You can take steps to slow the progression of diabetic peripheral neuropathy (DPN). Diabetic neuropathy, or nerve damage, is one of the most common complications of diabetes.
If you have diabetes and nerve damage, you're not alone. About half of people with diabetes also have diabetic neuropathy. The main cause of diabetic neuropathy is nerve damage in your feet and legs, also called diabetic peripheral neuropathy. But sometimes, DPN can progess to your hands and arms.
When diabetic peripheral neuropathy is left untreated, it can be dangerous. Research shows that it can greatly impact your quality of life. Almost 10% of people with the condition require a limb amputation.
So it's very important to be aware of DPN symptoms which can help you get diagnosed earlier. That way, you can get it treated quickly and lower your risk of DPN gradually getting worse. Here's what you need to know.
Know the Symptoms of DPN
You can help catch the early signs of DPN. If you have diabetes, monitor yourself and let your doctor know if your toes or feet get:
- Pain
- Numbness
- Burning
- Tingling
DPN often starts in your toes, spreads to your feet, then your calves. You may also notice nerve damage on both sides of your body.
Other DPN signs in your toes and feet can include:
- Extreme sensitivity to touch
- Pain that gets better with activity, like walking
- Intensely painful feet
As you lose feeling in your toes and feet, you may find it harder to:
- Sense pain
- Feel pressure
- Notice extreme hot or cold
Without feeling, you're more likely to injure your feet. You could step on a splinter or wear a shoe that causes a blister and not feel pain. If left untreated, the injury can cause serious complications like:
- Infections
- Foot ulcers
- Amputation
But you can take steps to prevent complications and slow the progression of DPN. Focus on four main areas of your health to lower your chances for DPN symptoms getting worse.
Take Steps To Get Your Diabetes Under Control
The biggest risk factor for diabetic neuropathy is high blood sugar levels over time. The higher blood sugar can damage your nerves, as well as the small blood vessels that provide your nerves oxygen and nutrients.
Work closely with a diabetes specialist to manage your blood sugar levels. The better control you have over your blood sugar levels, the less risk you have of your DPN getting worse.
Research suggests that people with type 1 diabetes who get their blood sugar to near-normal levels lower their risk of DPN by almost 80%. Near-normal blood sugar levels can also help manage DPN symptoms like pain and numbness.
Blood glucose meters
If you have type 1 diabetes, you may need to use a blood glucose meter or continuous glucose monitor (CGM) to check your blood sugar levels several times a day. These meters can help you find out whether you need to adjust your insulin dose or use an insulin pump.
With type 2 diabetes, you'll get an A1c blood test at least every six months. Your doctor uses the A1c blood test to measure your average blood sugar levels over the last two to three months. The test helps your doctor figure out if you're on the right medication.
Based on the testing, your doctor can give you a higher medication dose, switch to a different one, or start insulin shots. You may also need to go for more frequent A1c blood tests, too.
Finding your blood glucose target
You and your doctor will decide on the best blood glucose target for your age and health. The American Diabetes Association suggests that most adults with diabetes aim for these targets:
- An A1c of less than 7%
- A blood glucose range between 80 and 130 mg/dL before a meal
- A blood glucose of less than 180 mg/dL an hour or two after a meal
Other risk factors
You'll want to get other risk factors for diabetic peripheral neuropathy under control, too. Other health conditions that can raise your DPN risk include:
- Heart disease
- High triglyceride levels
- Overweight or obesity
- Smoking
- High blood pressure
Talk to your doctor about steps you can take to manage your other health conditions. Both lifestyle and medication can help you get your health conditions under control and lower your risk for DPN.
If you are a smoker with diabetes, you're about 40% more likely to have DPN. Ask your doctor about ways to quit.
Lead a Healthy Lifestyle
Choosing to eat a healthy diet and regularly stay active can also help with your DPN. In fact, the American Diabetes Association suggests diet and exercise as a standard DPN treatment for people with type 2 diabetes.
Here are some ways you can make healthier choices that may also ease DPN symptoms.
Eat a healthy diet
There's no one diet in particular to treat DPN. Try to focus on a nutrient-dense, plant-based diet that include:
- Low amounts of saturated fats
- Rich in fruits
- Lots of vegetables
- High levels of fiber from whole grains
Some research suggests a Mediterranean diet that's low in carbohydrates (around 45%) and higher in healthy fats (35%-40%) is helpful. With fats, cut out saturated fats as much as possible — 10% or less of your calories.
Stay active
Research suggests exercise may be able to stop DPN from progressing. One study found that people with type 2 diabetes who exercised saw nerve fibers grow back, while those who didn't lost them.
To stay active, you can try to:
- Aim for at least 150 minutes of exercise, like a brisk walk, most days of the week
- Add flexibility and balance training to your exercise routine
- Rotate in strength training at least twice a week
With DPN, high-impact activity may not be the best — such as running, which can cause foot ulcers and stress fractures. You are best off with lower-impact activities like walking, biking, and swimming.
Don't sit for too long
The American Diabetes Association suggests breaking up bouts of sitting with a burst of activity every 30 minutes. You can stand up, stretch, or walk around for a minute or two.
If possible, aim for three minutes of movement every half-hour, which has been shown to improve blood sugar levels in people with type 2 diabetes. If you are at work, set your alarm for every half-hour.
Manage stress
Stress can make it harder to manage your diabetes. When stressed, your body can release stress hormones like cortisol. These hormones can make blood sugar harder to regulate.
Help yourself with stress management techniques like meditation. Research shows that these practices may help improve symptoms of neuropathy, too.
Manage DPN With Medications
You and your doctor will design a treatment plan that includes medications. There aren't any medications that specifically slow down the progression of DPN. But the medicines can help you manage your symptoms.
With well-controlled pain, it's easier to stay active and lead a healthy lifestyle. And this can help you prevent DPN from getting worse. Here are some medications that your doctor may talk about.
Duloxetine (Cymbalta)
You can't use duloxetine if you're taking other antidepressants. Duloxetine can help relieve pain caused by DPN. You usually take it once a day. You may notice side:
- Nausea
- Sleepiness
- Dizziness
- Loss of appetite
- Constipation
Anti-seizure medications
You can take these medicines with duloxetine or another antidepressant. Some anti-seizure medications can help treat nerve pain such as:
- Amitriptyline (Elavil)
- Gabapentin (Gralise, Neurontin)
- Nortriptyline (Aventyl, Pamelor)
- Pregabalin (Lyrica)
You may also take gabapentin at night, to help prevent pain during sleep — because they can't be taken together. These medications can cause side effects like dizziness and confusion.
Tricyclic antidepressants
Shown to work well at a lower dose than what's used to treat depression, you may get a tricyclic antidepressant like:
- Amitriptyline (Elavil)
- Desipramine (Norpramin)
- Nortriptyline (Aventyl, Pamelor)
You can also take these antidepressants with gabapentin and pregabalin, but not duloxetine. When taking tricyclic antidepressant, you may notice:
- Dry mouth
- Sleepiness
- Dizziness
- Constipation
Patches and creams
If other medications don't help, your doctor may suggest a patch or cream. These contain an anesthetic (5% lidocaine) or capsaicin (comes from chili peppers). You place the cream or patch on your skin to temporarily block pain.
Alpha-lipoic acid (ALA)
Some research suggests that this antioxidant may help relieve DPN pain. But there aren't good long-term studies about how well it works or its safety. You can get ALA as a supplement over the counter.
Other options
Despite treatment, you may still have painful DPN. Your doctor may suggest other treatments like electrical nerve stimulation, or TENS. They may also talk to you about spinal cord stimulation (SCS). SCS is a small implant that can send electrical impulses and help ease your pain.
Take Care of Your Feet
Foot care is very important if you have DPN. It won't slow progression, but it can catch things early to help prevent more serious complications like foot ulcers and infection.
DPN can cause you to lose pain sensations in your feet. This makes it hard to know if your feet are hurt or injured. You can get lower blood circulation to your feet, which makes cuts and scrapes harder to heal.
If you have DPN, you are more likely to develop a serious skin or bone infection that leads to gangrene (death of skin tissue).
About 5% of people with diabetes need a toe or foot amputation. But you can help lower your chances with good foot care. Here are some things you can do to prevent DPN complications.
If your doctor or foot specialist thinks you have nerve damage, they may want to check if the nerves in your arms and legs work properly.
There are two nerve tests they may run:
- A nerve conduction study to check how fast your nerves send messages.
- An electromyography (EMG) to check how your nerves and muscles work together.
Following up with your doctor or a foot specialist can help you keep your feet healthy. Catching the signs early, making healthy choices, and keeping your blood sugar under control can help slow the progress of your DPN.
Show Sources
Photo Credit: Moment/Getty Images
SOURCES:
Scientific Reports: "Prevalence of peripheral neuropathy, amputation, and quality of life in patients with diabetes mellitus."
National Institute of Diabetes and Digestive and Kidney Diseases: "What Is Diabetic Neuropathy?"
UpToDate: "Patient education: Diabetic neuropathy (Beyond the Basics)," "Patient education: Foot care for people with diabetes (Beyond the Basics)."
Cochrane: "Enhanced glucose control for preventing and treating diabetic neuropathy."
Diabetes Care: "Diabetic Neuropathy: A Position Statement by the American Diabetes Association."
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Journal of General Internal Medicine: "The Effect of Cigarette Smoking on Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis."
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