Healthwatch: Dealing with diabetic neuropathy

Monday, March 7, 2011
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You know that "pins and needles" feeling you get after your foot falls asleep? Imagine having that feeling all the time, along with a burning sensation, and possibly numbness and loss of balance -- and no way to relieve it. For some diabetics, this is the daily reality of living with diabetic peripheral neuropathy, an irreversible complication of diabetes.

"When sugar levels are very high in the blood, the nerves, especially the sensory nerves, get injured or harmed," says Dr. Sonjay Fonn of Midwest Neurosurgeons in Cape Girardeau. "If it goes on for a long period of time, the harm to these sensory nerves is permanent. The only real cure is to catch this before it has become permanent and to prevent it from happening."

Most diabetics feel symptoms of neuropathy first in the lower extremities, especially the feet.

"It can affect any nerve, any number of nerves, any pattern of nerves -- but by and large, most who develop deterioration in the nerve endings feel it in their feet first," says Dr. Aaron B. Koonce of Southeast Neurology.

While the most common symptom is the tingling, burning feeling called paresthesia, patients may also experience loss of sensation and position, which then leads to loss of balance and difficulty walking.

"They're very, very prone to falling down -- not because of weakness in the muscles, but because they are unable to receive the right information from the feet to maintain balance in a meaningful way," says Dr. Ahmad Sheikh from Cape Diabetes and Endocrinology. As a result, it's easy for patients to injure themselves without realizing it. Patients can avoid this by wearing white shoes with no pressure points; not going barefoot; examining their feet each night to check for injuries; visiting a podiatrist at least once a year; and having someone else trim their toenails.

Sheikh also recommends using a cane to improve balance. While neuropathy patients may not be able to feel their feet, they can touch a cane to the ground so their hand can grasp that information, send it to the brain and maintain better balance. Physical therapy is another option to help patients improve their balance and walking, says Koonce.

Patients also benefit from the use of medications, including antidepressants, pain relievers and antiseizure medications. The nerve fibers don't regenerate after they're damaged, Sheikh explains, so the best doctors can do is treat the pain and tingling. There is no medication available to help with numbness, however.

The good news? More than 60 percent of diabetic patients don't have any complications, says Dr. Wu Wen of Southeast Endocrinology, and the chance of developing neuropathy may be lessened by catching diabetes early on and controlling the blood sugar as much as possible.

In addition, three years ago Fonn began offering spinal cord stimulation, in which an electrode is placed on the spinal cord through surgery, hooked up to a battery, and creates a pulse that interrupts the pain signals between the legs and brain. The battery can be recharged by simply placing a special type of magnet over the skin.

"This is essentially a pacemaker for the spine," says Fonn. "What it does is it fools the brain into believing that there is no pain." Patients report relief from their symptoms as soon as they wake up from surgery, says Fonn, and they can go home just two hours after the outpatient procedure.

Still, prevention of this permanent nerve damage is critical, says Fonn, and other doctors agree.

"It's so much easier and better to catch problems early or prevent them than it is to deal with the consequences," says Sheikh, like constant therapy, an emergency visit to the hospital or worse. Patients with diabetic neuropathy might also develop autonomic neuropathy, leading to incontinence, constipation, diarrhea, acid reflux, difficulty breathing, sexual dysfunction and inability to regulate blood pressure.

"Listen to your family doctor, take your medications and control, control, control the sugars," says Fonn. "Do not allow it to get to very high levels for a long period of time."

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