Diabetic neuropathy is a debilitating complication of diabetes.
Symptoms Of Diabetic Neuropathy
The usual symptoms of diabetic neuropathy are: tingling, a pins-and-needles sensation, a burning sensation, numbness, or pain. Symptoms are usually worse at night and can interfere with sleep. Initially, it affects the toes, which progresses to the entire foot and eventually can progress to the entire lower leg. Later in the course of the disease, hands can also be involved.
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.
Diabetic neuropathy often starts years before a person is diagnosed with diabetes. An oral glucose tolerance test (OGTT) can diagnose diabetes as well as pre-diabetes many years earlier.
Other factors that can contribute toward Diabetic Neuropathy:
- Vitamin B12 deficiency, which is common in those on metformin
- Excessive alcohol use
- 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.
Treatment Options for Diabetic Neuropathy
Again, good control of diabetes using my five-step treatment strategy is crucial, as it prevents further progression of neuropathy.
A spouse or a friend should regularly examine your feet for any ulcer or sign of infection. See a podiatrist on a regular basis.
There are also some vitamin therapies and prescription medications that can help reduce the symptoms of peripheral neuropathy.
Alpha-lipoic acid is a dietary supplement that has been used in Germany for more than thirty years for the treatment of diabetic 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. I feel that this product is safe. I have not seen any serious side effects in my patients. The usual dose is 600–1200 mg/day.
For superficial, burning-type pain, capsaicin works pretty well. It is a skin cream that is applied to the affected area, usually the feet. Capsaicin is derived 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.
In 2004, the drug Cymbalta was approved for the treatment of diabetic peripheral neuropathy. It works well in about 60% of patients. Most common side effects include dry mouth, nausea, constipation, diarrhea, dizziness, and hot flashes. Cymbalta is also used to treat depression.
Neurontin is an anti-seizure drug that is often used to treat the pain of peripheral neuropathy. Most patients tolerate this drug fairly well. Drowsiness, dizziness, and fatigue are the typical complaints I have heard from patients who are on this medication, especially at higher doses.
On rare occasions, other seizure medications such as Dilantin (phenytoin) and Tegretol (carbamazepine) are used to treat diabetic peripheral neuropathy. 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 have been used to treat the pain of 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 is a heart medicine used to treat arrhythmia. It has also been used 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.
Excerpts from my book, “Reverse Your Type 2 Diabetes”