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Diabetic and Peripheral Neuropathy

Diabetic neuropathy is a central nerve disorder as a result of diabetes. There are four types of diabetic neuropathy, peripheral, autonomic, proximal, or focal. The most common type of diabetic neuropathy is peripheral. Peripheral neuropathy is a condition that affects the extremities such as the arms, hands, legs, feet, and toes.

Who is a candidate for diabetic peripheral neuropathy?

Between 60% and 70% of persons with diabetes suffer from one form or another of diabetic neuropathy. Persons that have had diabetes for an extended period of time and elderly persons with diabetes (often these two go hand-in-hand), are more likely to suffer from some form of diabetic neuropathy. Persons who have had diabetes for twenty five years or longer are most likely to suffer from diabetic neuropathy.
Different types of diabetic neuropathy will show different symptoms which can affect any of the sensory, motor, and autonomic-or involuntary-nervous systems. Mild cases may go on for years and show no symptoms. Cases of peripheral neuropathy that are serious enough to show symptoms may have some (or all) of the following symptoms displayed:
  • Pain, tingling and/or numbness in the arms, hands, fingers, legs, feet, and toes.
  • Numbness and insensitivity to pain in the extremities.
  • An extreme sensitivity to touch, even just a slight touch can be painful.
  • Sharp pains and cramps, burning, stinging, tingling sensations.
  • Coordination and balance impairment.
  • Loss of reflexes.
  • Weakness of the muscles, especially in the ankles (this may affect the way the patient walks).
  • Deformities of the foot may occur, such as hammer toe and the collapse of the arch.
Sores and blisters may appear in the areas where the patient experiences numbness and tingling, this is largely due to injury going unnoticed. Untreated foot injuries often lead to amputation due to infection spreading inward into the bone. It is believed that more than half of amputations could have been avoided had the injury been properly treated. The symptoms of tingling and numbness, pain, cramping, tingling, and loss of balance and coordination may worsen at night.
Diagnosis of diabetic peripheral neuropathy is based on medical exams performed by your physician. The doctor will look at factors such as blood pressure, heart rate, reflexes, and muscle strength. They will also look at factors of sensitivity to touch, temperature, vibration, and position changes. It is recommended that persons with diabetes have regular examinations of the feet in order to determine if peripheral neuropathy is a factor. The physician will examine your feet to check for proper circulation as well as muscle skin, and bone condition. They may also perform a test to check for sensitivity to touch by using a thin filament to touch the bottom of your foot and may also prick you with a needle to check for sensitivity to pain. More testing that can be performed includes nerve conduction testing and electromyography. Nerve conduction tests determine the transmission of electrical impulses through a nerve and electromyography check how well the muscle responds to impulses from nearby nerves.
Often the physician will treat the pain from peripheral neuropathy with tricyclic antidepressants like Norpramin or amitripyline anticonvulsants such as Lyrica, Gabapentin, Horizant or Neurontin. Non-drug treatments could include the use of a device called a bed cradle. This device holds the sheets off of the person’s feet and legs so that they do not feel pain caused by sensitivity to light touch. There are also topical medications that can be used; these treatments are applied directly to the affected area of the skin (typically on the feet). These include capsaicin cream and lidocaine patches such as Lidoderm. The patient has a reasonable expectation to find some relief from the use of medications if used as prescribed. Persons suffering from peripheral neuropathy should make sure to take special care of their feet.