Millions of people suffer from diabetes. According to the World Health Organization, the number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014. WHO also projects that diabetes will figure as the seventh leading cause of death by the year 2030.
Diabetes is considered a deadly disease. If not controlled, high blood sugar can affect different body parts and can lead to different complications. One such common health complication associated with diabetes is diabetic neuropathy.
Diabetic neuropathy is the result of nerve damage caused by the toxic effects of high blood sugar level and poor blood circulation. In fact, a consistently high blood sugar level can cause damage to the peripheral nerves that are responsible for communicating messages between the brain or spinal cord and the rest of the body.
As a consequence of this progressive form of nerve damage, you may experience a gradual loss of sensation as well as pain and weakness in the areas affected, typically the feet and sometimes the hands as well.
Even though diabetic neuropathy is a fairly common complication with an overwhelming 60% of diabetics suffering from some form of nerve damage, certain factors make one increasingly susceptible to it.
A 2010 study by the American Family Physician reports that diabetic peripheral neuropathic pain affects the functionality, mood, and sleep patterns of approximately 10% to 20% of patients with diabetes mellitus.
Types of Diabetic Neuropathy
There are basically four types of diabetic neuropathies:
Peripheral neuropathy refers to the condition wherein the nerves that connect the brain/spinal cord to the skin, muscles, and internal organs start to malfunction due to progressive damage. As a result, the intricate communication system that spans between the central nervous system and the rest of the body gets disrupted.
The repercussions of this type of neuropathy are typically felt in the feet and legs and occasionally affect the hands and arms as well. About one-third to one-half of people with diabetes report symptoms associated with this kind of nerve damage, indicating its striking prevalence.
Proximal neuropathy is the second most common form of diabetic nerve damage that affects one’s movement, figuring after peripheral neuropathy. This rare type of motor dysfunction can exhibit mild to disabling symptoms, which include muscle weakness and decreased sensation and pain in the hip, buttock, or thigh.
The nerve dysfunction is typically confined to one side of the body but may rarely spread to the other side as well. The symptoms associated with proximal neuropathy gradually improve over a period of months or years.
As the name suggests, autonomic neuropathy affects the autonomic nervous system. It involves damage caused to the sympathetic and parasympathetic autonomic nerves that control the involuntary and nonsensory body functions.
This form of neuropathy affects the internal organs and can give rise to various problematic issues pertaining to the heart rate and blood pressure, digestive system, bladder control, sex organs, sweat glands, and eyes.
Another worrisome disadvantage of autonomic neuropathy is that the body fails to pick up on the warning signs of hypoglycemia, which can be especially life-threatening for a patient with diabetes.
Focal neuropathy is characterized by damage to a single nerve outside of the central nervous system and is usually caused by some kind of trauma, injury, or compression.
This form of mononeuropathy is relatively less common than peripheral and autonomic neuropathy and typically affects specific nerves located in the hand, head, torso, or leg. More rarely, it can affect a nerve in the back or the chest as well as one that controls eye muscles.
The symptoms associated with focal neuropathy tend to appear abruptly but resolve on their own, without causing any long-term damage.
The most well-known manifestations of focal neuropathy are entrapment syndromes, such as carpal tunnel syndrome wherein the median nerve becomes compressed when it passes through a small tunnel located in the wrist.
What Causes Diabetic Neuropathy?
Diabetic neuropathy is by and large the result of a prolonged struggle with diabetes. Chiefly rooted in the sustained levels of high blood sugar, the nerve damage tends to get aggravated when your diabetes is not properly managed over a long period of time. Other contributing factors for diabetic neuropathy include:
- Elevated cholesterol levels that cause damage to the blood vessels
- Physical damage to the nerves in the form of mechanical injury or compression as well as due to surgery
- Unfavorable lifestyle choices, such as excessive smoking or alcohol consumption
Such neuropathy can also be traced back to a deficiency of vitamin B12, which is made worse by Metformin, a common medication used to manage diabetes. Your healthcare provider can rule out any such vitamin deficiencies by conducting a simple blood test.
Symptoms of Diabetic Neuropathy
Diabetic neuropathy may exhibit varying symptoms depending upon the specific type of neuropathy and the nerves affected. At their onset, the symptoms associated with different forms of diabetic neuropathy are generally mild and minor and often tend to go undetected. In fact, some people experience no symptoms at all.
As the neuropathy gets progressively worse with more and more nerve fibers affected over time, the symptoms become more pronounced. What may start off as numbness, tingling, or pain in the feet can escalate to a more serious extent and result in a sensory loss, coordination difficulties, and even motor (movement) problems.
Diabetic neuropathy initially affects the peripheral nerves, and the damage is first felt in the extremities, particularly the feet. As you continue to grapple with diabetes over the course of several years, the resultant damage to the nerves gradually progresses more centrally and can end up affecting the involuntary (autonomic) nervous system as well.
Some of the common symptoms of diabetic nerve damage include:
- Numbness, tingling, prickling pain, or altered sensation in the toes, feet, legs, hands, arms, and fingers
- Pain in the legs, hips, and thighs
- Thinning or wasting of the muscles in the affected region
- Impaired movement due to difficulty in lifting the front part of the foot and toes, known as foot drop
- Twitching and muscle cramps
- Difficulty in focusing your eyes, sometimes resulting in double vision
- Indigestion, nausea, or vomiting
- Diarrhea or constipation, particularly at night
- Bloating or belching
- Dizziness or faintness on standing due to sudden plunges in blood pressure
- Problems with urination, such as trouble starting urination, failing to sense a full bladder, and inability to empty the bladder completely
- Erectile dysfunction (impotence) or ejaculation problems in men
- Vaginal dryness, low sex drive, and difficulty reaching orgasm in women
- Muscle weakness or paralysis affecting one or several muscles
- Weight loss
- Abnormal perspiration patterns, which include sweating too much or too little and, consequently, improper regulation of body temperature
- Swelling in the abdomen
- Hypoglycemia (low blood sugar) unawareness, a condition in which the body fails to recognize the symptoms of hypoglycemia
Location of Nerve Pain
The typical problem areas associated with diabetic nerve pain are the peripheral regions or extremities, which include your feet, legs, hands, and arms. However, even among these commonly identified neuropathic sites, your feet tend to bear the greatest brunt of diabetic nerve damage.
Prolonged periods of uncontrolled high blood sugar can trigger a number of problematic conditions that afflict your feet, collectively termed as “the diabetic foot.”
People with diabetes are increasingly prone to burning, tingling, or stabbing pain in the feet. This kind of neuropathic foot pain can occur simultaneously along with feelings of numbness and gradually give way to a loss of feeling or sensation in the feet.
It is on account of this reduced sensitivity that people with diabetes may not feel any pain or irritation arising from foot wounds or injuries. Such painless cut, sore, or blister, if not tended to properly, can eventually turn serious and cause ulcers and infections.
To avoid such complications, people with diabetes are advised to get their foot examined by a medical expert once each year. Such thorough examination can help diagnose new problems related to diabetic neuropathy or circulation problems along with identifying other signs of trouble, such as such as wounds, blisters, and a joint disorder known as Charcot arthropathy or Charcot’s foot.
Diagnosing Diabetic Nerve Pain
For the preliminary diagnosis of diabetic neuropathy, your doctor will take into account your symptoms and medical history. Thereafter, you will have to go through a physical examination before the doctor can give you his/her clinical verdict.
This presumptive diagnosis will then be backed up by a number of definitive tests specifically designed to estimate the loss of nerve function. For instance, nerve conduction studies aim at measuring the speed of nerve signals in the arms and legs, and electromyography assesses the electrical discharges produced in the muscles.
In the same vein, your doctor may feel the need to conduct a few additional tests of nervous system function to reach a more conclusive diagnosis. A clinical examination may identify early signs of neuropathy in diabetics without symptoms.
Risk Factors Associated with Nerve Pain
The threat of diabetic nerve damage becomes more and more imminent with time and the symptoms become more noticeable as the disease progresses. Thus, someone who has grappled with diabetes for years is likely to be at a much greater risk than those at relatively nascent stages of the disease.
Moreover, the poorer your glycemic control, the more likely you are to develop diabetic neuropathy.
Other factors that make one increasingly vulnerable to diabetic nerve damage include:
- People with high blood pressure
- People who are overweight or obese
- People above the age of 40
- People who smoke
- People of African or Native American descent
- People experiencing complications of their diabetes elsewhere in their body such as in the kidneys, heart, and eyes
Backention of Diabetic Nerve Pain
Some of the things you can do to prevent diabetic nerve pain include the following:
- Maintain your blood sugar levels within the target range by religiously following the doctor-stipulated medication regimen. Such steady glycemic control will help prevent or mitigate diabetes-induced nerve damage and, thereby, delay the onset of neuropathy.
- Avoid a sedentary lifestyle by engaging in some form of physical activity every now and then.
- Shed the excess weight to keep your cholesterol and blood glucose levels under control.
- Strictly follow a diabetic-friendly diet plan as the food you eat has a direct influence on your blood glucose levels.
- Try to keep your blood pressure under control as people with diabetes are more likely to have high blood pressure.
- Limit your alcohol intake.
- Quit smoking because it hampers blood flow to the tissues.
- Nerve pain can lead to infections, ulcers, and even amputations; hence, it is important to take proper care of your feet. Wash your feet daily, following which you must moisturize them once they have dried completely.
- Clean, trim, and file your toenails but try not to clip them too short.
- For people with neuropathic feet, it is recommended that they wear comfortable shoes.
- Change your socks frequently. Also, try to wear socks with the padding at the balls of heel and foot to give them extra protection against possible injuries.
- Schedule a regular visit to the podiatrist to get your feet examined for possible injuries, infections, or ulcers. You can also enlist the help of such a professional for callus or corn removal from the feet.
Treatment for Diabetic Nerve Pain
Treatment for diabetic nerve pain primarily hinges on delaying or stopping the degeneration of blood vessels and nerves, which is brought on by uncontrolled levels of high blood sugar. Another facet to most of the commonly available treatment plans is to decrease the severity of the symptoms associated with the disease.
Reining in elevated sugar levels and bringing them down to the normal range are perhaps the most important prerequisite for any treatment strategy to yield positive results.
Your doctor will consider all the necessary health markers before laying down an overarching course of treatment to achieve and maintain proper glycemic control through diet, exercise, and medications. Also, the feet need to be watched carefully.
One of the most common yet potentially threatening complications of diabetic neuropathy is a gradual loss of sensation in the foot. Due to this hampered sensitivity, diabetics often remain unaware of foot injuries which go untreated for a long time.
This negligence can take an ugly turn, as your injured foot might become infected and develop ulcers and gangrene. Once the situation goes out of hand, the doctor might have to resort to surgical treatments for the redressal of podiatric complications, such as surgical removal of dead or decaying tissue as well as partial or complete amputation of the foot.
The doctor may also recommend soothing baths and prescribe certain analgesics, antidepressants, and anticonvulsants to alleviate the pain and discomfort associated with diabetic neuropathy. How well any of these treatments will fare depends upon how well managed your diabetes is.
As many as 60% of people with type 1 diabetes have managed to stave off diabetic neuropathy simply by maintaining strict control over their blood sugar levels such that they remain within the stipulated limits.
When to See a Doctor
The following red flags should alert you to get immediate medical help:
- If you develop a cut or sore on your foot that fails to heal overtime or shows signs of infection
- If you experience burning, tingling, weakness, or pain in your hands or feet that end up disrupting your daily activities or sleep
- If you notice unusual changes in digestion, urination, or sexual function
- If you experience dizziness
If you suffer from diabetic nerve pain, the very first thing that you need to do is monitor your blood glucose levels. There will be an automatic improvement in nerve condition and pain as your blood glucose levels are under control.
At the same time, you can try some lifestyle changes and home remedies to help deal with the pain.
Natural Treatment Options for Diabetic Nerve Pain
Here are some home remedies for diabetic nerve pain.
1. Apply Capsaicin Cream
Capsaicin has analgesic and anti-inflammatory properties that can help reduce nerve pain due to diabetes.
When applied topically, capsaicin cream produces a warming sensation that helps reduce pain.
In a clinical study published in Acta Diabetologica, researchers found that when topical capsaicin was applied to the feet of patients with symptomatic diabetic neuropathy, capsaicin helped to improve the symptoms, including pain perception threshold.
There are over-the-counter pain-relieving topical capsaicin creams available in concentrations ranging from 0.025% to 0.075% capsaicin. All you need to do is apply the cream to the pain-affected areas two to three times a day. However, be sure not to apply capsaicin cream on broken or irritated skin.
2. Regular Exercise can be Beneficial
To deal with diabetic nerve pain, regular exercise is a must.
Exercising helps improve blood flow to your damaged nerves and helps nourish the damaged nerves back to normal condition. Exercising also helps lower blood sugars, increases your tolerance levels for the nerve pain, and keeps your diabetes in control.
A 2015 study published in Pain Medicine found that perceived pain interference may be reduced following an aerobic exercise intervention among people with painful diabetic peripheral neuropathy, without a change in pain intensity.
Another study published in the Journal of Diabetes and its Complications in 2012 reports improvements in neuropathic and cutaneous nerve fiber branching following supervised exercise in people with diabetic peripheral neuropathy.
To reap the benefits of exercise, there is no need to join a gym and do a rigorous exercise routine. You can simply go walking or swimming.
3. Drink Ginger Tea
Ginger has been used as an herbal therapy in Chinese and Indian medicine for centuries to help relieve pain.
Its powerful anti-inflammatory substance known as gingerol makes it an effective remedy for diabetic nerve pain. It can even increase mobility among those with chronic pain. Ginger also helps to manage blood sugar levels.
A study published in the Iranian Journal of Pharmaceutical Research in 2015 reports that ginger powder supplements may help improve fasting blood sugar. In this study, participants were given 2 grams of ginger every day for 12 weeks, and it helped to lower the levels of hemoglobin A1c, apolipoprotein B, apolipoprotein A-1, and malondialdehyde.
- Try to drink 2-3 cups of ginger tea daily. To make the tea, boil 1 cup of water and add 1 tablespoon of chopped ginger slices to it. Let it steep for 5-10 minutes, and your tea is ready.
- Also, take ginger supplements but only after consulting your doctor.
4. Healing Potential of Alpha Lipoic Acid
Alpha-lipoic acid (ALA), a kind of fatty acid, is another possible alternative remedy to treat diabetes-related nerve pain.
First of all, ALA helps fight free radicals, which cause cell damage. Second, it helps restore the functioning of damaged nerve cells and prevents further damage. It also helps the body to be more sensitive to insulin.
A 2009 study published in the Review of Diabetic Studies reports that ALA can help improve motor-nerve conduction velocity in experimental diabetic neuropathy and protects the peripheral nerves from ischemia in rats.
Another study published in the Netherlands Journal of Medicine in 2010 found that when given intravenously at a dosage of 600 mg once daily over a period of three weeks, ALA leads to a significant and clinically relevant reduction in neuropathic pain (grade of recommendation A).
5. Massage the Affected Area
Diabetic nerve pain can be taken care of with simple massage therapy. Gentle massaging along the length and sides of the affected area will help improve blood circulation and aid in the healing of damaged nerves. Massage even aids in improving range of motion.
A study published in Diabetes Spectrum suggests that massage may have a positive effect on blood glucose levels and symptoms of diabetic neuropathy.
Another 2017 study published in the Journal of Nursing Scholarship reports that aromatherapy massage is a simple and effective nonpharmacological nursing intervention that can be used to manage neuropathic pain and improve the quality of life in patients with painful neuropathy.
- Apply some lukewarm mustard, olive, or coconut oil on the affected area.
- Massage the area with long, gentle strokes for 5 to 10 minutes.
- After the massage, wrap the area with a warm towel.
- Do this several times a day.
6. Limit Your Alcohol Intake
Drinking occasionally is not bad, but drinking too much alcohol is associated with diabetic neuropathy. In fact, a high dose of alcohol is toxic to your nerves and can result in severe nerve damage and may worsen the neuropathy.
Excessive drinking even makes your body deficient in some nutrients and hence should be completely avoided.
A study published in Alcohol Health & Research World reports that occasional episodes of alcohol consumption generally do not worsen blood sugar control in people with diabetes and may even have beneficial effects. However, regular consumption of even moderate amounts of alcohol clearly interferes with diabetic blood sugar control and increases the risk of peripheral neuropathy.
Excessive drinking also increases the risk of alcoholic neuropathy.
A study published in the British Journal of Clinical Pharmacology reports that alcoholic neuropathy involves coasting caused by damage to nerves that results from long-term excessive drinking of alcohol and is characterized by spontaneous burning pain, hyperalgesia, and allodynia.
Limit alcohol to no more than four drinks a week, and if possible, avoid it completely.
7. Quit Smoking
If you suffer from diabetic nerve pain, it is time to quit smoking. Smoking causes your blood vessels to constrict, impairing your circulation. This, in turn, causes the peripheral nerves to get less nutrient-rich blood, which can lead to more pain.
A study published in the Journal of General Internal Medicine in 2015 reports smoking to be associated with an increased risk of diabetic pain neuropathy in persons with diabetes. However, more studies are needed to test whether this association is causal and whether smoking cessation reduces the risk of diabetic pain neuropathy in adults with diabetes.
Another 2017 published in the Turkish Society of Algology found smoking as a risk factor for neuropathic pain. According to this study, the possibility of neuropathic pain increases as the duration of smoking and addiction level increase, and with diabetes, this rate increases even more. It is extremely important that smokers should be informed regarding these facts and possibilities.
8. Relieve Pain with Chiropractic Care
Chiropractic care is an increasingly popular natural treatment for the treatment of nerve pain associated with diabetes.
These techniques help a lot in improving the range of motion by loosening the tight muscles, aiding in the circulation and nerve connection. Moreover, it is very relaxing for the whole body.
According to a 2015 report by Diabetes News Journal, chiropractic care is an effective treatment for peripheral neuropathy because it targets the root cause of the patient’s pain symptoms.
Always make sure that you choose a qualified and reputed chiropractic center.
9. Acupuncture can Provide Relief
Like chiropractic care, acupuncture is another effective option to treat diabetic nerve pain.
In this kind of traditional Chinese therapy, certain points on the body are stimulated with needles to help relax the tight muscles, boost blood circulation, and heal damaged nerves. This, in turn, reduces pain.
A 2010 study published in the Journal of Acupuncture and Meridian Studies reports that acupuncture may be clinically useful for the radical treatment of diabetic peripheral neuropathy.
Another study published in the Journal of Translational Medicine & Research in 2017 suggests that acupunctural therapy has the potential to treat a range of Type 2 diabetes symptoms, including hyperglycemia, diabetic neuropathy, and other pain-related complications.
Always have acupuncture done by a skilled and experienced acupuncturist.
Warm Water Bath
One of the easiest natural home remedies for getting relief from diabetic nerve pain is taking a warm bath.
Heat provides comfort and helps the healing process, as it improves blood circulation to the site of the damaged nerve. Moreover, warm water bath makes you get rid of stress and feel relaxed.
Enjoy a warm water bath twice daily for 20 minutes. However, always remember to check the water temperature with your hands instead of your foot before stepping into a bathtub.
For added benefit, you can put 1 cup of Epsom salt in your bathwater, once or twice a week.
- Take 1-2 teaspoons of cinnamon in your daily meals to control blood sugar levels.
- If you have a gluten allergy, you should not consume gluten as it can trigger and worsen your condition.
- Consume more B vitamin-rich foods as they support the breakdown of foods during digestion.
- Chew fennel seeds after having your meal to improve your digestion that gets adversely affected by diabetic neuropathy.
- You can also take evening primrose as it is high in omega-6 fatty acids, which are important structural components of your cell walls.
- Eat 4 to 5 nuts such as pecans, walnuts, and almonds each morning to improve the symptoms of neuropathy pain.
- Manage stress as it can have a significant negative effect on pain and inflammation in the body.
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