11 STEPS IN MANAGING DIABETIC NEUROPATHY

WHAT IS IT?

Peripheral Neuropathy is a nerve condition that affects the arms, hands, legs, and feet. The most common form of peripheral neuropathy is due to diabetes. People with diabetes have an abnormal elevation of their glucose and lack adequate insulin to metabolise the glucose. As a consequence,the blood glucose damages the nerve. This condition can occur in both Type 1and Type 2 Diabetes. It doesn't matter if the patient is on oral antidiabetic drugs, on insulin or is diet controlled. The nerve damage that occurs is considered to be permanent As the nerve damage occurs, the protective sensations are affected. These include a person's ability to determine the difference between sharp and dull, hot and cold, pressure differences, and vibration. These senses become dulled or altered. The process begins as a burning sensation within the toes and progresses up the foot in a very "stocking distribution".

WHAT ARE THE SYMPTOMS?

As the condition progresses, the feet become numb. Some individuals can feel as if they have worn socks on their feet, (in reality they are not). Other patients can describe the sensation as "walking on cotton", or a water-filled cushion. Some patients complain of their feet burn at night, causing troubled sleep. The feet may also feel like they are cold, however, to the touch, they have an average skin temperature The progression of the condition can be slowed or halted by maintaining the blood glucose levels in the range of ~ 100mg/dl to 200mg/dl. As the patient develops diabetic neuropathy, they are at a higher risk of developing skin ulcerations and infections. Areas of corns and calluses on the feet represent areas of excessive friction or pressure. These areas, if not properly cared for by a foot specialist, can typically break down and cause ulcerations. Ulcerations and infection are formed under these calluses and goes unnoticed, by the patients as they are not painful. Ingrown toenails can progress to severe infections in individuals with diabetic neuropathy.

TAKING CARE OF THE FOOT AT HOME

Simple things like trimming the toenails too close to the skin would be a considerable risk to those patients with Diabetes. People with neuropathy must religiously inspect their feet daily. They should not soak their feet in the water of extreme temperature, use heating or ice pads on their feet, this can result in accidental burns of the skin. Barefoot walking should be avoided because of the risk of stepping on something sharp and not being aware of it. The inside of the shoes should be inspected and felt by hand before putting the shoes on to ensure that no foreign object is inside the shoe

TREATMENT FOR PERIPHERAL NEUROPATHY

Treatment for peripheral neuropathy is, for the most part, directed at the symptoms of the condition. 1.control your sugar.

2. Vitamin D supplementation may be helpful if the patient has vitamin D deficiency.

3. Vitamin B12 supplements , particularly in vegetarian and patients taking metformin.

4. Alpha lipoic acid and benfothiamine supplements.

5. Quit smoking as it causes peripheral circulatory disease ( reduces blood flow to the extremities)

6. Stop drinking alcoholic drinks.

7. Control your cholesterol levels which can lead to atherosclerosis and Peripheral vascular disease.

8. Control high blood pressure.

9. Certain oral medications like Gabapentin, pregabalin , amitriptyline, nortryptyline, duloxetine etc may ease the burning pain that can be prescribed only by your doctor. Do not use them without their advice as they can have certain side-effects.

10. Topical ointments like capsaicin , Gabapentin, lignocaine etc can also be used only with the advice of your doctor.

11. Various newer therapies like Anodyne and Laser have helped the patients in managing pain and continue with their activities.