Tuesday, June 15, 2010

Coping With Diabetic Neuropathy

More than 25 years battling with diabetes mellitus, I have reached this level of (irreparable?) damage to the nerves in my feet, legs, hands and arms, and on one side of my body from  my right foot  up to my thigh,  hip and buttocks. My neurologists and diabetologists described my condition after thorough check-ups in June,  2009, as peripheral neuropathy- a family of nerve disorders caused by diabetes of longer duration and of advanced age that affects the lower limbs and hands.

The sharp pains at one side of my body affecting my right foot, going up my leg, thigh, hip is called proximal neuropathy, also known as lumbrosacral plexus neuropathy, or femoral neuropathy or diabetic amyotrophy. This last type  manifested when I was infected with Herpes Zoster, or shingles. My lumbrosacral x-ray revealed that my vertebrate is suffering from the narrowing of bones. To cope, small bone outgrowths are causing this seeming chronic pain. I was told to tone down my activities. I was not supposed to even mop my floor or carry pails of water to water my plants. I'm a health risk as a whole under my conditions. It is stressful to think, but I can't do otherwise than fight off my own depression in many other ways. Blogging is a friendly alternative!

Before it was clearly known to me, one year ago today, I consulted  several medical authorities because I could no longer tolerate my restless legs showing combined  disturbing tingling, burning sensation in my feet; sharp pains due to leg muscle cramps that attack even in my sleep; sensitivity to soft touch of the skin in my lower limbs;  occasional blisters in the soles of my feet; numbness at the tips of my toes, etc. That's quite a disturbance that didn't come overnight. They came by,  one after another, until I could no longer bear the pain.  After the nth of opinions-  I gathered that I was suffering from diabetic peripheral neuropathy and proximal neuropathy. My eldest daughter, Pot, came home to live with me while under heavy  medication.

Immediately, my neurologist, (I thought I would be in good hands if it were a doctor expert in nerve damage  who will look after my condition), put me into medication. He gave me Lyrica, alternated with Neurontin- but I maintained  the former because of its good effect on me. For my pain, he gave me Arcoxia, a better alternative than Tramadol (Ultram), so I preferred the former, too-  All these medications were taken by me for several months, on top of my regular daily insulin shots and other medicines to keep  my  blood glucose and  cholesterol levels, and blood pressure close to normal. I'd been spending a fortune on medication alone!

Today, I'm settled with my diabetologist who,  I'm confident, is smart- one I am comfortable with. He keeps records of my monthly check-up results in a chart- which speaks more than words, and which I can understand fairly well by just a glance. Our tandem works well. A status that works miracles on me whenever things seem not right. Recently, I weaned myself from Arcoxia. I'm now taking  a milder pain reliever, Celebrex , only when necessary or if the pain becomes unbearable. I'm in the process of weaning on trial from Lyrica, (having lessened my doses).  Although I feel the inconveniences coming back, I have  to find out if I can manage my pain to the minimum for obvious reasons. What is important is,  Pot is relieved from her caregiver status. I begged of her to let go of me and accept a job offer in the city- but on  her one strict condition- I'll live with her and her sister Kit. Arrangements are underway- on trial. I feel like a fish being plucked from the ocean to live in an aquarium. But, we'll see.

What is Diabetic Neuropathy?

Diabetic Neuropathy is the most common complication of diabetes. About 60-70% of people with diabetes, can over time, develop nerve damage throughout the body. It can occur in every organ system like the digestive tract, heart, and sex organs.  It may develop anytime and the risks rise with age. Neuropathy appears under these major risks: longer duration of high blood glucose, high levels of blood fat, blood pressure, and being overweight. Neuropathy can lead to sensory loss and damage to the limbs. It is also a major cause of impotence in diabetic men.

Diabetic foot disease, due to damage in blood vessels and nerves, often leads to ulcers and subsequent limb amputation. It is one of the most costly complications of diabetes, which may be prevented by regular inspection and good care of the feet.

What are the Causes of Diabetic Neuropathy?

 The causes are probably different for different types. Such types are: peripheral neuropathy, autonomic neuropathy, proximal neuropathy, and focal neuropathy. Diabetic nerve damage is likely due to a combination of factors such as the following:

1. Metabolic Factors- high blood glucose, long duration of diabetes, abnormal blood fat levels, low levels of insulin
2. Monovascular factors- factors leading to damage to the blood vessels that carryoxygen and nutrients to the nerves
3. Autoimmunic factors- factors that cause inflammation of nerves
4. Mechanical injury to nerves
5. Inherited traits that increase susceptibility to nerve disease
6. Lifestyle factors- smoking or alcohol use

Diabetic Peripheral Neuropathy

This type is also called distal sensorymetric neuropathy where the nerves of the feet and legs are likely to be affected first before the hands and arms This is often akin to the restless leg syndrome. The doctor may note the condition earlier even if diabetics don't feel the symptoms.

What are the Symptoms of Diabetic Peripheral Neuropathy?

1. numbness or insensitivity to pain or temperature in the feet, legs, hands, and arms
2. tingling, burning, or prickling sensation
3. sharp pains or cramps
4. extreme sensitivity to light touch of the skin along these areas
5. loss of balance and coordination of legwork
6. symptoms are worst at night at bedtime
7. muscle weakness, loss of reflexes, especially at the ankle leading to changes in the way a person walks
8. foot deformities such as hammertoes and the collapse of the midfoot
9. blisters, sores may appear in the numb areas of the foot because of extreme  pressure that is often unnoticed

How Can Doctors Diagnose Diabetic Peripheral  Neuropathy?

Doctors diagnose neuropathy on the bases of their symptoms and through a thorough physical examination. During the exams, he may check the person's blood pressure, heart rate, muscle strength, reflexes, sensitivity to position changes, vibration, temperature or light touch.

He may conduct a comprehensive  foot exams that assess the skin, muscles, bones, blood circulation, and sensation of the feet. He may assess the foot's protective sensation or feeling by touching the foot with monofilament- similar to a bristle on a hairbrush attached to a wand or by pricking the foot with a pin. He may also use a tuning fork which is more sensitive to touch pressure to assess vibration perception.

Other tests may include electromyography or nerve condition studies, a check of heart rate variability, and ultrasound.

People who cannot sense pressure from pinprick or monofilament may have lost their protective sensation and are at risk for developing foot sores that may not heal properly. My diabetologist recommends my wearing of white socks and preferably rubber shoes. White socks can visibly  show blood  stains when wounds aren't noticed in the soles of the feet due to loss of sensation.  The rubber sole of the rubber shoes protects the feet from getting hurt, too. I can walk around with blisters in the soles of my feet without knowing I have them. Once, my daughter found a staple wire stuck deep in one side of my right foot when she offered to massage it.

How Can We Treat Diabetic Peripheral Neuropathy?

 Doctors usually treat painful diabetic neuropathy with a combination of oral medication or treatments.


1.tricyclic antidepressant, such as amitriptyline, imipramine, desipramine (Norpramin, Pertofrane)
2. other types of depressant, such as duloxitine (Cymbalta), venlafarine, bupropion (Wellbutin), paroxetine (Paxil), cetalopram (Celexa)
3. anticonvulsants such as pregabalin (Lerica), gabapentin (Gabarone, Neurontin) carbamazepine, lamotrigine (Lamictal)
4. opioids and opioid-like drugs such as oxycodine, tramadol (Ultram)
5. duloxetine and pregabalin are approved by the US Food and Drug Administration specifically for treating painful diabetic peripheral neuropathy


 You don't have to be depressed in search for antidepressants that can help relieve your nerve pain. All medications have side effects and some are not recommended for use in older adults and those with heart problems. Over-the-counter medicines such as acetaminophen and ibuprofen may not work for treating most nerve pains and can have serious side effects. Therefore, it must be important to consult with your doctor before any treatment or medication is made. Self-medication is equally dangerous to your health.

However, treatments applied to the skin, topically to the feet, may include capsaicin cream and lidocaine patches (Lidoderm, Lidopain). Nitrate sprays or patches for the feet may relieve pain. Alpha-lipoic acid and evening primrose oil can help relieve symptoms and improve nerve functions. A good hand massage eases away the pain especially to give a feeling of volume to a collapsed midfoot. This explains why I appreciate very much a soft massage from my daughters since it is cumbersome for me to curl up with my ailing vertebrate.

Seriously, diabetic neuropathy problems can be controlled, prevented, and reversed if they are caught and treated in time. To do this, keep your blood glucose level close to the  normal range. Maintaining safe blood glucose level protects nerves throughout the body.

As of date, I'm hopeful for my recovery, since I manage quite well with slowly weaning away from pain reliever. It's been a year ago now since I was struck with this nerve damage. No matter how long my recovery period will take, I'm lucky to be able to stand and do some small brisk walk when I deem it necessary and lavish myself with short precious time working on my laptop- again!

1. Google- National Diabetes Information Clearinghouse (NDIC), Diabetic Neuropathies: The Nerve Damage of Diabetes
2. Outsmart Diabetes, Take Control (My Daily Guide in Managing My Diabetes), Abbot Nutrition


  1. hello again, tita.. this is jordan. i'm reading your articles to get insights about diabetes.

    i don't like to believe that my father has diabetic neuropathy as he didn't really undergo neorological tests for his diabetes. he had his brain checked multiple times already but those tests were for his mild strokes. however, he experiences the symptoms for neuropathy. sharp intense pain on the legs and joints, losing sense of balance, muscle weakness, etc.

    some of the medicines you mentioned are familiar like tramadol. my dad has stopped taking-n most of the medicines prescribed to him because, according to him, the medication worsens his condition.

  2. There I found this comment at last! I was just searching the wrong post.

    dbainhailingjob, I have regular monthly checkup with my diabetologist and we seem to agree when I complain about his prescription not doing any good. Then he prescribes other pain reliever. Your Dad is right when he says he feels he isn't doing well. I switched to several others after tramadol. Now I take Caltrate over the recent one Vit. B complex which makes me sleep less.

    I do brisk walking because it is said to regrow small nerves damaged by my condition(neuropathy). I simply live daily with the pain, somedays it's intense other days it's decreased. What I'm trying to do is make my BG count near normal since I can't arrive at the normal range for a longer period. Really difficult even with all those medications. Tell your Dad to move around and exercise daily. Make him busy, I do a lot of activities in my backyard garden. It helps! I'll pray for him always!

  3. my dad can be real stubborn at times. he doesn't have faith on doctors. he got checked by many doctors already but none seemed to have succeeded in making him believe in medication. right now, he's no longer taking any oral med- only his daily shots of insulin. and so far, his health seems to be stable except for the intense he feels every night. i read from one of your articles that the pain is intolerable most of the time. my dad summons me from my room every night just to massage his feet (even at the most convenient hours).

    right now, my dad stays at home doing light activities like feeding the dogs and ducks. he also walks around the neighborhood sometimes.

  4. Jordan,
    Let your Dad walk the dog in the neighborhood. I have a new post in the making about care of the feet of a diabetic which is a result of my researches. This helps me and I guess your Dad will have something to learn from it, too.

    Your Dad is just adjusting to his condition, so that your family's support is greatly important. Every member must maintain the highest level of tolerance and at the same time, explain to your Dad that his utmost cooperation with his doctors is highly necessary. This I know because I went into that stage myself. You see, I'm all alone in my home in the province, but I take everything in stride, with God's love. I want to prove to my 2 daughters who work in Manila that I'm doing fine. Now I'm back to my old love- singing in the church choir every 5:15 and 6:30 Sunday masses. The pain is there but life must continue because God blesses one who trusts Him, don't you think so?

  5. Diabetic walking shoes can be one of the best ways to prevent the worsening of food condition from diabetic neuropathy. These shoes are made with added depth or double added depth, soft insoles, and often seamless inner construction that ensures your feet are able to get the circulation they need to stay comfortable. Thanks a lot.

  6. Diabetic Neuropathy,
    I wear rubber shoes upon advice by my doctor. I only wear my soft leather pump shoes on formal occasions, sparingly. Might as well find one of the kind you suggest here. Thanks for the good offer!



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