Diabetic neuropathy is essentially the nerve damage that occurs because of problems associated with diabetes mellitus. About 60% to 70% of diabetic patients have some degree of neuropathy. The complications occur in both diabetic populations: type 1 and type 2 patients. The most common type of neuropathy is sensory neuropathy where sensations to the lower extremities decrease. This can lead to loss of protective sensation and results in the worse-case scenarios, lower leg amputation. Sensory neuropathy is sometimes referred to as “stocking-glove neuropathy.” Characteristics include:
• Loss of sensation
• Abnormal sensations (paresthesias)
The pain, which is described as burning or cramping can be worse at night. The paresthesias may be tingling, burning and itching sensations. The diabetic with sensory neuropathy may feel the sensation of walking on pillows. At times the skin becomes extremely sensitive where even the touch of the bed sheet cannot be tolerated. Complete or partial loss of sensitivity to temperature and touch is common. Foot care is very important because of the possibility of foot injury without the diabetic’s knowledge that the foot had been injured.
The following are recommendations when doing proper diabetic foot care:
– Wash feet daily with mild soap; do not use hot water. Test the water with hands.
– Pat feet dry; ensure the toes are dried in between thoroughly.
– Examine the feet every day for cuts, blisters, sores or other types of problems. Do not depend on “feeling” for them. Use a mirror if needed to see bottoms of feet.
– Use lotion on feet to keep them from drying out, however, do not get lotion in between the toes. Moisture caught between the toes will cause the skin to break down.
– Do not sure over-the-counter remedies for corns or calluses.
– Never use iodine, rubbing alcohol, or strong adhesive tape or bandages.
– Cut toenails straight across even with the rounded contour of the toes. Do not cut down corners. Best time to trim is after a bath or shower.
– Any toes that are overlapping can be separated with cotton.
– Do not use hot water bottles or heating pads. Wear socks to keep feet warm.
– Wear appropriate shoes; no open-toe, open-heel, or high-heel shoes.
– Do not go barefooted.
– Do not wear clothing that cuts off the circulation to the extremities.
– Exercise feet daily by walking or if unable to walk, move feet by flexing and extending feet. This will facilitate blood flow to your lower extremities.
– Do not cross legs; Do no stand or sit for prolonged amounts of time.
It is best to avoid neuropathic problems by addressing the issues as early as possible. Control of blood glucose is the number one way of helping diabetic neuropathy.
Treatments that may be initiated to help diabetic neuropathy are:
– Pain medications
– Neurologic modulating medications
– Laser Treatments
– Regional Nerve Blocks
– Tricyclic Therapy
– Nutritional Supplements