Type 1 Diabetes: Complications

Tingling, numbness, and/or pain in the extremities (i.e., hands, feet, arms, and legs) is the primary symptom of peripheral neuropathy, or PN. PN, which is sometimes called stocking-glove syndrome, may start out as a “pins and needles” sensation not unlike a foot or hand “falling asleep,” and can vary in intensity from mild discomfort to painful burning. People who have PN are often extremely sensitive to cold and hot temperatures and to touch. Conversely, many experience numbness that puts them at risk for burns and frostbite.

Peripheral neuropathy in the feet may be diagnosed by a podiatrist or other healthcare provider. Basic screening involves pressing a fiber filament (or monofilament) on different areas of the sole of the foot and measuring patient-reported sensitivity. More advanced testing can include nerve conduction studies and electromyography.

People with PN of the feet are at risk for foot problems such as hammertoes and Charcot foot. The loss of sensitivity in their feet may change their gait, or walk, and affect their balance. It can also cause minor injuries, such as blisters, to go undetected and develop into more serious infections.

Treatments for peripheral neuropathy and its symptoms may include:

• The prescription drugs Lyrica and Cymbalta (pregabalin, duloxetine HCI)
  
• Certain antidepressant drugs (amiltriptyline, venlafaxine)*
  
• The anticonvulsant drug Neurontin (gabapentin)*
  
• Topical lidocaine (an anesthetic)*
  
• Capsaicin cream (a substance derived from hot peppers that blocks pain signals)
  
• Anodyne therapy (using infrared light)
  
• Transcutaneous electrical nerve stimulations (TENS; using electrical signals to block pain)
  
• Alpha lipoic acid (ALA; a supplement) *
  
• Nerve decompression surgery
  
• ReBuilder neuromuscular stimulator
  

If you have peripheral neuropathy, good preventative foot care is of paramount importance. Talk to your healthcare team about what PN treatments may be right for you.

*This treatment is not FDA-approved for peripheral neuropathy, but has shown promise in clinical trials."

Reviewed by Francine Kaufman, MD. 4/08