Cells need glucose for energy but too much glucose is not good for our bodies and high glucose levels may damage the protective coating around our nerves. This damage can lead to burning, stabbing pain or ‘pins and needles’ in the extremities of your body. This happens generally in the feet and lower legs first and can also be present in your hands. The name for this condition is diabetic peripheral neuropathy (DPN).

There is also another possible cause for this condition. If you’re taking Metformin, it_.can reduce your Vitamin B12 levels, and a lack of this vitamin can damage your myelin sheaths (protective coating of your nerves).

Treatments

In treating DPN, your doctor may suggest oral medications to decrease the uncomfortable or painful sensations, which also have the added benefit of helping you sleep. This is the best option if you can tolerate them.

The other possibility is to start insulin, if you have not already, because insulin can heal those nerves to varying degrees. Exercise will also help reduce the unwanted sensations of DPN.

If these do not work for you, or they cause unwanted side effects, you could try a topical treatment. Unfortunately, most treatments do not have solid evidence to back up their effectiveness; however, they may be worth a try.

Topical treatments

Treatment with capsaicin 0.075% cream (Zostrix HP) applied to the painful area four times daily has resulted in significant relief for some people. Capsaicin is made from a member of the capsicum (chilli) family. It works by releasing the substance from nerve endings that creates pain. Capsaicin pushes the release of this substance and continually produces a burning sensation at the beginning of application. As the substance runs out the pain subsides.

Things to know before you buy this cream:

• Do not use it if you’re allergic to capsicum
• Do not apply Zostrix-HP on broken, cracked or irritated skin. Do not apply it inside mouth, ear, nose or genitals.
• It must be applied three to four times a day.
• Do not apply a large amount of Zostrix-HP in the affected area; little and often is the rule to follow. Use a glove to apply the cream and don’t wash the area for 30 minutes.
• Reports state the sensation is worse for up to 28 days before the pain relief will be felt in six weeks.

Other heat rubs, menthol, methyl salicylate, or arnica creams with massage may give you temporary relief. Massage may have the added benefit of also improving circulation. It might be a good excuse to get that foot rub!

Always be careful standing up after using creams as your feet may be slippery and you may be at risk of a fall.

Myths

The following myths are not helpful for peripheral neuropathy:

• Wrapping your feet in plastic or bandages. This may reduce your circulation.
• Placing your feet in cold or very hot water. Cold water restricts the blood vessels. Very hot water may cause damage to the skin, including burns, and therefore increases the risk of infection.

Remember to be kind to your feet this winter. Comfortable, covered shoes or slippers are appropriate.

NSW & ACT run a free-of-charge program to help you look after your feet called FootSmart. For more information on contact us on 1300 342 238.