury to nerves, such as carpal tunnel syndrome.
- Inflammation in nerves: Autoimmune factors can result inflammation in nerves.
- Inherited traits can increase susceptibility to nerve disease as well.
- Lifestyle factors, such as smoking, alcohol use, sedentary life style.
Diabetic neuropathy most commonly affects the feet and legs. Symptoms of diabetic peripheral neuropathy are:
- Pain: The character of pain can vary from cramping, sharp pain, burning, tingling sensation and pain to touch.
- Numbness (severe or long-term numbness can become lasing feature)
- Burning (particularly in the evening)
Pain and other symptoms are usually worsened at night. Nerve damage in the feet can result in loss of foot sensation, which can cause injuries to go unnoticed. Hence it is important that you practice proper skin and foot care. In patients with early symptoms of diabetic peripheral neuropathy optimal control of blood sugar can reduce the symptoms.
Tests and diagnosis
According to experts all people with diabetes should have a comprehensive foot exam each year to check for peripheral neuropathy.
Your may perform following tests as part of your diagnosis:
- Heart rate variability: This test shows how your heart responds to deep breathing, changes in blood pressure and posture.
- Ultrasound: Ultrasound is done to assess internal organs like intestines, the bladder and other parts of the urinary tract.
Doctors usually treat pain in diabetic neuropathy with oral drugs. No particular drug has been found to be effective in all patients. Alternative therapies have been noted to help some people. Most people usually need a combination of medications or treatments for relieving pain in diabetic neuropathy.
- Acetaminophen or Non-steroidal anti-inflammatory drugs (NSAIDs): Acetaminophen or NSAIDs such as ibuprofen, diclofenac, naproxen may be given for pain relief.
- The NSAIDs relieve pain but some may decrease kidney function in people with diabetes if taken for prolonged time.
- Tricyclic Antidepressants (TCAs) such as imipramine, amitriptyline and nortriptyline are effective for treating neuropathic pain. The pain relieving properties of TCA are evident at much lower doses than what is prescribed to a person with depression. Amitriptyline is the most commonly prescribed antidepressant medication for pain in peripheral neuropathy.
- Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs such as duloxetine, citalopram, escitalopram oxalate, fluoxetine, paroxetine and sertraline are antidepressants that are effective for neuropathic pain as well. These drugs are better tolerated and have fewer side effects as compared to TCAs.
- Anticonvulsants: Gabapentin and pregabalin are anticonvulsants that are approved for treatment of diabetic peripheral neuropathy. They stabilize damaged nerves and ease the pain signals send to the brain.
- Narcotics/opioids: These medications (codeine, morphine) are usually reserved for people who don’t respond to anything else. Oxycodone and fentanyl are the common opioids prescribed for moderate to severe pain.
- Topical therapy: Topical therapy for pain includes capsaicin cream and lidocaine patches. Nitrate sprays or patches for the feet have also been observed to relieve pain. Some studies indicate that alpha-lipoic acid, an antioxidant, and evening primrose oil have may help relieve symptoms and improve nerve function in diabetic neuropathy.
Alternative therapies that have found to beneficial in relieving pain include acupuncture, biofeedback, physical therapy, electrical nerve stimulation, magnetic therapy, and laser or light therapy. No particular therapy is beneficial in all patients. You will have to try and assess if a particular therapy can relieve your pain. Bed cradle is a device that can prevent sheets and blankets from touching sensitive feet and legs.
There are no home remedies that can effectively relieve pain. But home care can prevent further tissue damage and provide pain relief to an extent.
- Maintain your blood sugar levels in normal range with diet and medication.
- Do regular exercise and workouts as these will help maintain your blood sugar levels under control, and may reduce neuropathic pain.
- Maintain a healthy weight
- Inspect your feet daily for sores or injuries.
- Avoid smoking and excessive alcohol consumption (cigarette smoking can adversely affect circulation and increase the risk of eventual amputation)
The most effective way to prevent neuropathy is to keep your blood glucose levels in the normal range if possible with medications and diet.
Measures to prevent the complications of peripheral neuropathy are:
- Inspect your feet daily for sores or injuries.
- Use lotion or cream if your feet are dry.
- Take care for your nails and if needed go to a podiatrist.
- Wear properly fitting and comfortable footwear all the time to prevent foot injury.