Diabetic neuropathy is a nerve disease in diabetes. It is one of the devastating complications of diabetes.
Symptoms Of Diabetic 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 progresses to the entire foot. Eventually neuropathy can progress to the entire lower leg. Later in the course of the disease, it can also affect your hands.
Diabetic neuropathy often starts 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.
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 the 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 For Diabetic Neuropathy
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.
- Vitamin D, calcium, potassium, and magnesium deficiencies often mimic symptoms of peripheral neuropathy. Vitamin D deficiency is extremely commonly, 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 Neuropathy?
Good blood glucose control can prevent the development of 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 worsen diabetic neuropathy.
Treatment Options for Diabetic Neuropathy
Again, a good control of diabetes using my five-step treatment strategy is crucial, as it prevents further progression of 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.
Here is a list of vitamin therapies and prescription medications that can help reduce the symptoms of peripheral neuropathy.
Alpha-Lipoic Acid in The Treatment Of Diabetic Neuropathy
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 peripheral neuropathy. I use alpha-lipoic acid in my diabetic patients with peripheral neuropathy and have seen some good results. The usual dose is 600–1200 mg/day.
Capsaicin for Nerve pain in Diabetes
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.
Cymbalta (Duloxetine) In The Treatment Of Neuropathy In Diabetes
It is an anti-depression drug. However, In 2004, FDA approved it for the treatment of diabetic peripheral neuropathy. It works well in about 60% of patients with diabetic neuropathy. Most common side effects of Cymbalta include dry mouth, nausea, constipation, diarrhea, dizziness, and hot flashes.
Neurontin (Gabapentin) for Treating Diabetic Neuropathy
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 includes 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.
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.
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 peripheral neuropathy with dietary supplements as well as medications.
For more details, please refer to my book, “Reverse Your Type 2 Diabetes Scientifically”
