At least half of people with diabetes develop diabetic peripheral neuropathy (DPN), or nerve damage. Working with your entire health care team can help you manage this challenging condition.
"When you live with DPN, you can't rely on just one medical provider to manage the condition and treat symptoms," says Gordon Smith, MD, FAAN, chair of the Department of Neurology at Virginia Commonwealth University in Richmond.
Often, you'll have other medical conditions along with DPN that also need to be managed, such as sleep apnea and depression. "If you don't treat these underlying conditions, treatment for your DPN will be less effective," he says.
But carefully monitoring your blood sugar can help you get well-controlled levels. This in turn will help to slow the progress of DPN and may improve your symptoms, too.
Here's what you need to know so you can work better with your health care team.
Get Checked for Other Health Conditions
Your health care team will regularly evaluate your sleep and mood, says Smith. "If you don't get good-quality sleep, or are depressed, medications may be less effective," he says.
In fact, people with DPN also have:
- Anxiety, up to 60%
- Depression, about half
- Sleep disorders such as apnea, over 40%
Ask to see a sleep specialist if you have symptoms of sleep apnea, such as excessive daytime sleepiness and snoring. And if you often feel depressed or anxious, get referred to a mental health specialist such as a psychologist or psychiatrist – or both.
See the Right Specialists
When it comes to DPN, "it's a team sport, so we can manage all aspects of the condition and prevent it from getting worse," says David Armstrong, DPM, MD, PhD, a professor of neurological surgery at the Keck School of Medicine at the University of Southern California in Los Angeles. Here are some of the folks you may see:
Endocrinologist, or diabetes specialist. They can help you better control your blood sugar levels, a crucial piece to prevent DPN from progressing, says Armstrong.
Foot specialist. This doctor checks your feet regularly to assess nerve damage. They'll also look for skin changes and wounds, including foot ulcers, that can be serious if left untreated. Research shows that regular foot screenings in people with diabetes can lower your risk of foot amputation by up to 96%.
Neurologist. This nerve doctor can prescribe medicine to help treat and manage symptoms of DPN like pain, tingling, and numbness in your feet and legs.
Primary care provider. Your primary care doctor can help you with your day-to-day care. They can also help you lower other risk factors for DPN, like having high blood pressure, elevated triglycerides, and overweight.
Physical therapist. With DPN, you have a higher risk of falling because you lose foot sensation. "We routinely send folks to physical therapy to learn balance exercises that help to reduce fall risk," says Smith.
A recent review found that people with DPN who had physical rehabilitation improved their balance and lowered their fall risk. "A PT can also help you put together a good home exercise program," says Smith.
Nutritionist. The American Diabetes Association suggests lifestyle interventions like diet and exercise as a first treatment for DPN. A nutritionist can help you stick to a plant based diet that's rich in fruits, veggies, whole grains, and lean protein, but low in saturated fat.
Knock your socks off
Armstrong also recommends that every time you see your primary care provider, even for an unrelated reason, you ask them to check your feet.
"I tell my patients, ‘Knock your socks off,' literally," says Armstrong. "They can give a quick look and flag something. I have patients who did this and caught a small sore or foot ulcer before it became a big one, with big complications."
Use the Right Medications
Certain medications that your doctor prescribes can help treat neuropathic pain for your DPN, says Smith. These medicines won't reverse the neuropathy, but the American Academy of Neurology suggests all of these as standard treatments.
"You'll work with your health care provider to figure out which drug is best for you, based on your age and other health conditions," says Smith. He says that if your neuropathy prevents you from sleeping and you don't have a history of heart disease, your doctor might prescribe a low-dose tricyclic antidepressant. But if you're older with depression, an SNRI may be a better choice, depending on other health conditions.
If one medication isn't working, your doctor will likely choose a new medicine from one of the three other classes to relieve your nerve pain. Your doctor will also review your medication list, to make sure another medicine isn't making your DPN worse.
See a Foot Specialist
If you've had a past foot ulcer with DPN, you're at a higher risk of getting another one, says Armstrong. This raises your risk of a serious infection that can lead to amputation.
About 65% of people with DPN have an ulcer come back within three to five years. But a doctor that specializes in feet can help.
A great first step is to be closely monitored by a foot doctor. Your foot specialist might also suggest seeing other specialists such as a:
- Orthopedic surgeon
- Shoe specialist
- Physical therapist
Your foot doctor may also suggest wearing special shoes, or having surgery to correct another foot deformity.
Use Wearable Technology
Wearable technology can allow both your foot specialist and the rest of your health care team to gather real-life information about your daily activities. This can help your DPN treatment team make better treatment decisions.
Smart boot to prevent foot ulcers
The Sensoria Smart Boot is one example. Wearing the boot can help relieve pressure on certain parts of your foot to prevent foot ulcers.
The boot sends messages to a smartwatch-based monitoring system. This information is also sent directly to your foot doctor. Past research done by Armstrong has found that the Smart Boot may improve your balance, too.
Armstrong is now studying whether the boot system can help people get better treatment. "It gives us information about foot temperature, pressure, and walking cadence, which can indicate muscle loss due to limited mobility," he says. "All this data can help us come up with a better treatment plan."
Insoles to lower repeat foot ulcer risk
Another option are sensory insoles that connect to your doctor's office to continuously monitor your foot health. Some research suggests these insoles can lower your risk of foot ulcers coming back.
Foot check devices
There are also devices that you step on – a scale or mat – to take a picture of your feet. For example, smart foot monitors like the SmartMat and OneStep can take a picture, measure your foot temperature, and then send the information to your doctor.
"These can sometimes pick up something embedded in your foot that you can't feel, or a possible skin abnormality that could indicate the start of an ulcer," explains Armstrong.
These devices are often covered fully or in part by insurance, especially if you have DPN with a past history of foot ulcers, says Armstrong. But if they aren't, there are other options.
"I often just tell my patients to take a quick photo of their foot and send it to me," he says. "Anything we can do to reduce risk of foot amputation is a plus."
Show Sources
Photo Credit: E+/Getty Images
SOURCES:
Gordon Smith, MD, FAAN, chair, Department of Neurology, Virginia Commonwealth University, Richmond.
David Armstrong, DPM, MD, PhD, professor, neurological surgery, Keck School of Medicine, University of Southern California, Los Angeles.
National Library of Medicine: "Diabetic Peripheral Neuropathy."
Neurology: "Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary."
Diabetes Care: "Psychosocial Care for People With Diabetic Neuropathy: Time for Action."
UpToDate: "Patient education: Foot care for people with diabetes (Beyond the Basics)," "Patient education: Diabetic neuropathy (Beyond the Basics)," "Overview of management of diabetes-related foot disease."
Clinical Interventions in Aging: "A Systematic Review of the Effect of Physical Rehabilitation on Balance in People with Diabetic Peripheral Neuropathy Who are at Risk of Falling."
Therapeutic Advances in Psychopharmacology: "The cardiovascular safety of tricyclic antidepressants in overdose and in clinical use."
Journal of Diabetes, Science & Technology: "Smart Offloading Boot System for Remote Patient Monitoring: Toward Adherence Reinforcement and Proper Physical Activity Prescription for Diabetic Foot Ulcer Patients."
Lancet Digital Health: "Innovative intelligent insole system reduces diabetic foot ulcer recurrence at plantar sites: a prospective, randomised, proof-of-concept study."
