If you have diabetes and begin to experience extreme tingling sensations in your hands or feet, it could signal a larger problem. It could be caused by diabetic peripheral neuropathy, a disease that affects the nervous system and causes numbness or weakness. Diabetic neuropathy is one of the most common complications of diabetes. It affects 33% of U.S. diabetics over the age of 40. Here’s what you should know about the causes of this condition and your diabetic peripheral neuropathy treatment options.
What causes diabetic peripheral neuropathy?
Diabetic peripheral neuropathy is a condition that arises as a result of nerve damage that occurs due to diabetes. When the body’s blood sugar is poorly regulated, sharp spikes and drops in blood sugar levels can cause nerve ends to fray, resulting in diabetic peripheral neuropathy. There can also be accompanying damage to blood vessels that supply the nerves, increasing the severity of damage.
While research has not yet discovered exactly why there is such a substantial link between neuropathy and diabetes, it is likely caused by a combination of factors. In particular, damage to the nerves and blood vessels can occur when there is prolonged exposure to high blood sugar. While diabetes itself is the main risk factor for developing this condition, other risk factors include:
- Genetic factors
- Poor blood sugar control
- The length of time that you have had diabetes
- Presence of kidney disease
- Overweight and obesity
- Smoking habits
- Alcohol abuse
The amount of time that you have had diabetes also matters, as those who have been newly diagnosed are less likely to have peripheral neuropathy. Poor control of blood sugar is a major factor for this and every other complication that arises from diabetes.
Kidney disease also increases your risk of diabetic peripheral neuropathy, as the kidneys are unable to process the toxins in the blood and therefore make blood sugar management more difficult. Being overweight and smoking are two other factors that increase your risk of developing diabetic peripheral neuropathy.
Diabetic peripheral neuropathy symptoms
High blood sugar can damage nerve fibers throughout the body, but with diabetic neuropathy, the damage tends to occur in the legs and feet. Symptoms and complications of this condition include:
- Pain and numbness in your extremities
- Tingling or burning sensations
- No symptoms, followed by onset of sudden severe pain
- Skin infection
- Periodic sharp pain without any type of stimulation
- Oversensitivity to touch
- Decrease in balance, coordination, and reflexes
- Problems with the feet, including ulcers, infections, and changes in shape
- Problems with the digestive system, urinary tract, and cardiovascular system
- Sexual dysfunction
- Low blood pressure
- Urinary tract infections
- In severe cases, loss of a limb
A person with this condition may experience some or all of these sensations before they progress to the upper extremities. Symptoms may not move to upper extremities at all.
What are the best diabetic peripheral neuropathy treatments?
When it comes to diabetic neuropathy, early diagnosis, prevention, and treatment is crucial.
Talk to your doctor right away if you notice that there is a cut or sore on your foot that isn’t healing the way it should. You should also contact your doctor if you’re experiencing excessive burning, tingling, weakness, or other pain in your hands or feet, as well as any changes or problems with digestion, urination, or sexual function.
The American Diabetes Association strongly recommends that people with diabetes have a comprehensive foot exam by a doctor at least once a year. Since diabetic neuropathy appears most prominently in the feet, warning signs such as sores, cracked skin, blisters, or other abnormalities can indicate problems.
As with everything related to diabetes, managing blood sugar is of paramount importance. You and your doctor may focus on a stricter control of diet or an insulin regimen that better maintains stable, steady blood sugar. Spikes and drops in blood sugar are the main cause of nerve damage, so it is the most important factor when it comes to slowing the progression of the disease.
By intensely controlling your blood sugar, you can help delay the progression of diabetic neuropathy or even improve symptoms that you may already have.
With effective control, you can help reduce your risk of diabetic neuropathy by as much as 60%! Talk to your doctor to establish blood sugar levels that are appropriate for you.
Also, slowing nerve damage is another side of prevention. This is a broad category of treatment that involves more lifestyle changes than prescriptions or medicines. Quitting smoking, taking good care of your feet, and adding regular, daily exercise can help slow nerve damage in those with diabetic peripheral neuropathy. All of these things in turn help to manage blood sugar safely and to maintain a healthy weight, both of which are key components of an overall treatment plan for diabetes.
Diabetic peripheral neuropathy treatment options
Since there is no cure for diabetic peripheral neuropathy, treatment focuses on slowing the progression of the condition and relieving pain and other symptoms.
Other medical therapies can include a combination of prescriptions that address not only the physical pain but also the emotional aspects of living with a chronic condition. Let’s look at the wide range of diabetic peripheral neuropathy treatments that may work for you.
There are a number of pain-relieving options, not all of which are directed specifically at pain. The first class of medications are anti-seizure medicines like gabapentin (Gralise, Neurontin), pregabalin (Lyrica), and carbamazepine (Carbatrol, Tegretol) which are normally used for epilepsy.
For pain management, it can be helpful to wear comfortable clothing and shoes that offer support without being too tight. Over-the-counter non-steroidal anti-inflammatory drugs can also help manage mild pain but should not be taken in large doses for long periods of time due to the potential for serious gastrointestinal side effects.
Even when depression is not present, antidepressants are a frequently-prescribed treatment for chronic pain. Diabetic peripheral neuropathy responds well to antidepressants, but how exactly they work to relieve pain is not well understood. They seem to be able to change the way the brain senses pain. The most effective and common type of antidepressants for chronic pain are tricyclic antidepressants. They include:
- Clomipramine (Anafril)
- Desipramine (Norpramine)
- Imipramine (Tofranil)
- Nortriptyline (Pamelor)
Antidepressants are not a fast fix for diabetic peripheral neuropathy. Patients may wait at least a week for any type of pain relief to be felt, and some may take several months. It may also take some time to figure out which medications work best for each patient and at which dose.
For some patients, though, even the promise of pain relief may be enough to help them persist with their doctor until the right medication is found. Side effects can vary from medication to medication and should be considered. Some or all of the following may occur:
- Lightheadedness or dizziness
- Difficulty urinating
- Weight gain
- Sexual side effects (e.g., lowered sex drive or erectile dysfunction)
- Dry mouth
Tricyclic antidepressants may have a lower incidence of side effects because doctors typically start at the lowest dose possible and increase it if needed.
Other classes of antidepressants called serotonin and norepinephrine reuptake inhibitors (SNRIs) and selective serotonin reuptake inhibitors (SSRIs) have gained popularity as options also due to the low incidence of side effects. Most-prescribed SNRIs include venlafaxine (Effexor), duloxetine (Cymbalta), and milnacipran (Savella). SSRIs like paroxetine (Paxil) and fluoxetine (Sarafem, Prozac) are prescribed most often to help boost the pain-relieving effects of other medications but don’t seem to relieve pain on their own.
Non-viral gene therapy
A new study from Northwestern Medicine is offering hope for pain relief from peripheral diabetic neuropathy. In a double-blind, placebo-controlled study, participants found significant relief from just two low-dose rounds of a non-viral gene therapy called VM202. Eighty-four participants were divided into three groups: a placebo group, a low-dose group, and a high- dose group. Each group received two injections over two weeks. At three, six, and nine months, the low-dose group reported a significant reduction in pain over the placebo group. Even better, the low-dose group outperformed the high-dose group in terms of pain relief.
Dr. Senda Ajroud-Driss, associate professor in neurology at Feinberg, an attending physician at Northwestern Memorial Hospital, and an author of the study, believes that this is encouraging news for the relief of excruciating neuropathic pain. Although the study focused on pain relief, he hopes to see improvement in the condition of the nerves themselves:
“We found that the patients who received the low dose had a better reduction in pain than the people who received the high dose or the placebo. Side effects were limited to injection site reaction. We are hoping that the treatment will increase the local production of hepatocyte growth factor to help regenerate nerves and grow new blood vessels and therefore reduce the pain.”
This potential healing of the nerves is encouraging news for those who are living with daily pain. A larger, phase three trial is planned in the near future.
Managing other complications
Peripheral diabetic neuropathy comes with a host of complications that include urinary tract and digestive issues, problems with blood pressure, and sexual side effects.
- Urinary tract treatments: Urine leakage may become an issue if nerve damage persists. A combination of treatments that focus on behavioral modification, prescription antispasmodics, and devices to help control leakage seem to be the most effective ways to address this complication.
- Digestive treatments: Symptoms such as nausea, excess gas, and vomiting may be treated with smaller, more frequent meals or a change in the types of foods that a person consumes. This may include increasing dietary fiber and focusing on pureed foods that include more soups.
- Low blood pressure: Diabetics with diabetic peripheral neuropathy may experience increased dizziness when standing. The easiest way to address this is to take care when standing, but doctors may recommend compression stockings for the abdomen or legs to help prevent it as well.
- Sexual dysfunction: As with most things in medicine, treatment for sexual dysfunction focuses largely on male symptoms. Doctors may prescribe medicine to address erectile dysfunction for men. Women are advised to use a lubricant for their sexual issues.
There are a number of alternative therapies that may prove helpful in relieving pain, including:
- Topical capsaicin can help relieve pain (but may cause burning sensations)
- Transcutaneous electrical nerve stimulation (TENS) can block pain signals from reaching the brain
- Acupuncture may relieve pain with no side effects
These therapies in general have few side effects and may be worth trying as part of a comprehensive treatment plan.
For more on peripheral diabetic neuropathy treatments, including prevalence of the complications above, check out NIH’s article from Diabetes Care. To get specialized care for your pain, it may be time to bring in a pain specialist. You can find a pain doctor in your area by clicking the button below or looking for one in your area by using the tips here: https://paindoctor.com/pain-management-doctors/.