Do you feel burning, numbness and tingling in your feet and toes? Let’s talk about diabetic neuropathy!
What is diabetic neuropathy?
Diabetic neuropathy is an impairment of the nerve endings that may occur in people with diabetes or pre-diabetes.
Patients with diabetic neuropathy usually develop pain, burning, numbness, and tingling in their feet. The symptoms may slowly progress up to the legs and eventually the hands.
The symptoms may feel like “pins and needles” in the hands and feet. Patients may even have loss of balance or muscle weakness depending on the severity and the type of nerve fiber affected.
What are the complications of diabetic neuropathy?
Skin ulcer formation in the feet. Some patients may have impaired sensation in their feet. Due to reduced sensitivity, patients may not feel or notice any cut or opening in the skin. The sores or ulcers could get complicated by infections and subsequently may result in limb amputation.
Falls due to balance problems.
Chronic pain. Chronic pain may result in long term use of multiple medications. It may also result in emotional, social, and economic repercussions.
Other health conditions may present with similar symptoms. Some of these conditions are:
Other problems affecting the nerves. The nervous system could get involved in different ways in patients who have diabetes.
Radiculopathy. Which is nerve root involvement at the level of the lower back or spine.
Neuropathy due to other causes. Neuropathy may also be caused by: thyroid disease, alcohol use, liver or kidney disease, viral infections, cancer, chemotherapy, vitamin B12 deficiency, and others.
How can you know if you have diabetic neuropathy?
History and physical exam by your primary care doctor, physiatrist, endocrinologist, or neurologist. If you have symptoms that suggest diabetic neuropathy, a throughout medical evaluation is highly recommended.
Electrodiagnostic study. This test has two parts: nerve conductions tests and electromyography. It helps evaluate how the nerves are working. This test could be uncomfortable, but most of the patients tolerate it well.
MRI. If your doctor suspects nerve root involvement in the spine, he/she may order a lumbar MRI.
Laboratory workup (blood and urine)
- To check the blood glucose levels.
- It may help rule out other causes of neuropathy.
- Possible laboratory tests include:
- glucose tolerance test
- HbA1c (glycosylated hemoglobin- measures the average glucose levels in the last three months)
- thyroid function tests
- liver and kidney function tests
- vitamin B12 and folic acid levels
- lipid panel
What is the treatment for peripheral neuropathy?
Medications. The medications prescribed to treat diabetic neuropathy are mainly used to control the pain. Your doctor may consider different classes of medication, such as anticonvulsants, antidepressants, and even opioids.
According to an article published in Medicina 20201 the treatment options include:
First option: pregabalin, duloxetine (both FDA approved for this use), and gabapentin.
Second and third lines of treatment: opioids and topic analgesics.
Let’s not forget that there is an opioid use and abuse crisis in the United States, due to their risk of addiction.
Topical medications. Certain topical medications like lotions, patches, or sprays could be of benefit.
Dietary supplements. Alpha-lipoic acid (ALA) is not FDA approved. However, based on an evaluation done by this agency, ALA seems to be safe and potentially effective2,3.
Other medical treatments. Electrical stimulation (know as TENS: Transcutaneous Electrical Nerve Stimulation) could be considered for the relief of neuropathic pain.
Lifestyle changes. Regular diet and exercise are key to prevent and reduce symptoms. This is in part due to better control of the blood glucose levels.
Physical Therapy. Physical therapy may be of benefit to some patients. It may include working with balance problems, addressing the risk of falls, general physical conditioning, and weight control.
What can you do to improve the symptoms of diabetic neuropathy?
Glucose control, glucose control, glucose control! Monitor your blood sugar levels regularly. Have a glucose monitor (glucometer) at home. Make a log to register your glucose readings and discuss it with your doctor. Have your laboratory bloodwork as recommended by your doctor.
Have an adequate nutrition and follow a regular exercise program. Never enough repetition!
You may want to read my article on Exercise Guidelines to Start Working Out. These guidelines are for healthy people. You may read them to get some basic knowledge and encouragement. But always consult with your doctor. He or she may do an exercise prescription specifically for you.
Make sure that any other conditions, such as elevated cholesterol and high blood pressure, are under control.
Avoid toxic habits, such as smoking and drinking alcohol.
Take care of your feet. You should take a look at them every day. Keep them moisturized and use adequate shoes and socks. If you develop a skin ulcer, seek immediate medical care.
Educate yourself every day!
- Ardeleanu V, Toma A, Pafili K, Papanas N, Motofei I, Diaconu CC, Rizzo M, Stoian AP. Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review. Medicina (Kaunas). 2020 Jan 9;56(1):25.
- Callaghan BC, Cheng HT, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol. 2012 Jun;11(6):521-34.
- Alpha Lipoic Acid Pharmacy Compounding Advisory Committee Meeting 12 September 2018. Available online: https://www.fda.gov/media/116311/download
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