Taking Steps to Prevent Diabetic Neuropathy

WHAT IS DIABETIC NEUROPATHY?

Diabetic neuropathy (sometimes referred to as “diabetic nerve pain”) is a medical term for a type of nerve damage that can happen if you have diabetes. All patients with diabetes are at risk of developing diabetic neuropathy, so it is important to understand its causes.

WHAT CAUSES DIABETIC NEUROPATHY?

Diabetic neuropathy develops when blood sugars are high for long periods of time and the nerves in the legs and feet become damaged and start to cause pain.¹After years of diabetes, it is common to start seeing signs and symptoms of diabetic neuropathy. It is important to note that the condition develops slowly, and you may not notice the symptoms until after many years of high blood sugar. The symptoms of diabetic neuropathy include pain, and numbness in your legs and feet. Sometimes these symptoms can be very painful and dangerous to your health as the circulation or sensation in your legs and arms is decreased.

There are 4 main types of diabetic neuropathy: peripheral neuropathy, autonomic neuropathy, radiculoplexus neuropathy, and mononeuropathy. As a person with diabetes, you can have one type of neuropathy or several different types. Although the symptoms of these different types of neuropathy are slightly different, all types of neuropathy cause cramping, pain, and tingling sensations. The most common type of neuropathy is peripheral neuropathy. Peripheral neuropathy often starts in the feet and then moves up to the hands and arms (your peripheral limbs). Although the main symptoms often include numbness and pain, additional signs of diabetic neuropathy include:

• Tingling (often widespread in the legs)
• Burning feeling in legs and/or arms
• Pain
• Cramps
• Foot sores, infections, and joint pain
• Weakness in muscles
• Dizziness or coordination problems

WHAT ARE THE RISK FACTORS ASSOCIATED WITH DIABETIC NEUROPATHY?

Some of the risk factors associated with diabetic neuropathy include:

• Being overweight or obese. A person is obese if their body mass index (BMI) is greater than 30, and overweight if it is greater than 25. A BMI over 25 puts a person with diabetes at greater risk for diabetic neuropathy.
• Having diabetes for a long period of time. The longer you have diabetes, the greater your risk of developing diabetic neuropathy. It is most common to develop the condition after about 10 years of being diabetic. With each passing year, it becomes even more important to keep your blood sugar under control in order to avoid diabetic neuropathy.
• High blood sugar. High blood sugar is the greatest risk factor for complications with diabetes, including nerve damage. One of the ways to avoid complications is to keep your blood sugar in the range set by you and your health care provider.
• Smoking. Because of the damage that smoking does to your heart, lungs, and overall health, it is the greatest risk factor for complications with diabetes. This is especially true if you have diabetic neuropathy, since smoking hardens your arteries making blood flow to your feet more difficult.

HOW IS DIABETIC NEUROPATHY TREATED?

Like diabetes, diabetic neuropathy has no known cure. Because of this, treatment focuses on:

• Decreasing the pain
• Keeping complications down
• Slowing the disease

The most important focus of diabetic neuropathy treatment is pain relief. Not everyone responds well to the same treatments for pain relief, so your health care provider will often try several different approaches to help relieve your pain. Some people do well with acupuncture, massages, or alternative therapies for pain relief. Patients are often looking for pain relief and need to find ways to manage their pain on a daily basis. There are many different types of medications that may help relieve the pain of diabetic neuropathy that you can discuss with your health care provider, such as:

• Anti-seizure drugs. The drugs in this class include gabapentin (Neurontin), pregabalin (Lyrica), and carbamazepine (Tegretol, Carbatrol). These drugs are used to treat seizure disorders and can be prescribed to help with your nerve pain.²They work by calming the nerves associated with diabetic neuropathy, reducing the stabbing pain that is caused by the condition.
• Antidepressants. Antidepressants are another type of drug that may be used to treat diabetic neuropathy. Examples of these drugs include amitriptyline (Elavil), desipramine (Norpramin), imipramine (Tofranil), and duloxetine (Cymbalta). Antidepressants work in diabetic neuropathy by blocking pain messages on their way to your brain.
• Pain relievers. Pain relievers such as, acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin are often helpful to treat the discomfort associated with diabetic neuropathy. NSAIDs work by reducing inflammation.
• Anesthetic creams. Anesthetic creams such as lidocaine, capsaicin, and others^3,4are a great option for patients with diabetic neuropathy, as they numb the specific area of your skin where the pain is located. Your health care provider will prescribe what works best for you.

IS THERE A WAY TO AVOID DIABETIC NEUROPATHY?

Diabetic neuropathy is a common complication of diabetes. It is important to be aware of the risk of this condition and the symptoms so that treatment and foot care are started as early as possible. The American Diabetes Association recommends a detailed foot exam for all patients with diabetes every year.⁵During this exam, the provider will check for sores, blisters, and circulation in your feet. In addition, the patient should ensure the following:

• Keep blood pressure under control. Since patients with diabetes are more likely to have high blood pressure, it is very important to try to keep it under control to reduce the risk of diabetic neuropathy. High blood pressure damages your blood vessels, and when present with diabetes, puts you at a great risk for diabetic neuropathy.
• Eat healthy every day. Remember, it is very important to include fruits and vegetables in your daily food choices and to avoid fats to keep your nerves and arteries healthy and prevent hardening in your arteries.
• Stay active. The American Heart Association and the American Diabetes Association generally recommend about 30 minutes of moderate exercise a day at least 5 times a week.⁶Staying active will keep your heart in shape and your arteries from hardening, helping the circulation to the nerves in your hands and feet.
• Keep feet clean and dry. Wash your feet every day with lukewarm water and mild soap. Avoid soaking your feet. Dry your feet carefully, including the area between your toes, by blotting or patting with a soft towel. Keep your feet moisturized, but be sure not to put lotion between your toes since this can cause fungal infections. Although the moisture will help keep your feet from drying out, too much moisture can make it easier for fungus to grow around your feet.⁷
• Cut your toenails with caution. Make sure you always cut in a straight line to keep your nails from growing into your skin and causing infection. Keeping your nails evenly trimmed will prevent ingrown nails and other problems that can lead to infection.
• Wear good shoes. It is very important to wear shoes that protect your feet.⁷Make sure your shoes fi t well, especially around your toes. Make sure your socks are always clean to avoid infection and fungus. Good orthopedic shoes will help support your feet and protect them from injuries.

Although diabetic neuropathy is a problem that causes pain for diabetics in their hands and feet, there are many ways to help decrease the pain and help protect your feet from infection. Following these basic tips can help ensure that diabetic neuropathy does not worsen or cause problems for your feet, as you strive to achieve your active, healthy living goals!

Kristene Diggins, FAANP, CNE, NEA-BC, DNP, DCC, MBA is a doctorally prepared nurse practitioner (NP) who has recently completed her MBA. Dr. Diggins works as the manager of professional practice for MinuteClinic, striving to enhance the practice of convenient care for patients and providers. She has worked as a provider in convenient care for 8 years and also teaches as NP adjunct faculty for Kaplan University and the University of Phoenix online. Kris enjoys international medical opportunities, as her career goal is to enhance health care access, globally.

References

1. Neuropathy (nerve damage). American Diabetes Association website. www.diabetes.org/living-with-diabetes/complications/neuropathy.
2. Feldman EL, McCulloch DK. Treatment of diabetic neuropathy. UpToDate website. www.uptodate.com/contents/treatment-of-diabetic-neuropathy.
3. Griebeler ML, Morey-Vargas OL, Brito JP, et.al. Pharmacologic interventions for painful diabetic neuropathy: An umbrella systematic review and comparative effectiveness network meta-analysis.Ann Intern Med.2014;161(9): 639-649. doi: 10.7326/M14-0511.
4. Kiani J, Sajedi F, Nasrollahi SA, Esna-Ashari F. Topical clonidine and capsaicin in the treatment of diabetic neuropathy.J Res Med Sci. 2015;20(4):359-363.
5. Foot care. American Diabetes Association website.http://www.diabetes.org/living-with-diabetes/complications/foot-complications/foot-care.html. Updated October 10, 2014. Accessed August 26, 2015.
6. American Heart Association recommendations for physical activity in adults. American Heart Association website.www.heart.org/HEARTORG/GettingHealthy/PhysicalActivity/FitnessBasics/American-Heart-Association-Recommendations-for-Physical-Activity-in-Adults_UCM_307976_Article.jsp. Updated August 17, 2015.
7. Steps to prevent or delay nerve damage. American Diabetes Association website.www.diabetes.org/living-with-diabetes/complications/neuropathy/steps-to-prevent-or-delay.html. Updated December 5, 2013.