An estimated 50 percent of people with diabetes have some form of neuropathy. The highest rates of neuropathy are among people who have had diabetes for at least 25 years.
Over time, diabetes causes changes in many parts of your body. These are called the long-term complications of diabetes. These changes can cause eye and kidney problems, as well as heart and blood vessel disease. Another complication of diabetes is called neuropathy (ne-ROP-uh-thee), or nerve damage from diabetes. In fact, this is the most common complication of diabetes. The nerves in the feet and legs are the ones most often damaged. Sometimes the nerves in the hands and arms also are affected. No one really knows exactly why this happens, but it is mostly due to the effects of high blood glucose levels over the years. Having neuropathy does not mean that you will feel or act nervous. Neuropathy has to do with your sense of touch. When nerves are damaged by diabetes, they become either less sensitive (you feel less than before) or more sensitive (you feel more than before). The way you will feel depends on which nerves are affected and how they are affected.
SYMPTOMS
Less sensitive nerves do not send feelings of pain, heat or cold to the brain as easily. Some people notice numbness or heaviness (similar to when your foot goes to sleep). Other people don’t notice any symptoms. Feeling pain is one way that the body protects itself. If you aren’t able to feel pain, you can hurt yourself very easily. For example, you could burn your foot with your bath water if you can’t feel that it is too hot. You might walk around with a tack in your shoe and not know that you are hurting your foot. Before your feet lost their sensitivity, they would let you know when something was wrong. Now you need to do what the nerves in your feet used to do for you. Take extra care of your feet and legs. Wear shoes that fit well to avoid blisters. Look at your feet (top and bottom) each time you take a shower to see if there are any cuts, red areas, signs of infection or other changes. If your nerves become more sensitive, you may feel burning, numbness, tingling, pain from the weight of clothing or sheets or shooting pain in the legs and feet. These signs usually do not happen all at once. They may seem to come and go. You need to tell your doctor about these feelings, even though they may not seem very important at the time.
TREATMENT
Pain from neuropathy can be severe. It also can be hard to treat. Pills with narcotics in them are not the best choice for this type of pain. There are medicines you can take that are better for the long-term control of pain. Keeping your blood glucose close to normal often helps to relieve the pain over time.
To relieve pain, burning, tingling or numbness, your health care provider may suggest:
- relaxation exercises and walking for leg pain.
- capsaicin (Zostrix HP; Capsin 0.075%) is available over the counter and may relieve pain.
- a Transcutaneous Nerve Stimulation unit. A TENS unit is a box you wear that provides an electric shock to the painful nerves.
- pain clinics. Your health care provider can give you more information on a pain clinic in your area.
Neuropathy also can damage the nerves that control your stomach, your bladder and how you digest food. Signs of this damage include diarrhea, nausea, vomiting and urine staying in your bladder.
In the past, there was very little that could be done to ease the pain of neuropathy. But, this is an area backed with a great deal of research. New medicines are being tested for neuropathy. Ask your health care provider about a diabetes specialist, a diabetes center or a neurologist if you need more help with your neuropathy. In the meantime, good blood glucose control can do a lot to ease the pain of neuropathy.
PRACTICAL TIPS FOR TAKING CARE OF YOUR FEET
People with neuropathy need to take special care of their feet. The nerves leading to your feet are the longest in the body and are the ones most often affected by neuropathy. Loss of sensation in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers. More than half of all lower limb amputations in the United States occur in people with diabetes—86,000 amputations per year. Health professionals estimate that nearly half of the amputations caused by neuropathy and poor circulation could have been prevented by careful foot care. Here are the steps to follow:
- Clean your feet daily, using warm -not hot- water and a mild soap. Avoid soaking your feet. Dry them with a soft towel and dry carefully between your toes.
- Inspect your feet and toes every day for cuts, blisters, redness, swelling, calluses or other problems. Use a mirror (laying a mirror on the floor works well) or get help from someone else if you cannot see the bottoms of your feet. Notify your health care provider of any problems.
- Moisturize your feet with lotion, but avoid getting it between your toes.
- After a bath or shower, file corns and calluses gently with a pumice stone.
- Each week, or when needed, cut your toenails to the shape of your toes and file the edges with an emery board.
- Always wear shoes or slippers to protect your feet from injuries. Prevent skin irritation by wearing thick, soft, seamless socks.
- Wear shoes that fit well and allow your toes to move. Break in new shoes gradually by wearing them for only an hour at a time at first.
- Before putting your shoes on, look them over carefully and feel the insides with your hand to make sure they have no tears, sharp edges or objects in them that might injure your feet.
If you need help taking care of your feet, make an appointment to see a foot doctor, also called a podiatrist.
