Diabetic Peripheral Neuropathy (DPN)

An estimated 30 Million Americans suffer from some type of Peripheral Neuropathy (PN). As provided on our website, there are many causes of PN, which all can vastly change both the projected outlook and the treatment regimes of what is sometimes an underlying condition. Therefore, over the next several months, we will be attempting to take each of these different causes and give you more directed information. Today we will start with the largest group, Diabetic Peripheral Neuropathy (DPN). There are 4 main types of Diabetic Neuropathy and we will discuss the other 3 in separate posts.

Just the Facts

DPN is the most common type of PN. Today it is estimated that 60-70% of diabetics have DPN. Under-managed DPN is the number one cause of non-traumatic lower limb amputations in the United States. Nearly 54,000 diabetics have amputations each year, and the truly horrible figure here is that 75% of amputations are preventable! The estimated annual cost to treat diabetes related chronic complications such as DPN is $58 Billion. A study conducted by PNRR from January 2012 to September 2019 reports that out of 557 patients that reported with DPN, 439 found it to be painful and only 118 found it to be non-painful.

Overview

Diabetic neuropathy is a type of nerve damage that can occur if one has diabetes. High blood sugar (glucose) can injure nerves throughout the body. Diabetic neuropathy most often damages nerves in the legs and feet.

Depending on the affected nerves, symptoms of diabetic neuropathy can range from pain and numbness in the legs and feet to problems with the digestive system, urinary tract, blood vessels and heart. Some people have mild symptoms. But for others, diabetic neuropathy can be quite painful and disabling.

Diabetic neuropathy is a common and serious complication of diabetes. But people can often prevent diabetic neuropathy or slow its progress with tight blood sugar control and a healthy lifestyle.

DPN is the most common type of diabetic neuropathy. It affects the feet and legs first, followed by the hands and arms. Signs and symptoms of PN are often worse at night, and may include:

Numbness or reduced ability to feel pain or temperature changes
Tingling or burning sensation
Sharp pains or cramps
Increased sensitivity to touch — for some people, even the weight of a bedsheet can be painful
Muscle weakness
Loss of reflexes, especially in the ankle
Loss of balance and coordination
Serious foot problems, such as ulcers, infections, and bone and joint pain Numbness or reduced ability to feel pain or temperature changes

Diagnosis

Foot Exam

Diabetics should have a compete foot exam once a year! If they already have foot problems, they should have their feet checked more often. A complete foot exam includes a check of the skin on the foot, the foot muscles and bones, and the blood flow. Your provider will also check for numbness in your feet by touching your foot with a mono-filament. It looks like a stiff piece of nylon fishing line or a bristle in a hairbrush. Your provider may also use a tuning fork to see if you can feel it moving.

Nerve Conduction Studies (NCS) and Electromyography (EMG)

If the doctor thinks you might have nerve damage, you may have tests that look at how well the nerves in your arms and legs are working. NCS check the speed with which nerves send messages. This is normally done with electrode patches attached to your skin and one stimulates the nerve with an electric impulse and the other records it. THe electric impulse voltage is very low and this test is not associated with any major risks. An EMG checks how your nerves and muscles work together. Make sure to notify your doctor about any over-the-counter or prescription medications you may be taking. It’s also important to tell your doctor if you have a bleeding disorder, or if you have a pacemaker or implantable defibrillator. The EMG procedure, known as needle EMG, also uses sensors to evaluate electrical signals. The sensors are called needle electrodes, and they’re directly inserted into muscle tissue to evaluate muscle activity when at rest and when contracted. The EMG is also a low risk procedure although you may feel sore in the area that was tested and this may remain sore for a few days. Both of the above procedures should only take between 30 to 60 minutes.

Treatment

While keeping blood glucose levels in goal range can prevent peripheral neuropathy and keep it from getting worse, there aren’t any treatments that can reverse nerve disease once it’s established. Once neuropathy is detected, the focus is on keeping the feet and legs healthy and on managing pain. To treat nerve damage, you will need to keep your blood glucose levels in your target range, manage your pain and protect your feet. IMPORTANT - If you ever have a cut on your legs or feet, wash it out well with a wound care product and if it does not begin the healing process in a couple of days, seek medical treatment. I am posting one of my favorite hand sanitizers here that is also a wound care disinfectant. It is foaming and non-alcoholic so it will not dry out your skin.

Also simple saline solutions work really well for wound care, and Arm&Hammer makes one which i have posted.

Many people get depressed when they have nerve damage and may need medication for depression as well as counseling. Your provider will also prescribe medication to control the neuropathic pain to go along with your other diabetes medication. For more questions over this see our website and specifically our other articles here. You can hit the subscribe button on any of these pages to be notified of new articles!

Lastly, I know this is all scary, and I cannot promise that it will be an easy road, but I can promise that you do not have to be alone on this road if you don't want to be!! We at neuropathy.info are trying to build an online community for just this reason. Come by and read some more articles and even say hi in the forums!