Complications of Diabetes: Peripheral Neuropathy

by admin on July 29, 2014

As many as 50% of people with diabetes at some point develop a sensation of “numb toes” or “a burning sensation” or “fuzzy feet.”  These are all symptoms of one of the more common foot-related complications of diabetes: Neuropathy.

Neuropathy is, very simply, nerve damage.  The exact mechanism is unknown, except that the risk of developing neuropathy is directly related to a person’s average blood sugar (i.e. diabetics whose blood sugar is usually close to 100 have a low chance of getting it, those whose average is 200 are more than twice as likely.)   Thus, keeping blood sugar under control is the best way of preventing neuropathy from occurring in the first place.

The symptoms I described in the beginning of this post are related to sensory neuropathy, which is the effect of sensory nerves (nerve endings) being affected by neuropathy.  There are two other types of nerves affected by neuropathy also.  Motor neuropathy is damage to the nerves that control the muscles of the foot.  Damage to motor nerves leads to weakness of the muscles, and typically causes hammertoes and flattened arches.  Autonomic neuropathy is damage to the nerves that control our glands and circulation.  As a result, often the sweat glands stop working altogether, and the skin dries out and can crack.  Circulation can be diminished, which leads to delayed healing and increased rates of infection.

I already mentioned that good control of blood sugar is the best way to prevent neuropathy.  Of course, if it were that easy, diabetes wouldn’t be an epidemic!  The truth is, like most problems of diabetes, there is no easy cure for neuropathy.  One common and low-risk treatment is vitamin B-6 (pyridoxine), which is prescribed for this condition.  It works best for recent cases of neuropathy; the longer you’ve had it, the less effective it is.  Most other medications used for neuropathy (drugs such as gabapentin, Elavil, or Lyrica) only control the symptoms and do not actually treat the problem, but if you have a painful case of neuropathy, they can be well worth the money.  Two somewhat experimental treatments are infrared light exposure (a form of physical therapy) and nerve releases (a surgical technique.)  Both are available but still being researched; results are forthcoming.

Neuropathy is important in the discussion of diabetes-related foot problems, because it is usually at the root of them.  Two of the more costly complications of diabetes, diabetic ulcers and charcot foot, are only possible if the individual has neuropathy to begin with.  Still, a diagnosis of neuropathy is definitely not the end of the world.  Diabetic shoes are an important tool in the prevention of foot problems; they are so important that Medicare pays for a pair of diabetic shoes each year in individuals with diabetes.  Diabetic skin cream is formulated to help replace the moisture lost by the lack of sweat glands in the feet, keeping the skin soft and flexible.  Orthotics and braces are useful for addressing the mechanical problems like flat feet and hammertoes, as well as deformity caused by Charcot.

Of course, being vigilant and proactive are the best ways to prevent neuropathy and its complications.  Your primary care doctor is well-versed in the complications of diabetes, and may refer you to a podiatrist if your symptoms are worrying.  Don’t worry; these symptoms and complications are entirely treatable.  Submit an inquiry under the “contact” tab if you have further questions.

Up next: Neuropathy and diabetic ulcers

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