Diabetic Peripheral Neuropathy is a nerve disease that affects the nerves in the feet and hands of a diabetic person. It is one of the most devastating complications of Diabetes, as it drastically reduces quality of life. Often it can lead to other complications of diabetes as well.

Symptoms Of Diabetic Peripheral Neuropathy

The usual symptoms of Diabetic Peripheral Neuropathy are:

• Tingling
• Pins-and-needles sensation
• Burning sensation
• Numbness
• Pain

These symptoms are usually worse at night and can interfere with sleep. Initially, Diabetic Peripheral Neuropathy affects the toes, which can slowly progresses to affect the entire foot. Eventually, neuropathy may progress to the entire lower leg. Later in the course of the disease, it can also affect your hands as well.

Diabetic Peripheral Neuropathy may start years before a person gets the diagnosis of Diabetes. An oral glucose tolerance test (OGTT) can diagnose Diabetes as well as pre-diabetes many years earlier.

Note: I had seen several cases in my clinical practice who suffered from symptoms of peripheral neuropathy for years before they came to see me. They had been to internists, endocrinologists and neurologists at prestigious medical centers. Unfortunately, they were told that they did not have diabetes as their fasting blood glucose did not meet the diagnostic criteria set by the American Diabetes Association. Consequently, these patients suffered from fear of the unknown, in addition to devastating symptoms of neuropathy itself. Some thought they might have cancer. They turned out to be suffering from insulin resistance and pre-diabetes or even diabetes when I tested them with oral glucose tolerance test (OGTT).

Complications Of Diabetic Peripheral Neuropathy

Numb feet are at a high risk for injury, such as by accidental scalding from hot water or by accidental puncture, like a small piece of gravel into the sole of the foot. Because of a lack of sensation, wounds go unnoticed, especially in between toes and on the soles of the feet. Infection settles in these wounds and can cause serious destruction to soft tissues and even extend to the underlying bone. Bone infection is very difficult to treat and may require amputation and a prolonged course of antibiotics.

Early diagnosis is important in order to prevent further progression of this complication. An endocrinologist and a neurologist can diagnose Peripheral Neuropathy at an early stage. Often, it requires specialized diagnostic testing.

Aggravating Factors

In addition to uncontrolled blood sugars, other factors can worsen Peripheral Neuropathy in diabetes. These factors are:

• Vitamin B12 deficiency, which is common in diabetic patients who are on metformin.

• Excessive alcohol use: Alcohol is a direct toxin for the nerves. It also causes magnesium deficiency which further worsens neuropathy.

• Deficiency of Vitamin D, calcium, potassium, and magnesium often mimic symptoms of Peripheral Neuropathy. Vitamin D deficiency is extremely common, especially in elderly patients as well as in individuals who avoid sun exposure. Potassium and magnesium deficiencies are frequently present in patients who are on diuretics.

How to Prevent Diabetic Peripheral Neuropathy

Good blood glucose control can prevent the development of Diabetic Peripheral neuropathy. Therefore, excellent blood glucose control is crucial right from the time of the diagnosis of Diabetes. In addition, take Vitamin D in adequate doses. Add magnesium supplement and abstain from alcohol. Additionally, avoid any unnecessary medications such as diuretics which can cause deficiency of potassium ans magnesium.

Treatment Options for Diabetic Peripheral Neuropathy

Again, good control of Diabetes using my five-step treatment strategy is crucial, as it prevents further progression of Diabetic Peripheral Neuropathy.

A spouse or a friend should regularly examine your feet for any ulcer or sign of infection. Also see a podiatrist on a regular basis.

Vitamin Therapies and Prescription Medications

    1. Alpha-Lipoic Acid

A dietary supplement, Alpha-lipoic acid may effectively reduce the pain of diabetic neuropathy. In Germany, health care professionals routinely use it to treat Diabetic Peripheral Neuropathy.

Several clinical studies have shown the effectiveness of alpha-lipoic acid in treating Diabetic Peripheral Neuropathy. I use alpha-lipoic acid in my diabetic patients with Diabetic Peripheral Neuropathy and have seen some good results. The usual dose is 600–1200 mg/day. 

     2. Capsaicin

For superficial, burning-type pain, capsaicin works pretty well. It is a skin cream which you apply to the affected area, usually the feet. Capsaicin comes from hot red peppers.

It takes about two to three weeks before the pain starts subsiding. Beware! Initially it may cause some worsening of pain. 

     3. Cymbalta (Duloxetine)

It is an anti-depression drug. However, in 2004, the FDA approved it for the treatment of Diabetic Peripheral Neuropathy. It works well in about 60% of patients with Diabetic Peripheral Neuropathy. Most common side effects of Cymbalta include dry mouth, nausea, constipation, diarrhea, dizziness, and hot flashes.

     4. Neurontin (Gabapentin)

It is an anti-seizure drug. However, it also effectively treats the pain of Diabetic Peripheral Neuropathy. Most patients tolerate this drug fairly well. Typical side-effects of Neurontin include drowsiness, dizziness, and fatigue, especially at higher doses.

On rare occasions, other seizure medications such as Dilantin (phenytoin) and Tegretol (carbamazepine) can also treat Diabetic Peripheral Neuropathy. However, these drugs have serious side effects and should only be prescribed by a physician knowledgeable about these drugs.

     5. Nortriptyline, Amitriptyline, Desipramine

These are older anti-depression drugs that sometimes physicians use to treat the pain of Diabetic Peripheral Neuropathy. Patients often do not tolerate these drugs well due to their common side effects, which include drowsiness, dizziness, dry mouth, impotence, retention of urine and heart arrhythmias. These drugs must not be used in patients with a history of glaucoma, urinary retention, and heart arrhythmias. 

     6. Mexitil (Mexiletine)

It is a heart medicine. Occasionally physicians use it to treat Diabetic Peripheral Neuropathy. Due to its potential serious side effects, this drug should only be prescribed by a physician experienced in prescribing this drug, such as a cardiologist.

In Summary

Diabetic Peripheral Neuropathy is a debilitating complication of Diabetes. However, it can be prevented if you take charge of your Diabetes. Therefore, don’t ignore its symptoms. The good news is that you can treat the symptoms of Diabetic Peripheral Neuropathy with dietary supplements as well as medications.

For more details, please refer to my book, “Reverse Your Type 2 Diabetes Scientifically”