Diabetic Peripheral Neuropathy
Peripheral Neuropathy (PN), also called sensorimotor neuropathy or symmetric neuropathy, is nerve damage that occurs in the arms and legs. Legs and feet are likely to be affected before arms and hands. Tingling, numbness, and/or pain in these extremities is the primary symptom of 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. Other symptoms of PN include sharp pains or cramps and a loss of balance and coordination. People who have PN are often extremely sensitive to cold and hot temperatures and to touch. Symptoms of PN are often worse at night. 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. Doctors generally diagnose PN on the basis of symptoms and a physical exam. 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. If foot injuries aren't promptly treated, infections may spread to the bone, and foot amputation may be necessary. Some experts estimate that half of those amputations are preventable if inferior problems are caught and treated in time.
Treatments for peripheral neuropathy and its symptoms may include:
- Blood glucose monitoring, meal planning, and physical activity
- 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)*
- The prescription medical food, Metanx*
- Nerve decompression surgery
- ReBuilder neuromuscular stimulator
- Acupuncture, biofeedback, or physical therapy
Alternative and complementary therapies, such as Neuragen PN (a homeopathic remedy), supplements, and even massage may also be an option in treating peripheral neuropathy. It is best to discuss these and all potential remedies with your doctor before implementing.
Good preventative foot care, as well as keeping blood glucose levels as close to a normal range as possible, is of paramount importance in the quest to manage diabetes and stave off complications. Experts recommend that people with diabetes have a thorough foot exam annually to check for PN. People with PN need more frequent foot exams. Be sure to see a podiatrist regularly.
Reviewed by Francine Kaufman, MD. 01/09
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