Diabetes Self-Management Articles

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Diabetic Peripheral Neuropathy

by Laura Hieronymus, MSEd, APRN, BC-ADM, CDE, and James Borders, MD

Painful symptoms occur in about 33% of people who have diabetic peripheral neuropathy. The good news is that the pain is usually treatable. The bad news is that not everyone receives treatment, sometimes because they never tell their health-care provider about the pain they are experiencing. If you feel pain, be sure to tell your health-care provider so you can get a proper diagnosis and talk about possible treatments. When you talk to your health-care provider, be sure to describe the location of the pain, the frequency with which you feel it, and its intensity or severity.

Risk factors
There are a number of things that place a person at increased risk for diabetic peripheral neuropathy. The older you are and the more years you have had diabetes, the higher your risk. Some other risk factors include frequent or chronic high blood glucose, high blood pressure, elevated cholesterol and triglyceride levels, and smoking. Some studies suggest that people with painful neuropathy tend to have higher glycosylated hemoglobin (HbA1c) levels, which means their average blood glucose level is high; greater fluctuations in blood glucose levels; and more episodes of hypoglycemia (low blood glucose).

A person’s risk of neuropathy can be lowered — by lowering blood glucose, blood pressure, blood cholesterol, and blood triglyceride levels to goal levels and by stopping smoking. Avoiding excessive alcohol consumption is also recommended for the prevention of diabetic peripheral neuropathy, as well as other complications of diabetes. If your HbA1c test results are over 7%, if your blood pressure is higher than 130/80 mm Hg, if your low-density lipoprotein (LDL) cholesterol is over 100 mg/dl, or if your level of triglycerides is over 150 mg/dl, ask your doctor what steps you can take to lower these numbers. Your doctor should also be able to help you learn to prevent frequent episodes of hypoglycemia, stop smoking, and get help for excessive drinking.

Everyone with Type 2 diabetes should be screened for diabetic peripheral neuropathy at the time of their diabetes diagnosis and then routinely thereafter. People with Type 1 diabetes should be screened within five years of their diabetes diagnosis and at least annually thereafter.

There are several ways of checking the sensory function in your feet, including checking your response to very gentle pressure on the bottoms of your feet with a device called a monofilament tool, and checking your perception of vibration using a tuning fork. Your health-care provider should also ask you about any symptoms of neuropathy that you may have (such as tingling or numbness) as well as examine your feet and legs for ulcers, calluses, and any deformities. Your footwear should be inspected at each diabetes care visit for signs of abnormal pressure in the shoes or signs that your shoes are too small.

Everyone with diabetic peripheral neuropathy, whether it causes symptoms or not, should be educated on proper foot care, as described in “Basic Foot Care.” Following these tips can help you prevent foot ulcers or get them treated early if they develop. If your health-care provider deems it necessary, he may refer you to a podiatrist (foot doctor) for further care.

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