Losing the gift of pain
Pain is not often thought of as a gift. Pain is the body’s early warning system to let us know something is wrong or that we are hurt and need attention. So when one cannot feel pain, especially on the feet, the results can be devastating — ulcers, loss of leg and loss of life.
Diabetic neuropathy is damage to the nerves caused by high blood sugar in persons with uncontrolled diabetes. Diabetic peripheral neuropathy affects the arms, hands, legs and feet, starting at the tips of the toes or fingers then moving up the feet and arms.
Diabetic neuropathy can affect three different types of nerves:
• Sensory nerves, which help people feel pain, temperature, and other sensations.
• Motor nerves, which control the muscles and give them their strength.
• Autonomic nerves, which allow the body to sweat.
Diabetic peripheral neuropathy develops slowly and gets worse over time. Some patients develop this condition even before they are diagnosed with diabetes. The longer one has diabetes, the higher the likelihood of developing diabetic peripheral neuropathy.
The loss of sensation caused by the nerve damage puts a patient at a high risk to develop skin ulcers (open sores) that can become infected and may not heal. This serious complication of diabetes can lead to loss of a foot, a leg, or even a life.
The nerve damage that characterizes diabetic peripheral neuropathy is more common in patients with poorly controlled diabetes. However, even diabetic patients who have excellent blood sugar (glucose) control can also develop diabetic neuropathy because of restricted blood flow to the nerves.
As diabetic peripheral neuropathy progresses, various nerves are affected. These damaged nerves can cause problems that encourage the development of ulcers.
• Foot deformities (such as bunions or hammer toes) resulting from motor neuropathy may cause poorly fitting shoes to rub against the toes, creating a sore or ulcer. Because of the loss of sensation caused by sensory neuropathy, the diabetic does not feel the rubbing and is unaware that this is happening. In addition, the diabetic may not realize that he or she has stepped on a small object and has a cut in the skin.
• Dry, cracked skin caused by autonomic neuropathy, may cause a break in the skin that allows bacteria to enter and cause infection.
Depending on the type(s) of nerves involved, the diabetic may develop one or more symptoms.
For sensory neuropathy, it can be numbness or tingling in the feet, pain or discomfort in the feet or legs, including prickly, sharp pain or burning pain to the feet.
For motor neuropathy, it can be muscle weakness and loss of muscle tone in the feet and lower legs, loss of balance, changes in the shape of the foot that can lead to areas of increased pressure.
For autonomic neuropathy, it can be dry, cracked skin on the feet.
To diagnose diabetic peripheral neuropathy, the podiatrist will take a history of symptoms and perform simple in-office tests on the feet and legs. This may include testing of the diabetic’s reflexes and their ability to feel light touch and vibration. In some cases, additional tests of the nerves may be ordered.
The first and most important treatment of diabetic peripheral neuropathy is control of the patient’s blood sugar level. Good control of blood sugar can prevent or delay the development of neuropathy and other diabetic complications. If neuropathy does develop, medications are available to help restore the nerve and relieve the painful symptoms such as numbness, tingling or burning. Natural remedies such as Vitamin E, folic acid and topical creams have also helped some persons. In some cases, the patient may also undergo physical therapy to help reduce balance problems or other symptoms.
The diabetic plays a vital role in preventing developing peripheral neuropathy and its possible consequences. Here are some important preventive measures:
• Eat well, exercise and take your medications as ordered by the doctor to keep your blood sugar levels under control.
• Exercise helps with ensuring good blood flow to the feet.
• Wear well-fitting shoes to avoid getting blisters, sores or other injury.
• Inspect your feet daily. If you notice any cuts, redness, blisters, or swelling, see your podiatrist right away. This can prevent small problems from becoming worse.
• Visit your podiatrist on a regular basis for a routine foot exam to help prevent foot complications of diabetes.
• Keep your regular appointments with your primary care physician or endocrinologist to make sure your diabetes is well managed.
• Working together we can prevent and treat foot complications from diabetes and prevent people from losing their legs and their lives.
•For more information visit www.apma.org or www.footphysicians.com; to see a podiatrist visit Bahamas Foot Centre, Rosetta Street, telephone 325-2996 or Bahamas Surgical Associates, Albury Lane, telephone 394-5820.