What is Diabetic Peripheral Neuropathy?

Diabetic Peripheral Neuropathy (DPN) is nerve damage that is caused by high blood sugar and triglycerides. It is unfortunately very common and up to half of all people with diabetes may struggle with diabetic peripheral neuropathy. DPN can cause people to have both pain and numbness and lead to severe problems like ulcers, bone infections, and even amputations. It can also cause problems with balance, problems walking, decrease muscle tone and lead to structural changes in feet. People may not always be aware that they can’t feel their feet enough to protect them – and this is why it is essential to have a diabetic foot exam at least once a year.

Pain

People with DPN have a burning, tingling, pins and needles sort of pain that is often worse at night or after being on their feet a lot. It is usually symmetrical and progresses from the toes up the legs over time. After a while, it can also affect the hands.

Numbness

If you can’t feel your feet, then it is harder to protect them. People with diabetes have problems sensing pressure, pain, and temperature at times. This can lead to foot sores developing. These sores can develop by stepping on something, friction or other causes. Once established they are then often hard to heal and have a higher risk of infection if the person’s blood sugar isn’t controlled. If the person is a smoker or has peripheral vascular disease, it can be especially hard to heal.

Sometimes people can have so much numbness that they may not be able to feel if they have a broken bone in their foot. This can lead to them walking on it and developing a problem called a Charcot foot – which could need surgery or even lead to amputation.

Unusually shaped feet may not fit right in shoes, which leads to an increased risk of ulcers and adverse outcomes. DPN can lead to other structural changes feet which can make it more common to get ulcers. Once people have one ulcer, they are more likely to get another one. If these sores aren’t tended adequately they can get infected, this infection can spread to the bone and lead to amputation. Treatment may involve removing dead/infected skin, staying off feet, using a special brace to care for it. Frequently patients will be under the care of a podiatrist or a wound care clinic to help care for foot sores. If your PCP refers you to one these specialists – please go!

Treatments:

While DPN can be very painful, there are treatments which your doctor may recommend for this nerve pain. Antidepressants – like amitriptyline or duloxetine, anticonvulsants – like gabapentin or pregabalin are effective and reducing pain and increasing function for people dealing with DPN. Physical therapy can help with strength and balance, and bed cradles can be used to keep blankets off feet during the night.

Tips for healthy feet:

  1.  Inspect your feet daily – use a mirror or ask someone to help if you can’t see. Check your whole foot – big toes, little toes, the ball of the foot, sides of foot, heel… 
  2. Bathe feet in lukewarm water every day
  3. Moisturize feet – but not between toes. Extra moisture can lead to infection. Feet can become drier because the nerves that control the oil/moisture in your feet aren’t working right anymore.
  4. Cut nails carefully – straight across, file edges if needed.
  5.  DON’T cut corns/calluses yourself – talk with your family doctor or podiatrist about it. If not appropriately treated these can turn into sores.
  6. Wear clean, dry socks – maybe diabetic socks.
  7. Wear socks and shoes all the time. Don’t walk barefoot
  8. Protect feet from hot and cold – wear shoes on the sand/sidewalk, test water with fingers before getting in the tub, no hot water bottles or heating pads to your feet.
  9. Look and feel in shoes before putting your feet in. You could walk all day with a pebble in your shoe and injure your foot without knowing it.
  10. Consider special shoes or orthotics – Buy them later in the day when feet are larger and break them in slowly.
  11. Stop smoking – smoking damages blood vessels and makes it harder to heal and dramatically increases your chance of amputation.

***Note *** This post, like all my other posts, is for general medical information only and is not to be taken as direct advice.  Please consult your personal physician for more information.

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