CONDITIONS
Diabetic Peripheral Neuropathy
Diabetic Peripheral Neuropathy (DPN)
Peripheral neuropathy is a type of nerve damage typically affecting the feet and legs and sometimes affecting the hands and arms. It is a most common occurrence in diabetic people with one-half of people with diabetes having this condition.
Estimates in India are varied from 20% in some regions to 40%.
In India, a major problem DPN is that the changes are subtle and usually occur with age which leads people to ignore the signs of nerve damage, incorporating it as a part of getting older.
What are the symptoms of Peripheral Neuropathy?
Every nerve in the peripheral system has a specific function and the symptoms depend on the type of nerves affected. The types of nerves are:
Sensory nerves receiving sensation, such as pain, vibration or touch, from the skin. Motor nerves that control muscle movement. Autonomic nerves that control functions such as blood pressure, sweating, etc.
Symptoms of peripheral neuropathy might include:
- Gradual onset of numbness, or tingling sensation in the feet or hands.
- Sharp, pointing, pulsating, or burning pain.
- Extreme sensitivity to touch.
- Pain during normal activities such as putting slightest weight on them or when they’re under a blanket.
- Muscle weakness.
- Feeling as if you’re wearing gloves or socks when you’re not.
- In case motor nerves are affected, then movement may be affected.
If autonomic nerves are affected, symptoms might include:
- Excessive intolerance to heat.
- Either too much sweating or not being able to sweat at all
- Bowel, bladder or digestive problems.
- Drops in blood pressure, causing dizziness or lightheadedness.
What are the causes of peripheral neuropathy in people?
The most common cause among people is diabetes, as more than half the people with diabetes gradually develop some type of neuropathy.
Over time, high blood glucose, and corresponding high levels of fats, such as triglycerides, in the blood from diabetes damages the nerves and the small blood vessels nourishing the nerves, leading to peripheral neuropathy.
How is Peripheral Neuropathy diagnosed?
Doctors diagnose peripheral neuropathy based on the symptoms, family and medical history, a physical exam, and tests. A neurological exam and a foot exam is conducted as a part of physical exam.
In case of diabetes, the doctor does the following examinations to check the blood flow and feeling, or sensation, in the feet:
- place a tuning fork against the great toes and higher on your feet to check for feel of vibrations.
- touch each foot and some toes with a nylon strand to see if there is sensation (monofilament test)
- check for patterns made by patient while walking
test the balance - in some cases, ask if they can feel temperature changes in the feet
Following tests may be conducted:
Blood tests: Detects low levels of vitamins (B12), diabetes, signs of inflammation or metabolic issues that may cause peripheral neuropathy.
Imaging tests: CT or MRI scans can look for herniated disks or pinched nerves, also called compressed nerves, other problems affecting the blood vessels and bones.
Nerve function tests: Electromyography (EMG) measures and records electrical activity in your muscles to find nerve damage. A thin needle (electrode) is inserted into the muscle to measure electrical activity as you contract the muscle.
How is Peripheral Neuropathy treated?
Treatment goals are usually to manage sugar levels in case of diabetes and to improve symptoms.
Medicines: Medicines are prescribed to treat conditions associated with peripheral neuropathy and also to improve the symptoms. These medicines are:
- Pain relievers
- Anti-seizure medicines to improve nerve pain.
- Topical treatments
- Antidepressants such as amitriptyline and nortriptyline to help improve pain.
Therapies:
Scrambler therapy: Using electrical impulses nonpain messages are sent to the brain to replace them with the pain messages the nerves send to the brain.
Spinal cord stimulation: Devices known as neurostimulators are put into the body from where they send low-level electrical impulses that block pain signals from reaching the brain.
Physical therapy: In case of muscle weakness or issues with balance, physical therapy helps in improving the ability to move. This involves the use of hand or foot braces, a cane, a walker, or a wheelchair.
Surgery: Neuropathies caused by pressure on nerves, such as from tumors, might require surgery.
Other aids such as orthopedic shoes are sometimes recommended to improve walking problems, which will prevent foot injuries.
How can Peripheral Neuropathy be prevented?
The best way to prevent peripheral neuropathy is to manage underlying condition, diabetes, in this case. Maintaining adequate blood glucose levels is the key to avoid complications arising from diabetes.
Making healthy lifestyle choices and habits that support the nerve health is advised.
These can be achieved by:
- Eating diet rich in fruits, vegetables, whole grains and lean protein to keep nerves healthy. Keeping good levels of vitamin B-12 by eating meats, fish, eggs, low-fat dairy foods and fortified cereals. Vegetarian people can consume fortified cereals but can also ask doctors about B-12 supplements.
- Exercising regularly: Post consultation with a health care professional, at least 30 minutes to one hour of exercise at least three times a week is recommended.
- Avoid factors causing nerve damage: These are repetitive motions, exposure to toxic chemicals, smoking and drinking too much alcohol.
References
- Darivemula S, Nagoor K, Patan SK, Reddy NB, Deepthi CS, Chittooru CS. Prevalence and Its Associated Determinants of Diabetic Peripheral Neuropathy (DPN) in Individuals Having Type-2 Diabetes Mellitus in Rural South India. Indian J Community Med. 2019 Apr-Jun;44(2):88-91.
- How Is Diabetic Nerve Pain Treated? WebMD. February 2024. https://www.webmd.com/diabetes/peripheral-neuropathy-treating-nerve-pain
- Peripheral neuropathy. Mayo Clinic. February 2024. https://www.mayoclinic.org/diseases-conditions/peripheral-neuropathy/symptoms-causes/syc-20352061
- Peripheral Neuropathy. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). February 2024. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/peripheral-neuropathy#diagnose-pn
