Diabetes and Your Nerves (Part 1)

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Diabetic Neuropathy

Diabetes can harm your nerves. That damage, called neuropathy (pronounced new-ROP-a-thee), may be painful. It can cause numbness, poor digestion, fainting, sexual dysfunction, and other symptoms. What can we do about it?

Neuropathy has many causes, but the main one in diabetes is high blood sugar. The sugar interferes with the nerves’ ability to transmit signals and weakens the blood vessels that supply the nerves with nutrients. The nerves then start to send wrong signals, such as tingling or pain in areas that really aren’t hurting. If damage goes on, the nerves may stop signaling completely, causing numbness or loss of function.

Neuropathy is among the most common complications of diabetes. As many as 70% of people with diabetes have some form of neuropathy.

According to WebMD, there are four classes of diabetes-related neuropathy. The two main ones are peripheral neuropathy (PN), which affects the feet and legs, and less often, the arms, hands, abdomen and back, and autonomic neuropathy, which affects internal organs such as the stomach, bladder, sex organs and blood vessels. Both types can be disabling, painful, and can lead to other problems.

In PN, the small nerves in the legs and feet are damaged. Although often very painful, the big danger from PN is numbness. Not feeling the feet leaves you off balance, increasing the danger of falls. You will also be unaware of things like sharp objects that may dig into the foot and cause injury, such as too-tight shoes. These unfelt injuries put you at risk for infection, a major cause of amputation in people with diabetes.

• Autonomic neuropathy is usually less painful, but no less damaging. In the digestive system, symptoms include bloating in the stomach, diarrhea, constipation, heartburn, nausea, vomiting, and feeling full after small meals.

This condition is called gastroparesis (gas-tro-par-EE-sis, Latin for “weak stomach”). You may have to eat small, frequent meals to make things easier on your stomach.

In the bladder, neuropathy makes urination hard, as I wrote about here . In men, it can cause erectile dysfunction (ED).

A very dangerous symptom of autonomic neuropathy is low blood pressure and fainting when you stand up, because blood vessels don’t tighten as they should to keep blood flowing to the brain. You may also notice faster heartbeat, dizziness, nausea, and vomiting with this kind of neuropathy. If you have this form, be careful to get up slowly and wear compression stockings to keep blood from pooling in your legs and feet.

Dealing with neuropathy
Since the main cause of neuropathy in diabetes is high blood sugar, the most important thing is to keep you sugar levels down. Maintaining near-normal sugars is what our website is about. You may want to reduce carbohydrates, move more, and perhaps take medications like metformin or effective herbal treatments.

You’ll also want to practice careful foot care. The basics: Check your feet and legs daily for signs of injury or infection. Use lotion on your feet if they’re dry (but not between the toes). Cut toenails carefully and see a podiatrist. Wear good-fitting shoes, and don’t go barefoot because of risk of injury.

There’s quite a bit more to foot care. A panel of foot experts wrote articles about it for us here and here. Well worth reading. You might like this piece too on foot numbness.

A wide range of medications can help PN pain. Narcotics such as codeine, anti-inflammatories such as ibuprofen, antidepressants, anti-anxiety drugs, and seizure medications all seem to help. There are now medications especially for PN, such as pregabalin (brand name Lyrica) and gabapentin (Neurontin). We wrote about pain medications here.

Beyond keeping down blood sugar, it’s important to stop smoking and limit alcohol. Both smoking and excess drinking damage nerves.

Other nutritional approaches also make a difference. Nutritionist Amy Campbell wrote here, “Alpha-lipoic acid, an antioxidant, has been used in Europe for years to treat peripheral neuropathy. Fish oil supplements may help improve blood flow and reduce inflammation. Curcumin (found in the spice turmeric) and evening primrose oil are other supplements that may help.” She also quotes a study showing a vegan diet reduces PN pain.

Other supplements that many find helpful for neuropathy are coenzyme Q-10, vitamins B6 and B12, although none of these have strong clinical evidence. Vitamin D, potassium and magnesium have stronger evidence supporting their pain-relieving ability.

There are other types of neuropathy and more approaches to treating it. I’ll write about them next week. The encouraging thing is that PN is among the most reversible diabetes complications. If you can get your sugars down, the symptoms often go away.

Diabetes Self-Management reader John C commented on this topic: “I am fortunate to be one of those who has managed to reverse my numb and painful feet by returning my glucose levels to almost normal. Takes a long time (years), but it is possible.”

If John can do it, you probably can too. We’ll talk about it next week, but get us started by telling us your own experience with neuropathy in a comment.

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