Type 1 Diabetes: Complications

Peripheral neuropathy is a nerve disorder with symptoms that include numbness, pain, tingling, and possibly loss of all sensation in the feet. This loss of sensation makes the patient unaware of cuts on the bottom of the feet, which can lead to infection. Approximately 15% of diabetes patients will develop a foot ulcer and need amputation. According to the ADA, diabetic neuropathy is the most common cause of nontraumatic limb amputations worldwide. Beyond drug therapy, there are several developments in peripheral neuropathy treatment that have provided relief to many.

The ADA estimates that 60% of people with diabetes will suffer at least mild neuropathy in their lifetime. To combat this, pain medications are usually prescribed with a reminder to closely monitor blood glucose levels and watch for possible side effects.

Anodyne Therapy
One treatment for peripheral neuropathy is Anodyne Therapy. FDA-approved since 1994, this treatment is administered via a machine that emits monochromatic infrared photo energy in order to increase nitric oxide in the blood.  It has been clinically proven to increase sensation in the areas affected by neuropathy and decrease pain. It has also been found effective in restoring balance, thus preventing falls, and in treating chronic wounds.

There are 3,600 centers across the U.S. – and additional locations worldwide – where patients can receive this therapy, although a smaller version of the machine can be purchased for long-term, at-home use. Treatment pads are used that produce a warm, soothing sensation. Sometimes there is tingling and pulsing which is a sign that blood flow is being restored. The patient usually has 10-24 therapy sessions but studies have found significant progress within 10-12 treatments. As a result, over 80% of Anodyne Therapy patients have reported excellent to total pain relief. The rate of falling incidents decreased by over 75% and patient activity levels were reported up by over 70%.

So far, it has been determined that there are no side effects if the machine is properly used and monitored. The heating pads can be used on any area of the body and it can be used over any implants because there is no electrical charge. However, women who are pregnant and those with active cancer malignancies must consult their doctor before beginning Anodyne Therapy. The therapy should also not be used directly over heating agents such as Ben Gay, Icy Hot or Capsaicin.

Currently, Anodyne Therapy is covered by Medicare in most areas. Patients with Medicare must first go to a care center for the initial treatment where their progress will be monitored and documented. At that point, insurance may then approve continuing the treatment at home. Patients not using insurance and who wish to purchase the system on their own for use at home can do so at any time.

Nerve Decompression Surgery
If pain medication has proven ineffective or if you are plagued by side effects from those medications, nerve decompression surgery may be an option for you. This form of plastic surgery relieves pressure on the nerves, which is caused by swelling. According to Dr. Rick Delmonte of St. Luke’s-Roosevelt Hospital in New York City, people with diabetes have excess blood glucose, which degrades to sorbitol and other sugars. “Sorbitol is hydrophilic; it brings water into the nerve and the nerve swells and gets pinched.”

To release this pressure, surgeons, such as Dr. Delmonte and his surgical partner, Dr. William Samson, perform an operation similar to carpal tunnel surgery, which takes less than 2 hours. A cut is made over the compressed nerve thereby releasing the tight area through which the nerves pass. This is done by dividing a ligament or fibrous band that crosses the nerve. Drs. Delmonte and Samson have performed dozens of these operations with great success.

The ideal candidate for this type of surgery has:
1. good control of their blood glucose;
2. already tried medication to control the pain but either has side effects, their cognitive function is disturbed, or the medication has proven ineffective;
3. no swelling in the feet;
4. been medically approved to undergo a 2-hour general anesthetic;
5. a pain level of 5 or more out of 10;
6. evidence on neurosensory testing of large nerve fiber loss;
7. signs of nerve compression upon physical examination.

Studies so far have shown no development of ulceration in patients who have had the surgery nor have there been any amputations. These patients have resumed their mobility within 2 weeks.

Before undergoing surgery, a potential patient must undergo a pressure-specific sensory device test (PSSD), which is a noninvasive computerized exam that determines the remaining nerve function at various anatomical points. The test is not covered by most insurance companies but the surgery itself usually is.

Dr. Lee Dellon of The Dellon Institutes for Peripheral Nerve Surgery was the first to perform this surgery over 10 years ago at Johns Hopkins University. Today only a small number of doctor have been trained in the procedure. To find out more, visit The Dellon Institutes for Peripheral Nerve Surgery.