*Today, I ran into a good friend I’ve known since college. In addition to being happy to see him, he stunned me with two shocking facts.
The first was that this year marks the 40th anniversary of us entering college. The second was that he was diabetic, and experiencing the symptoms of diabetic neuropathy.
Not only was he in almost constant pain, he had even resorted to sleeping with his sneakers on, in order to have enough pressure on his feet to quiet down the nerves.
We all know that diabetes can be a devastating condition, but what many don’t realize is that over time diabetes can lead to blindness, kidney failure, and nerve damage.
DPN (diabetic peripheral neuropathy) is a serious condition that results from damage to nerves due to prolonged exposure to high amounts of glucose in the bloodstream as a result of diabetes. It often results in pain or numbness in the feet, but also manifests itself in intense pain often described as aching, tingling, burning and numbness, but because DPN damages nerve fibers, virtually any nerve in the body can be affected. The feet and toes are commonly affected early in the course of a generalized neuropathy.
The term “peripheral” means that the disease is occurring to nerve tissue outside the brain and spinal cord. This includes injury of nerves to muscles (motor nerves), nerves from the skin (sensory nerves), and/or nerves to the gut and other internal organs (autonomic nerves).
More than half of all diabetics suffer from DPN. In the U.S., African Americans are 1.6 times more likely to have diabetes than non-Hispanic whites, and Hispanic/Latino Americans are 1.8 times more likely to have diabetes than non-Hispanic whites.
The leading cause of amputations in the U.S., DPN causes as much as 40 to 60 percent of lower extremity amputations, with the African American, Latino and Native American diabetic populations at twice the rate of the diabetic white population.
In the United States, more than 50,000 diabetes-related amputations are performed each year, but comprehensive foot care programs can reduce amputation rates by 45 to 85 percent.
It is helpful to understand the different types of nerves that can be involved. The sensory nerves send messages back to the brain about various sensations, such as temperature, pain, and movement. Motor nerves send signals from the brain to the muscles to tell them to move. Autonomic nerves are involuntary, and control such things as heart rate, smooth muscles, and the function of glands. Diabetic neuropathy can cause pain in the nerves of both legs or partial or complete loss of feeling, particularly in lower limbs. The pain is often worse in bed at night.
Diabetic peripheral neuropathy is the most common neuropathy in the United States and the world. It is estimated that there are 15-20 million cases of diabetic neuropathy in the United States. Given the size of this problem, isn’t it strange that more people do not know about it? Diabetic neuropathy contributes to the incidence of lower limb amputations in diabetic patients because diabetics are less likely to perceive a wound in their feet or legs.
Since diabetic neuropathies are a family of nerve disorders caused by diabetes, some people with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Neuropathic pain can feel like burning, prickling, tingling, aching, stabbing, pins and needles, shooting, and even like an electrical current “buzz.” The most common type of neuropathic pain occurs on both sides of the body, as in both legs and feet, or both hands. Neuropathic pain can come and go or it can continue for a long time. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs.
About 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat and blood pressure and those who are overweight.
As with any medical problem, the proper diagnosis of a peripheral neuropathy requires that a physician take a history and perform a physical examination. The history must include a review of any currently prescribed medications because some medications can cause a peripheral neuropathy.
In some cases, diabetic neuropathy can be prevented. Patients who follow their recommended self-care program are less likely to develop diabetic neuropathy. Here is what you can do to prevent nerve damage:
• Keep your blood glucose as close to normal as you can.
• Limit the amount of alcohol you drink.
• Don’t smoke.
• Take care of your feet
• Tell your doctor about any problems you have with
1. your hands, arms, feet, or legs
2. your stomach, bowels, or bladder
• Also tell your doctor if you
1. have problems when you have sex
2. cannot always tell when your blood glucose is too low
3. feel dizzy when you go from lying down to sitting or standing
No one knows exactly what causes diabetic neuropathy, but studies have shown that people whose blood sugar levels are not well controlled are more likely to develop it. Research also suggests that about half of persons who have had diabetes for a long time (more than 25 years) will develop some type of neuropathy. People with diabetes who smoke and drink alcohol are more likely to develop neuropathy.
Pain medications can help, especially if taken at regular times throughout the day. Waiting until the pain becomes severe before taking medication is not as effective as taking regularly scheduled doses. Your health care provider will prescribe pain medication after reviewing your medical condition. Depending on the type and level of pain, your health care provider might recommend an over-the-counter pain medication or a prescription drug.
Diabetic neuropathic pain can be prevented in some cases and improved in most cases.
Remember, I’m not a doctor, I just sound like one. Take good care of yourself, and live the best life possible!
This column is meant form informational purposes only, and is not meant to take the place of proper medical advice or treatment from a qualified health professional.
Glenn Ellis, author of Which Doctor?, is a health columnist and radio commentator who lectures around the country on health issues relevant to the African-American community.