Diabetes and Neuropathy

Diabetes is the most common cause of peripheral neuropathy and at least half of the patients with diabetes will experience some degree of peripheral neuropathy.  Why is this? What is peripheral neuropathy? What are the symptoms? Is there a treatment for peripheral neuropathy?

Diabetes is a disease that is characterized by having blood sugar levels higher than the normal; normal levels are less than 128 mg/dL. Not only does this high blood sugar characterize diabetes, it also is the cause of nerve damage leading to peripheral neuropathy. Peripheral neuropathy is the loss of sensation in the nerves that send information from outside surroundings of the body to the brain. For example, it is not uncommon to have a patient come into the office and upon checking the patient’s shoe, an object may be found such as a watch, small toy, nail etc. For many people this would cause pain and the nerves would tell the brain that the shoe needs to be taken off and the object that has fallen into the shoe needs to be removed, since it is causing pain to the bottom of the foot. However, due to the nerves being damaged, they are unable to tell the brain that there is something in the shoe and this object may begin to cause or has already caused trauma, such as an ulceration.

For most patients, severe peripheral neuropathy causing total loss of sensation does not happen overnight; it is a process. The symptoms of early peripheral neuropathy are: tingling, pain, numbness, and burning that usually begins in the toes. The peripheral neuropathy may eventually progress to complete loss of sensation in the feet. It is important, if you are experiencing these symptoms to schedule an appointment at the Platte Valley Foot and Ankle Clinic immediately since there are medications, which are able to help control the pain, associated with peripheral neuropathy and may slow the progression of complete loss of sensation.

Peripheral neuropathy can be diagnosed with simple testing; the simplest way of determining the possible presence of peripheral neuropathy is a complete history of the patient’s symptoms and medical history. In addition, simple physical exams can be performed that focus on testing the sensation ability of the nerves. For example, there is the Semmes Weinstein Monofilament Test; this test is performed with the patient’s eyes closed and the monofilament will be touched to 10 spots on the foot in order to test each of the nerves that contributes to the sensation of the foot.  If the patient is unable to feel all 10 sites, there may be some degree of peripheral neuropathy present. Like stated above, this is a very simple physical exam test and is completely non-invasive and painless. This is just one example of several physical exam tests that can be performed to assess for peripheral neuropathy.

If peripheral neuropathy is present, there are various treatments. The most simple and healthiest way to slow the progression of peripheral neuropathy is to keep the blood sugar level controlled. If a patient is experiencing pain due to peripheral neuropathy, there are several medications that can be prescribed to help control it, such as, prescription pain medications, gabapentin, which is an anti-seizure medication, capsaicin, which is a topical skin cream that can be combined with other medications, topical anesthetic patch to wear on the skin, amitriptyline and nortryptyline, which interfere with the chemical signals in the brain and spinal cord to block the sensation of pain, and a transcutaneous electrical nerve stimulation, which is a type of therapy that is done on a regular basis.

Diabetes is not the only cause for peripheral neuropathy, even though half of patients with diabetes will develop some degree of peripheral neuropathy. Some of the other diseases and causes of peripheral neuropathy include: alcoholism, lupus, rheumatoid arthritis, Guillain-Barre syndrome, exposure to heavy metals, chemotherapy, Lyme disease, shingles, hepatitis C, HIV, Charcot Marie Tooth disease, amyloid polyneuropathy, trauma, tumors that compress or surround the nerves, deficiencies of vitamin B, E, and niacin, kidney disease, liver disease, and hypothyroidism.

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