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What is painful diabetic neuropathy?
Painful diabetic neuropathy is a type of nerve damage caused by diabetes. It primarily affects the nerves in the feet and legs, but it can also affect the arms and hands. This condition is characterised by pain, tingling, numbness, and sensitivity to touch. It occurs due to prolonged high blood sugar levels, which can damage the nerve fibres throughout the body.
What causes painful diabetic neuropathy?
Painful diabetic neuropathy is primarily caused by high blood sugar levels associated with diabetes, which can damage the nerves throughout the body. The exact mechanisms are not completely understood, but several factors contribute to the development of this condition:
- High blood sugar levels: chronic high glucose levels can lead to biochemical changes in nerves, impairing their ability to transmit signals. Over time, this can cause nerve damage (neuropathy), resulting in pain and other symptoms.
- Blood vessel damage: diabetes can also damage the small blood vessels that supply blood and nutrients to the nerves, which can result in decreased oxygen and nutrient supply, further damaging nerve function.
- Inflammation: diabetes can cause inflammation, which may contribute to nerve damage and the development of neuropathic pain.
- Metabolic factors: high levels of fats in the blood (lipids) and possibly low levels of insulin or insulin-like growth factors can damage nerves.
- Nerve compression: people with diabetes may also be more prone to nerve compression or entrapment, which can exacerbate neuropathic pain.
The damage caused by these factors can lead to the malfunctioning of nerve fibres, where they may send incorrect signals to pain centres or fail to send signals at all.
What are the symptoms of painful diabetic neuropathy?
The symptoms of painful diabetic neuropathy can vary in severity and nature but typically include:
- Pain: this is often described as burning, shooting, or stabbing. The pain may be constant or intermittent and is usually worse at night.
- Numbness or tingling: a loss of sensation or a feeling of wearing an invisible glove or sock may occur. Tingling, often described as a “pins and needles” sensation, is also common.
- Sensitivity to touch: people with this condition may experience heightened sensitivity to touch, where even light pressure from clothing or bed sheets can be painful.
- Muscle weakness: in advanced cases, the muscles of the feet or hands may become weak, resulting in difficulty walking or handling objects.
- Loss of reflexes: particularly the ankle reflexes.
- Balance and coordination problems: loss of proprioception (the sense of body position) can make it difficult to coordinate complex movements like walking or fastening buttons.
- Extreme sensitivity to temperature: individuals may have an abnormal response to cold or heat due to nerve damage.
- Skin changes: the skin may become dry or cracked because the nerves controlling moisture and oil production in the skin are not functioning properly.
These symptoms usually develop gradually. They may start with mild tingling in the extremities and progress to more severe pain and sensory loss over time. Effective diabetes management and maintaining blood sugar levels within the recommended range can help slow the progression of neuropathy and alleviate symptoms.
Who is at risk of diabetic neuropathy in Singapore?
In Singapore, the risk of developing diabetic neuropathy is closely linked to the presence and management of diabetes. Individuals who are at higher risk of diabetic neuropathy include:
- People with poorly controlled diabetes: those who have difficulty managing their blood sugar levels, with frequent high blood sugar episodes, are at greater risk.
- Long duration of diabetes: individuals who have had diabetes for many years are more likely to develop neuropathy.
- Older adults: the risk of diabetic neuropathy increases with age, particularly as the duration of diabetes increases.
- Those with high levels of blood fat and low levels of HDL cholesterol: unhealthy cholesterol levels can contribute to the risk of developing diabetic neuropathy.
- Smokers: smoking affects blood circulation and increases the risk of neuropathy.
- People with high blood pressure: hypertension can contribute to blood vessel damage, which can exacerbate the risk of nerve damage.
- Overweight or obese individuals: obesity, particularly with a significant amount of abdominal fat, increases the risk of diabetes and, consequently, diabetic neuropathy.
In Singapore, there is a high prevalence of diabetes among the population, particularly in older adults.
Regular medical check-ups, good blood sugar control, a healthy diet, regular physical activity, and smoking cessation are key strategies to reduce the risk of developing diabetic neuropathy.
How is diabetic neuropathy diagnosed?
Diabetic neuropathy is diagnosed through a combination of medical history review, physical examination, and specific tests. Here’s how the diagnosis for diabetic neuropathy works:
- Medical history: your specialist will ask about your symptoms, duration of diabetes, blood sugar control, and other health conditions. They will inquire about the type and pattern of symptoms, such as numbness, tingling, pain, weakness, and any changes in bowel or bladder function.
- Physical examination: a comprehensive exam will be conducted, focusing on the nervous system. This includes checking muscle strength, tendon reflexes, and the ability to feel various sensations (such as touch, vibration, temperature, and pain).
- Neurological tests: these may be performed to assess the nerve function in different body parts. Tests can include:
- Electrophysiological tests:
- Blood tests: these are used to rule out other causes of neuropathy, such as vitamin B12 deficiency or thyroid problems, and to assess diabetes control.
- Other tests: in some cases, additional tests may be necessary to rule out other conditions or to assess the extent of the nerve damage. This could include imaging studies like MRI or CT scans, especially if structural abnormalities or other neuropathies are suspected.
Early diagnosis and management are crucial to prevent the progression of diabetic neuropathy and manage its symptoms effectively. Therefore, regular check-ups and monitoring are important for individuals with diabetes to address neuropathy early.
What are the treatment options for diabetic neuropathy?
Treatment for diabetic neuropathy focuses on managing symptoms, slowing the progression of the condition, and addressing any complications that arise. Here are some of the common treatment options for diabetic neuropathy:
- Blood sugar control: the most critical step in managing diabetic neuropathy is tight blood sugar control. This can slow the progression of neuropathy and, in some cases, improve symptoms. Patients are advised to monitor their blood glucose levels regularly and adhere to their diabetes management plan, including diet, exercise, and medications.
- Pain management: various medications are used to alleviate the pain associated with diabetic neuropathy, including:
- Antidepressants: certain antidepressants, such as amitriptyline, duloxetine, and venlafaxine, can help relieve nerve pain.
- Anticonvulsants: medications like gabapentin, pregabalin, and carbamazepine are often prescribed to reduce nerve pain.
- Topical treatments: topical treatments like capsaicin cream and lidocaine patches, can be applied to the skin to relieve pain.
- Opioids: opioids are generally used as a last resort due to the risk of dependency and side effects.
- Lifestyle modifications: healthy lifestyle choices can help control blood sugar levels and reduce symptoms. This includes maintaining a healthy diet, engaging in regular physical activity, avoiding alcohol and smoking, and managing body weight.
- Foot care: proper foot care is essential to prevent complications like ulcers and infections. This includes regularly inspecting the feet, wearing appropriate footwear, and seeking prompt treatment for foot injuries or abnormalities.
- Physical therapy and rehabilitation: physical therapy can help improve muscle strength, mobility, and daily functioning. Occupational therapy may also help manage daily activities and improve quality of life.
- Supplements and vitamins: some studies suggest that certain vitamins and supplements, such as alpha-lipoic acid, vitamin B12, and omega-3 fatty acids, might help improve symptoms of diabetic neuropathy.
- Neuromodulation: May be suitable in selected individuals suffering from painful diabetic neuropathy, your pain specialist will do a thorough assessment and guide you through a personalised management plan.
Treatment choice depends on the individual’s specific symptoms and the severity of the neuropathy. A multidisciplinary approach involving endocrinologists, neurologists, pain specialists, and other healthcare professionals is often the most effective way to manage diabetic neuropathy. If you are suffering from diabetic neuropathy, please schedule an appointment with us for a thorough diagnosis and an appropriate treatment plan.
Frequently asked questions
Diabetic neuropathy cannot be completely reversed, especially if it has progressed significantly. However, early intervention and strict blood sugar control can slow its progression and alleviate symptoms.
Long-term complications can include an increased risk of foot injuries and infections leading to ulcers and possibly amputation, loss of sensation, and problems with digestion, urination, and sexual function.
Preventing diabetic neuropathy involves maintaining tight control of blood sugar levels, following a healthy lifestyle, regular monitoring by healthcare professionals, and managing risk factors like high blood pressure and cholesterol.
Individuals with diabetic neuropathy should have regular check-ups with their specialist at least once a year, or more frequently if their symptoms are severe or changing, to manage the condition and prevent complications.
Total Pain Specialist