Diabetic Peripheral Neuropathy

Diabetic neuropathy is a form of nerve injury caused by diabetes. High blood sugar (glucose) can harm nerves all over your body. It mostly hits the nerves in the legs and feet. Symptoms depend on which nerves are hurt. They range from aching and numbness in your legs and feet to trouble with your gut, bladder, blood vessels, and heart. Some people have only mild signs. For others, the symptoms are hard to live with. Diabetic neuropathy is a serious problem that affects up to 50% of people with diabetes. Still, good blood sugar control and a healthy lifestyle can usually prevent it or slow it down.

An interventional pain physician who also treats the metabolism behind the pain. Most people get split between offices: the primary care doctor or endocrinologist manages blood sugar, a neurologist confirms the nerve damage, and the burning gets a gabapentin prescription. Here one physician measures the damage, treats the pain directly with nerve blocks and nerve stimulation, and works on the insulin resistance that keeps injuring the nerve.

Blood sugar control stops new damage. It does not touch the pain you already have, and that pain needs its own treatment. What type 2 diabetes remission does to chronic pain explains why the two are treated together.

There are four main types of diabetic neuropathy. You can have one type or several.
Your symptoms depend on the kind of nerve damage and which nerves are hit. Symptoms usually come on slowly. You may not notice a thing until a lot of nerve damage has already happened.

Peripheral Neuropathy

It is also called distal symmetric peripheral neuropathy. This is the most common type. It hits the feet and legs first, then the hands and arms. Signs of peripheral neuropathy that are often worse at night include:

• Sharp pains or cramps.
• More sensitive to touch.
• Severe foot problems, such as bone and joint pain, infections, ulcers, etc.

Autonomic Neuropathy

The autonomic nerves run your heart, bladder, stomach, gut, sex organs, and eyes. Diabetic nerve injury can strike any of these areas. It can cause:

• Low blood sugar that you no longer feel coming on.
• Bladder or bowel problems.
• Eyes that adjust more slowly from light to dark.

Proximal Neuropathy

This type is also called diabetic amyotrophy or diabetic polyradiculopathy. It often hits the nerves in the thighs, hips, buttocks, or legs. It may hit the chest and belly too. Symptoms usually start on one side of the body, but they can move to the other.

• Severe hip, thigh, or buttock pain.
• Thigh muscles that grow weak and shrink over time.
• Trouble getting up from a chair.
• Severe stomach pain.

Mononeuropathy

Mononeuropathy means damage to one specific nerve. It is either cranial (a head nerve) or peripheral. It may also lead to:

• Trouble focusing or double vision.
• Aching behind one eye.
• Hand weakness that makes you drop things.

• You have an infected cut on your foot, or one that will not heal.
• Burning, shaking, weakness, or pain in your hands or feet that disrupts daily life or sleep.
• Changes in digestion or urination.
• Dizziness and fainting.

The American Diabetes Association advises screening for diabetic neuropathy soon after a type 2 diabetes diagnosis. With type 1 diabetes, screening starts five years after diagnosis. After that, get screened every year.

The exact cause of neuropathy is unknown. Researchers believe untreated high blood sugar wrecks nerves over time. It stops them from sending signals well, and that is diabetic neuropathy. High blood sugar also weakens the walls of the tiny blood vessels that bring oxygen and food to the nerves.

Risk factors

Anyone with diabetes can get neuropathy. These risk factors make nerve injury more likely:

Poor Blood Sugar Control

Blood sugar out of control raises the odds of every diabetes problem, nerve damage included.

Diabetes History

The longer you have diabetes, the higher your risk, most of all if your blood sugar isn’t well controlled.

Kidney Disease

When the kidneys fail, toxins build up in the blood and damage nerves.

Being Overweight

A BMI of 25 or higher raises your risk of diabetic neuropathy.

Smoking

Smoking narrows and hardens your arteries. That cuts blood flow to your legs and feet. It makes healing harder and harms the nerves in your limbs.

Diabetic neuropathy is usually found with a physical exam and a careful look at your history and symptoms.

Your doctor will check your:

• Muscle strength and tone.
• Tendon reflexes.
• Sensitivity to touch and vibration.

Along with the exam, the specialists at Padda Institute may do or order tests to pin down diabetic neuropathy, such as:

Filament Test

A soft nylon fiber (monofilament) is brushed on your skin to test how well you feel touch.

Sensory Testing

A test with no needles that checks how your nerves respond to vibration and heat or cold.

Nerve Conduction Testing

This test is often used to find carpal tunnel syndrome. It measures how well the nerves in your arms and legs carry electrical signals.

Muscle Response Testing

Electromyography is often done with nerve conduction studies. It measures the electrical signals your muscles give off.

Autonomic Testing

Special tests may measure how your blood pressure shifts when you change position, and whether you sweat normally.

Controlling your blood sugar can stop more nerve damage. But it won’t undo the damage or ease the pain it causes. You may need a specific treatment for diabetic nerve pain.

Pills that just mask the symptoms are the most common approach.

• Opioids are used by 50 percent of diabetic peripheral neuropathy patients.
• Anti-inflammatory drugs are used by 40% of people.
• Serotonin reuptake inhibitors are used by 20% of patients (SSRI).
• Tricyclic antidepressants are used by 11% of people.
• Anticonvulsants are used by 11% of people (Neurontin and Lyrica).

Many drugs are used for the pain of diabetic neuropathy. But the US Food and Drug Administration (FDA) has approved only duloxetine and pregabalin for diabetic nerve pain.

Pregabalin (Lyrica, Pfizer) is the “gold standard” in treating peripheral neuropathy. It helps 39 percent of patients cut their pain by 50 percent. But it also causes problems in at least 38 percent of patients. These drugs have big downsides and side effects.

Combined Therapy

Specialists at Padda Institute use combined therapy to treat diabetic neuropathy with success. It joins two well-known methods into one program. It shows strong promise for diabetic neuropathy and for neuropathy with no known cause (idiopathic). Combination therapy has two parts. One is a local anesthetic Ankle Block. The other is Electronic Signal Therapy (EST), which uses an advanced electro anesthetic wave generator.

Ankle Block

The ankle block targets five nerves that carry feeling below the ankle. Four are branches of the sciatic nerve (superficial peroneal, deep peroneal, sural, and posterior tibial nerve). The fifth is a skin branch of the femoral nerve (the saphenous nerve). The common peroneal and tibial nerves are the two end branches of the sciatic nerve.

Electronic Signal Treatment

EST uses electrical signals to regrow nerves and boost blood flow. It does this by waking up nerve function in the damaged areas. The signals vary in both strength (amplitude, AM) and speed (frequency, FM). A computer controls them and sends set cell-signal patterns in from outside the body.

The device makes a digital sine-wave alternating current with matching harmonics. In the body, this current has effects that are scientifically documented and/or theorized. The device uses advanced communications technology. It sends higher frequency signal energy through custom electrodes. The pattern keeps shifting between ordered and random. That shifting stops the nerves from getting used to the signal (neuron accommodation).

Combined therapy uses 0.25 percent Marcaine, a local anesthetic, and a vasodilator (a drug that opens blood vessels for a short time to boost blood flow). When your nerves are stimulated, they get more blood flow. That makes them regrow faster.

Combined therapy is believed to:

• Increase cell growth.
• Increase metabolic activity.
• Reduce swelling around the nerve.
• Stimulate nerve function.
• Directly increase blood and oxygen flow to the nerves.
• Promote wound healing.
• Reduce inflammation.
• Reduce scar tissue.

With a pain plan that works, the patient will get more movement back.

Auricular vagal nerve stimulation. When drugs and metabolic care have not controlled the pain, we use the NS-100 — an FDA-cleared Class II programmable peripheral electrical nerve stimulator made by Nalu. It goes on the nerve branches at the ear and works as a vagal stimulator. It changes how the brain and spinal cord process pain signals. It does not cut off the nerves in the feet. It is worn for up to 30 days, most often around 20. Placement uses local anesthetic with no sedation. You drive yourself home, and there are no activity limits. Peripheral nerve stimulation is a covered category under Medicare’s national coverage determination for electrical nerve stimulators. Local coverage policy sets the criteria — we check your own coverage before booking. Read more about peripheral nerve stimulation.

Diabetic neuropathy raises the risk of a fall. But it is not the only reason a diabetic patient gets unsteady — the inner ear can be hit on its own, apart from the nerves in the feet. Balance and fall-risk testing measures both.