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Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) is a type of nerve damage that impacts the feet, toes, legs, hands, and fingers of individuals with diabetes. In fact, upwards of 70% of all people with diabetes will eventually develop peripheral neuropathy. The highest rates of DPN are among people who have had diabetes for at least 25 years, but it can impact people across all types of diabetes and ages.

Like any health condition, the signs and symptoms, along with their severity will vary from person-to-person. Some people may experience no symptoms at all while others experience pain, tingling, numbness or loss of feeling in their hands, arms, feet, and legs. The largest risk factor for diabetic peripheral neuropathy is associated complications, as the consequences can be life-threatening. Some complications include foot ulcers and amputations.

Causes of Diabetic Peripheral Neuropathy

Anyone with diabetes may develop neuropathy, but there are many risk factors that may make a person more susceptible to the condition. Researchers believe it is the work of multiple components that result in the development of DPN, some of which include:

  • Chronically high blood sugar levels
  • Genetics
  • Smoking
  • Increased Alcohol Use
  • Chronically high blood sugar levels
  • Genetics
  • Smoking
  • Increased Alcohol Use
  • Length of time you have diabetes
  • Being Overweight
  • Kidney Disease
  • High Blood Pressure
  • Length of time you have diabetes
  • Being Overweight
  • Kidney Disease
  • High Blood Pressure

Doctors typically diagnose neuropathy on the basis of clinical symptoms and a physical exam that may include a monofilament test.

If you have diabetic neuropathy, you may not feel pain, so there can be a number of subsequent complications. These include the loss of a limb and Charcot foot or joint.

Symptoms of Diabetic Peripheral Neuropathy

Typically, DPN symptoms will develop gradually, but symptoms will present differently from person-to-person. For many individuals symptoms worsen at night but up to half of all people with neuropathy don’t notice any symptoms at all.

If you notice any of the following signs or symptoms consult your primary care doctor or care team immediately.

  • Pain
  • Burning
  • Stabbing
  • Numbness
  • Loss of Feeling
  • Muscle Weakness
  • Pain
  • Burning
  • Stabbing
  • Numbness
  • Loss of Feeling
  • Muscle Weakness
  • Poor Coordination
  • Muscle Cramping
  • Muscle Twitching
  • Insensitivity to Pain
  • Hypersensitivity
  • Insensitivity to Temperature
  • Poor Coordination
  • Muscle Cramping
  • Muscle Twitching
  • Insensitivity to Pain
  • Hypersensitivity
  • Insensitivity to Temperature

After a lower leg amputation, 80% of people pass away within 5 years. The risk of death doubles for people who have had a foot ulcer, so it is very important to catch any potential injury early on.

Furthermore, people with diabetes are prone to foot deformity like Charcot foot.

There are a number of things that you can do to protect your foot health. This includes wearing socks daily, monitoring foot temperature daily, do daily visual and physical foot checks, and regularly see your care team.

Diagnosing Diabetic Peripheral Neuropathy

If you believe you have DPN or have any of the symptoms mentioned above reach out to your primary care provider and care team. Your healthcare provider will conduct a screening including a medical history and possible lab tests to check for vitamin deficiencies or other causes of nerve damage like thyroid problems. The most critical component of your evaluation will be a foot exam that may include a monofilament test. Your healthcare provider will examine your feet and conduct nerve tests.

If you have diabetes, you should have a comprehensive foot exam by a podiatrist at least once a year. Depending on your risk factors, or if you’ve been diagnosed with DPN you may need to see a podiatrist and have foot exams more regularly.

The American Optometric Association recommends that everyone with diabetes have a comprehensive dilated eye examination once a year to detect the early signs of the disease.

Avoid Complications Due to DPN

While there is no cure for DPN, you can manage your symptoms and prevent related complications by taking the following steps:

  1. See a Podiatrist: Discuss your risk factors with your podiatrist and develop a care plan including regular visits to their office.
  2. Manage Your Diabetes: Work with your care team to manage your blood glucose and keep your hemoglobin A1c in the correct range.
  3. Manage Your Associated Conditions: If you have high blood pressure, or other health conditions work with your care team to manage their symptoms and complications.
  4. Conduct Visual and Physical Foot Checks Daily: Inspect all areas of your feet and toes. Note any changes including wounds, discoloration, or increases in temperature.
  5. Monitor Foot Temperature: Monitoring foot temperature has been clinically proven to be more effective for early detection and prevention of diabetic foot ulcers than daily visual foot checks alone.
  6. Manage Symptoms: Work with your healthcare team to prevent any pain or discomfort you may be feeling. There are a number of options for treatment.

Complications of Diabetic Peripheral Neuropathy

One of the primary concerns for people with DPN are the potential complications. Because individuals with diabetic peripheral neuropathy may have loss of sensation or feeling in their feet, toes, fingers, and hands, it can be difficult for them to feel an injury. This becomes a problem because if you don’t notice an injury and continue to walk on it or don’t take care of it can quickly become a serious problem.

Some of the complications of DPN include:

  • Foot Ulcers: Due to lack of feeling in your feet and toes a small cut may go unnoticed and develop into a foot ulcer.
  • Amputations: When foot ulcers, infections, and gangrene are not treated properly, it may become impossible to treat and require amputation.
  • Charcot Foot: Due to nerve damage there can be bone deterioration, typically this results in deformity of the foot.

Things to Remember

Every person is different, so it’s important to discuss your risk factors and potential complications with your healthcare team.

It is possible to detect  the early signs of complications due to diabetic peripheral neuropathy. Wearing appropriate footwear, including Diabetic socks on a daily basis, regular visits to your doctor or podiatrist, temperature monitoring, and managing your blood glucose levels all play a factor in the prevention and early detection of foot injuries. In fact, temperature monitoring can reduce ulcers by up to 87.5%.

Education is key to managing DPN. Research the potential complications and get tested by your healthcare provider to find out if you have diabetic peripheral neuropathy.

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