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Diabetic Neuropathy

Diabetes is a disease effecting the proper regulation of your body’s glucose. There are two different types — type I (insulin dependent diabetes mellitus) and type II (non-insulin dependent diabetes mellitus). Type I is typically discovered in children. The far more common type II diabetes is an acquired disease, usually diagnosed later in life.

In type II diabetes, the body stops responding to insulin (the hormone responsible for helping to control blood sugar), or the body doesn’t produce enough insulin. Contributing factors for the development of type II diabetes are obesity and inactivity, although there is also some genetic component. The incidence of type II diabetes is on the rise, especially in developed countries.

The goal for patients with diabetes is to develop a strategy for tight glucose (sugar) control either by diet, exercise or medications. Control of glucose levels will help prevent complications from diabetes. Patients with diabetes are at increased risk for development of peripheral neuropathy. This is damage to the nerves going to different parts of your body.       

Symptoms

Patients with nervous system complications related to diabetes may experience pain and numbness starting in the hands and feet. Some do not experience pain but rather just experience numbness. The neuropathy typically starts in the hands and feet and will start to spread upwards toward the trunk of the body. The pain associated with peripheral neuropathy is typically described as burning and tingling. 

Causes

Diabetic peripheral neuropathy is related to uncontrolled glucose levels in patients with diabetes. Damage to the nerves is caused by excess sugar in the blood stream over time.  The nerves in the hands and feet are particularly vulnerable to damage.    

Treatments

The treatment for diabetic peripheral neuropathy starts with you, the patient, and your primary care doctor working on a strategy to maintain strict control of your blood sugar.  Strict control may be through diet and exercise alone, or may be through addition of a combination of diabetes medications. This may not alleviate the current symptoms, but may help prevent further diabetic complications. 

If you have pain associated with diabetic peripheral neuropathy, your primary care physician may refer you to a pain management specialist. On your initial visit at the JLR Center for Pain Medicine, your doctor will perform a comprehensive medical history and physical examination.  A treatment plan will then be devised with your particular needs in mind.

Early treatment focuses on confirmation of the diagnosis and the initiation of a treatment to alleviate pain. Your doctor may also want to confirm the diagnosis by ordering certain labs to rule out other causes of peripheral neuropathy or have you obtain a nerve conduction study and an electromyography (EMG). Most of the time, the diagnosis can be made by obtaining the history and physical.  

Your pain management physician may prescribe a combination of medications to include nerve-stabilizing medications (anti-convulsants), anti-depressants which also work to stabilize the nerve, and topical patches and creams. If the pain persists, despite the initial treatment options, your provider may suggest a spinal cord stimulator trial.