MBBS, MRCGP ( UK), D Diab (UK)
1: what is diabetes?
Diabetes is a chronic condition in which there is an excess amount of glucose (sugar) in your blood as your body is not able to utilise this glucose effectively. This is because of
A) either your pancreas (which is an organ in your body behind the stomach) is not producing insulin at all or is producing only little insulin. Insulin is needed to push the glucose into your cells. When there is less insulin glucose cannot enter into your cells and thus remains in the blood.
B) or the insulin that is produced is not working properly as your body resists it, this is called insulin resistance.
2: so what happens when glucose/sugar in blood remain high?
Now blood circulates everywhere in your body - from your head to your feet. When your blood has consistently high glucose levels, this glucose deposits in the organs. This leads to complications of eyes, kidneys, nerves and heart.
3: what is diabetic peripheral neuropathy?
Neuropathy means damage to nerves. Peripheral nerves are nerves of arms, hands, legs and feet. So diabetic peripheral neuropathy refers to the damage done to the nerves which supply your hands and legs as a result of high circulating blood glucose level over a long period of time. These damaged nerves cannot now effectively carry signals to the brain, and between brain and other parts of the body. Other nerves in the body also can be affected in addition to the peripheral nerves.
4: what are the symptoms of diabetic peripheral neuropathy?
You may not be able to feel sensation of heat, cold or pain in your feet, legs or hands (in other words your hands and feet may feel numb). You may feel tingling, pin-prick sensations, stabbing sensation, burning sensation, cold sensation, buzzing sensation, pinching sensation, deep pain or cramps of your hands, feet and legs. Some patients experience an exaggerated sensation to touch. These symptoms may be worse at night.
Some patients also experience weakness of their limb muscles. They may experience difficulty in walking or getting up from a chair or walking up the stairs. Some patients have balance problems.
Different patients feel different symptoms of nerve damage. Some people may feel tingling first and then later experience pain. Some others may lose feeling in their toes and fingers and then have the numbness.
These changes happen slowly over a period of years and hence you may not even have noticed it. Further, as initially the symptoms are mild and subtle, you may tend to ignore it. You may even attribute it to your old age!
5: why are the symptoms important?
Numbness/loss of sensation is of particular importance. You may think that you have a high pain threshold as you are able to bear the pain of seemingly severe wounds on your feet and hands whereas some other person would have cried out. But it is actually that your nerves are damaged and hence you are not able to perceive the pain.
So imagine a scene where you don't know that you have nerve damage. You walk bare foot and step on a thorn. You get hurt but as you don't feel the pain you will not notice it. In a diabetic patient, wound healing happens slowly. So now this small wound festers and becomes big and ultimately forms an ulcer. If it is still not taken care of, the infection spreads and ultimately the toe /foot need to be amputated.
6: what are the risk factors for peripheral neuropathy?
-high blood glucose levels
-high triglyceride levels
-high blood pressure
-excess body weight
7: how to diagnose peripheral neuropathy?
Your doctor will lightly press a thin nylon rod (10 gram monofilament) to your feet. He will also press a 128hz tuning fork to the bony prominences of your foot. More sophisticated examination includes biothesiometry and matscan.
8: when to screen for diabetic peripheral neuropathy?
Type-1 diabetes: as diabetic peripheral neuropathy is not common in the first five years of onset of diabetes, it is wise to screen for this after 5 years. Screening should be done annually. For children, screening should be done once the child is past puberty and has had diabetes for at least 5 years.
Type-2 diabetes: screening should be done at onset of diabetes and once every year.
9: how can I prevent from developing diabetic peripheral neuropathy?
The best way to prevent from developing peripheral neuropathy is by maintaining a very good control of your blood glucose levels. So, it is advisable to take your diabetic medications regularly as prescribed. In addition, you should also follow a healthy diet without any high calorie and any high sugar food items, regular physical activity, maintain appropriate weight, stop smoking, maintain normal blood pressure and keeping your lipid/cholesterol levels in normal range.
10: what to do if I have already developed symptoms of peripheral neuropathy and am suffering?
Although peripheral neuropathy cannot be cured, it can be appropriately managed using tablets and creams. Acupuncture, biofeedback and physiotherapy have also helped certain people. It is advisable to consult your doctor so that he could prescribe the correct treatment for your symptoms.