Since April is National Foot Health Awareness Month (yes, they pretty much have a month for everything — April is also National Pecan Month and Fresh Florida Tomato Month), we wanted to revisit our 411 series on diabetes complications with a look at the foot.

Neuropathy is one of the most common diabetes complications, affecting 60 to 70 percent of us PWDs. Of course, it’s more likely to occur if your A1c (average blood glucose level) remains high over time, but simply having diabetes for decades can bring on diabetic neuropathy too. The highest rates of diabetic neuropathy occur in folks who’ve had diabetes for longer than 25 years.

Of course, remember that diabetes-related neuropathy doesn’t just mean your feet. There are actually 4 different kinds:

  • The most common is peripheral neuropathy, which causes pain, tingling, burning or numbness in the extremities, especially the feet, but also in the hands and harms.
  • Autonomic neuropathy, which causes problems in digestion, bowel and bladder function, sexual response (for both men and women), and perspiration. It can also affect the heart and blood pressure, as well as nerves in the lungs and eyes. Autonomic neuropathy can also cause hypoglycemia unawareness, which possibly explains why people who have had diabetes for many years often stop feeling their lows.
  • Proximal neuropathy, which means “origin,” causes pain in the thighs, hips, or butt and leads to weakness in the legs.
  • Focal neuropathy, which causes sudden weakness or pain of one nerve or a group of nerves anywhere in the body.

Ugh…

Many people assume that diabetic neuropathy stems from impaired circulation caused by atherosclerosis (or narrowing of the arteries), just as atherosclerosis in the heart and head can lead to heart attacks and strokes. This isn’t actually true. While circulation changes certainly contribute, a larger factor is neuropathy itself, which means injury to the nerves—in this case to the small sensory nerves in the feet.

One of the biggest dangers here is that the numbness neuropathy can cause in your feet often goes unnoticed by you, so you may have small or large feet injuries and not even know it! If there are symptoms, they are usually painful, such as a tingling or burning sensations.

If you do have symptoms of neuropathy or suspect there is a problem, get thee to a podiatrist asap! Or, at the very least, to your endocrinologist, for a thorough examination. There are several tests doctors can run, including an electromyography, which checks how your nerves respond to electrical signals. Once you have a diagnosis, you can focus on treatment.

Treatments for Diabetes Neuropathy

Unlike other diabetes complications, diabetic neuropathy symptoms can often be alleviated through either better blood sugar management or through oral medication. There are two medications that are FDA-approved to treat diabetic peripheral neuropathy: Lyrica and Cymbalta. Anybody heard of these?

The American Academy of Neurology recommends Lyrica and Cymbalta as the most effective treatments for diabetic peripheral neuropathy. However, both have risks for side effects, like weight gain, so keep that in mind.

There are also some alternative therapies, including:

– Alpha Lipoic Acid: an anti-oxidant found in foods like potatoes, spinach and broccoli, but also in over-the-counter supplements usually found in the vitamin section of your local drugstore. ALA has been known to help prevent certain kinds of cell damage in the body, and there’s anecdotal evidence that it will also helps nerve damage caused by diabetes. But it is not FDA approved, so try at your own risk!

– Vitamin B-12: A specific form of Vitamin B-12 found in spinal fluid, called methylcobalamin, has shown to have significant effect treating diabetic neuropathy.  But experts say more studies are required to prove real effectiveness. However, Metformin has been shown to cause low levels of vitamin B-12, which can cause peripheral neuropathy. So if you’re on Metformin, you may want to get checked for that!

– Transcutaneous electrical nerve stimulation (TENS), which is a type of therapy that attempts to reduce pain by applying brief pulses of electricity to nerve endings in the skin.

A couple other tips that experts recommend (we know it’s hard to forgo your flip-flops and cute shoes 😮 ) –

  • Avoid walking around barefoot, even if the weather is nice and the ground seems smooth and “safe.” It’s just too easy to injure your feet this way, or pick up tiny splinters that you don’t notice until they cause real problems
  • Try to wear moisture-resistant socks and well-fitting shoes with flexible soles made from crepe or foam rubber and soft leather tops that allow your feet to breathe. They don’t have to be clunky diabetic shoes, but they should fit properly and support your feet. To prevent pressure sores on your feet, make sure your socks don’t bunch or wrinkle inside your shoes.

A Personal Connection

Last winter, I actually started noticing a sharp pain in my feet. I’m just 25, so this couldn’t be happening! But sure enough, I’d feel pain first thing in the morning, when I would climb out of bed and put my feet on the ground. As soon as I stood up, the pressure of my weight as I walked made it feel like I was walking barefoot on rocks. By the time I got to the bathroom down the hall, the pain would be gone. Occasionally throughout the day the same pain would come back, but for the most part it appeared to be mostly in the early morning.

This was also around the time when my blood sugars were elevated more than they’ve been in the past. My A1c had jumped to over 8%, and it’s probable that was the culprit. As a twentysomething diabetes advocate, I’ll admit, I was a little embarrassed that I could have a complication. But I also knew that being embarrassed was not a reason to suffer in silence! So I scoured the internet for information and found many forums discussing possible treatments. I didn’t feel that the pain was worth a prescription drug, like Lyrica, so on the recommendation of fellow patients and on the advice of my doctor, I gave Alpha Lipoic Acid a try, as well as working harder to get my blood sugars down.

After a few weeks of ALA, I did notice a marked difference in how my feet felt. However, this is not medical advice — I am not a doctor, nor do I play one on TV — but it is a word of advice to pay attention to what your body is telling you and to talk to your doctor quickly. If I had kept the pain in my feet a secret out of shame, who knows how long I would have suffered?

Prevention

Whether you are already dealing with diabetic neuropathy or you’re looking for ways to prevent it, checking your feet regularly is very important. Here are some simple steps for keeping your feet happy:

  • Wash your feet daily in lukewarm water, including between the toes. Dry them gently and moisturize well.
  • Diabetes may cause you to sweat less, which can lead to cracked, dry skin. So when you trim your toenails, take care not to injure the surrounding skin.
  • If you have poor blood circulation in your legs or aren’t able to see well enough to trim your nails, have your podiatrist do it for you.
  • Be sure to see your doctor if any sores on your feet don’t start to heal in a few days.

Support

Finally, if you’re dealing with diabetic neuropathy, you’re definitely not alone. Pfizer, the makers of Lyrica, have created resources to “walk you through” how to handle diabetic neuropathy, including a video series on some fitness exercises for people who are facing limited mobility because of the pain. And even though it’s Pharma-sponsored, it was co-created with Dr. Steve Edelman and the team at Taking Control of Your Diabetes, so you know the info was vetted by someone who cares.  

There is a Neuropathy Support Network, which offers resources for folks living with a variety of neuropathies and how to find various levels of support. But I think the best place to find support for diabetic neuropathy is on networking sites like DiabeticConnect and DiabetesDaily — you know, from other people living with diaetes and this complication.

With proper treatment, diabetic neuropathy doesn’t need to slow you down. It can be painful, but taking action early on will help slow down and even reverse the symptoms. It’s worked for me, and hopefully it will work for you. And remember, nothing replaces the advice of your medical team so please, if you’re having an issue with your feet (or another body part), see a doctor asap.