Neuropathy is a potentially serious complication of diabetes
Diabetes can be nerve-wracking, but did you know it can also be nerve-wrecking? Diabetic neuropathydamage to nerves in various areas of the bodyaffects 60 to 70 percent of people with type 1 and type 2 diabetes. Because diabetic neuropathy sometimes doesn't produce clear symptoms, it often goes undiagnosed and untreated. Nerve damage can cause serious complicationsincluding infections and foot ulcers that can result in amputation of the toes and feet.
Fortunately, keeping blood sugar levels under tight control and being vigilant about foot care can help prevent neuropathy.
Catching Neuropathy Early
Nerves are the body's communication network, sending messages to and from your brain, registering pain, temperature and touch; they also tell your muscles when and how to move, and regulate body functions like digestion and heart rate.
While the exact mechanism of diabetic neuropathy is not fully understood, it's believed that high blood sugar levels and other factors damage the blood vessels that nourish the nerves and cause the microtubules that carry signals to degenerate and malfunction.
Prevent Nerve Damage
The best way to prevent neuropathy is to keep your glucose levels well-controlled (less than 7 percent A1c), says Thomas Donner, M.D., associate professor of medicine in the division of endocrinology and metabolism at the Johns Hopkins University School of Medicine in Baltimore. Although, he adds, sometimes symptoms of neuropathy can be what lead to the diagnosis of diabetes in the first place.
Another possible scenario of diabetic neuropathy is nonexistent or vague symptoms—for example, your feet feel "weird," but not bad enough to set off alarm bells; or your balance seems "off," but you don't attribute it to a loss of sensation in your feet, which is one of the hallmarks of nerve damage. The longer diabetic neuropathy goes untreated, the greater the likelihood of serious complications.
If nerves become damaged to the point where you lose sensation completely and can't feel if your feet are sore or injured, foot ulcers are more likely to develop and infection can set in, potentially spreading to the bone and requiring amputation.
"The good news is that more than 80 to 90 percent of cases that get to this point are preventable," says David G. Armstrong, D.P.M., M.D., Ph.D., professor of surgery at the University of Arizona College of Medicine in Tucson, and former chair of the Interest Group on Foot Care of the American Diabetes Association. "In addition to keeping your glucose level under control, it's just a matter of paying close attention to your feet."
Armstrong stresses the importance of taking your socks off and carefully checking your feet daily, because not everyone is given, as he calls it, "the gift of pain." Look for any red spots, cuts, signs of infection or a foreign object—like a staple—that you may have stepped on and not felt.
It's also critical to have your doctor do routine examinations of your feet and screen for nerve damage at least once a year, says Amanda Peltier, M.D., M.S., assistant professor of neurology at Vanderbilt University Medical Center in Nashville. Simple yet effective tests for sensation that can be done in a doctor's office include using a tuning fork to apply vibration to the foot or touching the foot in various places with a monofilamenta thin, bendable fiber that looks like a piece of fishing line.
Occasionally, nerve-conduction studies—in which small shocks are administered to the nerves via electrodes placed on the skin—are needed to confirm a diagnosis of peripheral neuropathy. (More extensive tests are used to diagnose autonomic neuropathy.)
"Less important than which test is used is that something is being done regularly," says Dr. Peltier. "The biggest problem is that testing may not be done as frequently as it should be. The earlier you catch diabetic neuropathy, the better the chance you have to slow its progress."
From our sister publication, Diabetes Focus (Summer 2011)