Author: The Stance Integrated Pain and Spine Clinic, Koramangala, Bangalore Date: 2020-12-05
Do you have Diabetic Neuropathy?
If you have pain and discomfort in the feet or hands which feels like:
Decrease in sensations your soles or palms feel numb feels like wearing socks or gloves when you are not feeling cotton or water in your shoes you are unsure of walking on an uneven surface,
pins and needles sensation in your hands and feet whenever you rest or sleep, which becomes less on walking
Sudden current-like shocks occur without any specific movements
Painful sensation to touch
Increased pain sensitivity, even minor pressure or pinch feels very painful.
All this started in the toes or fingers but gradually travelled up, first covering the soles or palms, the entire foot or hand, then towards the knee or elbows.
It appears to be in the area of socks or gloves, classically described as a �stocking and glove� pattern. It commonly occurs equally on both sides but can be unequal or one-sided.
How common is it?
Diabetic neuropathy is the most common complication associated with diabetes mellitus. It occurs in approximately half of diabetic patients and thus it is the most common complication of diabetes, this neuropathy can cause disturbing symptoms as described above and in severe cases foot ulceration leading to amputation.
Why do some people get neuropathy while others don’t?
Control and duration of diabetes is the most important factor. The higher the level- the more the chances. The older diabetes � the more the chances.
The second most important factor. This means that controlling blood sugar with medicines is not enough if the body weight is high.
Cigarette smoking reduces the blood supply to small nerves. This leads to more chances of getting diabetic neuropathy.
Drinking, alcohol can damage nerves and worsen your peripheral neuropathy. Alcohol also can make it harder to control your blood sugar levels.
Low Vitamin B12 level
Hyperlipidemia and Hypercholesterolemia – Higher blood levels of fats and bad cholesterol increase the chances of getting neuropathy
Poorly controlled blood pressure increases the chances of getting DN by damaging small nerves.
Is the diagnosis straightforward then?
Yes! Most of the time.
But unfortunately, that is why any person with foot pain who has diabetes is diagnosed with diabetic neuropathy which is wrong because of many reasons.
Firstly, the treatment of diabetic neuropathy is difficult so once you know you have diabetic neuropathy there is little hope left, and you may get wrongly treated by subsequent doctors.
Secondly, diabetes and diabetic neuropathy are more common in older and obese people, with more chances of having pain in the ankle joint, small joints of the foot, plantar fasciitis, or muscular pain in the calves. Sometimes these conditions are causing the majority of the pain, if these are overlooked and only treatment for neuropathy is done then most of the pain is not relieved.
Thirdly, sometimes some other more serious condition may be coexisting which should be noticed and taken care of.
Because of these reasons, you should always refer to a pain doctor. and get a proper diagnosis made.
The pain physician will do some basic tests including blood glucose, HbA1c, vitamin B12, cholesterol, and lipids
What can be done to prevent or halt diabetic neuropathy?
Strict sugar control
The chances of getting diabetic neuropathy decrease proportionally with better blood sugar control. And if you are already suffering from diabetic neuropathy then strict blood sugar control will make sure that it does not worsen.
Higher body weight is an additional factor in diabetic neuropathy which means that a person with more weight has more chances of getting diabetic neuropathy than a person who has the same blood sugar level but is not obese. This is why losing weight is a very important measure in diabetic neuropathy treatment.
Exercise and stress management
Regular exercise has been shown to give relief in diabetic neuropathy because it leads to nerve regeneration. You should do exercises under the guidance of an expert who considers your age, weight, the status of your heart and lungs, and the presence of any joint pains.
Any type of mental stress will lead to a worsening of diabetic neuropathy, firstly, by making it difficult to control your blood sugar, and secondly, by increasing inflammation in the whole of the body and especially around the nerves
High-quality footwear, periodic foot examinations, and care of feet
Wear comfortable shoes that give adequate protection to your feet while being soft and cushioned at the same time.
Make it a habit to regularly e examine your feet and look for any areas of discolouration or breaking of the skin.
Keep your foot clean and apply a good lotion regularly never let your foot become dry
My pain is severe, what to do for relief?
These are vitamins and neuroprotective medicines that have a limited but important role in halting the disease progression, these are alpha-lipoic acid, thiamine, and vitamin B12
The analgesics for neuropathic pain are different from the traditional ones. They include antidepressants like amitriptyline, anticonvulsants like pregabalin, and SNRIs like duloxetine, even tramadol can be effective.
Treatment of coexisting conditions.
Coexisting joint and muscle pains should be treated quickly and effectively so that the quality of life improves. And more importantly, a significant decrease in your suffering will make you hopeful and hope is paramount in these chronic disturbing illnesses.
This is the latest advanced method of treating nerve pains. In this, a small needle is placed near the affected nerves and a small neuromodulating current is given. This works like a pacemaker and resets the nerve, it is perfectly harmless and gives long-lasting relief.
The team at The Stance clinic is trained and experienced in the treatment of Diabetic Neuropathy pain.
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