Diabetic Neuropathy Overview

Neuropathy is a common complication of diabetes. We asked diabetes educator Carla Cox to answer these frequently asked questions about Diabetic Neuropathy. 

What is neuropathy?

Neuropathy is nerve damage that affects up to 50% of people with diabetes. It can impact the periphery (legs, feet and hands) or it can impact different organs of the body, such as the stomach (slowing stomach emptying after a meal) and the heart (reducing the ability for the heart to respond as needed). The nerves are damaged and nutrients to the nerve tissue can also be interrupted, delaying nutrients and oxygen to the tissue. It can happen early in the course of the disease largely because many people with diabetes have had elevated glucose values for months or years before diagnosis.

Risk factors for developing neuropathy include:

• high blood glucose over time
• obesity
• high fats in the diet and in the bloodstream (triglycerides and cholesterol)
• smoking
• having diabetes for a long period of time
• age (being older increases risk). 

What are the signs and symptoms of neuropathy?

Common symptoms of neuropathy include:

• tingling of the hands and feet
• numbness
• burning
• muscle weakness
• poor coordination. 

One big concern is that when numbness occurs in the feet sores and ulcers can develop without an individual being aware. This can lead to damage requiring aggressive foot care, and at times, amputation. Look at the bottom of your feet daily. Any persistent redness or sores that do not heal suggests a visit to your health care provider is needed as an early preventative measure. During any visit with your provider, your feet should always be checked for signs of numbness using a small device called a microfilament. Initial treatment for evidence of pressure may be managed with well-fitted walking shoes or athletic shoes. A referral to a podiatrist is recommended when concerns arise. 

Can neuropathy be prevented?

Efforts to prevent neuropathy include checking your glucose values regularly to determine if you need to make changes in your exercise routine, food plan and/or medication regimen. If you are following the guidance of your health care team and continue to have elevated glucose levels, talk with them about changes you may need to make! Maintaining or achieving a healthy weight, normalizing blood pressure and blood fats, and not smoking will also help to prevent neuropathy. 

What treatments are available for neuropathy?

Once you develop neuropathy it cannot be cured. There are some medications that can lessen the discomfort and it is important to discuss options with your provider. There is some evidence that a healthy food plan and exercise may help to lower the progression. In addition, keeping glucose values within target range (70-130 mg/dl before meals and up to 180 mg/dl 2 hours after a meal) is recommended. There is some evidence that spikes in glucose can also magnify the symptoms, so limiting foods that cause your glucose values to rise rapidly may be helpful. Non-medication treatments that can be tried include topical capsicum cream (made from chili peppers) and acupuncture. If you are deficient in vitamin B12 (most common in persons on a strict vegetarian diet, those on Metformin and persons using some anti-reflux medications) a supplement may reduce pain.