Fred is a 59-year-old science writer who has lived with type-1 diabetes for more than 50 years. He used to walk six miles every day, partly to keep his blood sugar and blood pressure stable. When he developed sharp, stabbing pains in his feet, he knew he was joining an unfortunate majority.
About 60-70 per cent of people who have diabetes will develop diabetic neuropathy — nerve damage that can affect any organ of the body. The Endocrine Society says people with poor glucose (blood sugar) control and those who have had diabetes for a long time are at highest risk, especially if they smoke. The National Institute of Diabetes and Digestive and Kidney Disorders lists alcohol use, autoimmune disorders, genetics and untreated injuries as risk factors too.
Symptoms of Diabetic Nerve Pain
Not every patient develops symptoms but when they do, they often report feeling pain, numbness or weakness in their hands or feet. Fred says, "It feels like a hot nail being driven into my foot. It spikes up to a solid six or seven on the pain scale, lasts about 20 seconds, and then completely disappears — absolute relief, with no lingering sensation. Then, a minute later, it spikes again. It's like going from 0 to 65 miles per hour in the flash of a single synapse."
Pain isn't the only problem diabetic neuropathy can cause. Peripheral and autonomic neuropathy can lead to additional problems.
Peripheral neuropathy in the hands, feet, arms and legs (the most common kind) can cause loss of balance, problems with walking and falls particularly in older patients. If your feet are numb, then abrasions or cuts may go unnoticed, which can lead to infection. That's why diabetics have to be so careful about foot health and their shoes. Autonomic neuropathy can reduce circulation, oxygenation and nutrition to the heart, blood vessels, digestive system, urinary tract, lungs, eyes and sex organs, which can cause them to dysfunction
What Causes Nerve Damage?
Aaron I. Vinik, MD, PhD, is the director of the Research and Neuroendocrine Unit at Eastern Virginia Medical School in Norfolk. He says there are different causes and risk factors, depending on whether you have type-1 diabetes (which used to be called juvenile onset diabetes) or type-2 diabetes (which typically develops later in life).
"In type-1 diabetes, the major risk factor and underlying cause is hyperglycemia or elevated blood glucose," Vinik says. "In type-2 diabetes, nerve damage can be caused by a number of factors in addition to diabetes. Nerve damage can even occur with prediabetes when glucose levels may be normal, but there are other contributory factors like obesity, insulin resistance, elevated lipids including triglycerides . . . and immune destruction of nerves. All these factors can combine to create a poor environment for nerve health."
How Is Diabetic Neuropathy Diagnosed?
According to Vinik: "The diagnosis is made by a physician who takes a careful medical history, is aware of the whole symptom complex and does a physical examination for sensory perception of heat, cold, pain and touch/pressure. We also test for strength of the lower limbs and ankle reflexes." Physicians might also order nerve conduction studies to determine the extent of nerve damage, ultrasound to look at internal organs and cardiac tests to determine if the heart and blood vessels are affected.
How Is Diabetic Neuropathy Treated?
The first step is damage control: stabilize your blood sugar so it stops damaging nerves. That requires a combination of diet, medication and exercise under the careful watch of a good endocrinologist. Then, doctors treat pain with a range of medications, including several anti-depressants and anti-convulsants like pregabalin (Lyrica) and gabapentin (Neurontin), which specifically target nerve pain and sometimes opioid medications for severe pain.
Vinik says there are more promising treatment options, including use of diuretics, splinting, steroids and even surgery to release trapped nerves. He says recent studies show that certain nerve fibers can even be induced to regenerate with lifestyle changes.
Fred struggled to find the right combination of medications that would relieve his pain and let him continue taking long walks. Eventually, though, he hit on a combination that works, "well enough," he says. "When the pain overwhelms me, I take a combination of acetaminophen, gabapentin and medical cannabis. The gabapentin and acetaminophen help with the pain, and the cannabis allows me to ignore it so I can go about my business. I sometimes feel a little drowsy, but it's better than being trapped by pain."
Note to readers: To learn more about preventing and managing diabetic neuropathy, log on and check out the Endocrine Society's Diabetic Neuropathy fact sheet. Then talk to your doctor about your risk factors and the measures you can take to control your diabetes and save your nerves.
Jeanne Faulkner is an RN with 25 years' experience working in women's health. Based in Portland, OR, she's the author of Common Sense Pregnancy and writes about health and wellness for a variety of publications and websites. As a CARE chairperson for advocacy, she's traveled worldwide to raise awareness of poverty eradication and global health issues.
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