What is diabetic peripheral neuropathy?

Diabetic peripheral neuropathy refers to damage of the nerves of the hands and/or feet caused by diabetes. It usually affects the feet first.

Why does it occur?

Extended periods of high blood glucose can damage nerves, causing either reduced sensation (numbness) or cause them to become highly sensitive resulting in pain or intense discomfort. The effects of diabetic peripheral neuropathy can be worsened by sudden changes to blood glucose levels.

There are other types and causes of peripheral neuropathy, but in this article we will concentrate on diabetic peripheral sensory neuropathy.

How is it diagnosed?

A diagnosis of diabetic peripheral neuropathy is made from a detailed history of your symptoms and a physical examination, which will include testing your feeling with simple instruments such as a thin piece of monofilament and/or a tuning fork. There are other nerve conduction tests that can be performed by a neurologist when the diagnosis is unclear.

There are two types of diabetic peripheral sensory neuropathy: painless and painful. It can be common to experience both painless and painful types.

Painless diabetic peripheral neuropathy

Painless peripheral neuropathy is often described as numbness or a loss of sensation in the feet. Due to the numbness, you cannot feel when your feet are injured.

You may also experience a loss of balance and coordination as you are less aware of where your legs, hands and feet are in relation to the rest of your body. This increases the risk of trips and falls.

Painful diabetic peripheral neuropathy

Painful peripheral neuropathy is often described as pins-and-needles, tingling, burning and/or sharp shooting pain. This pain can be worse at night time, interfering with sleep and affecting mood.

You may feel like you are walking on cotton wool, a pillow, hot coals or rocks. The pain can last for a short time or be chronic in nature, requiring ongoing therapy and support.

If you are experiencing painful diabetic peripheral neuropathy you will benefit from a clear explanation, ongoing support and a management plan.

What is the treatment?

The aim of treatment is to reduce your pain and improve quality of life. The simplest initial treatment is improving your blood glucose levels to prevent any further nerve deterioration. It is very important that you monitor your levels to maintain targets.

There are also medications and treatments out there to help manage the pain of diabetic peripheral neuropathy and these should be discussed with your healthcare team.

What can I do to help?

• Manage your blood glucose levels.
• Maintain a healthy lifestyle and engage in regular physical activity.

How do I look after my feet?

For people with diabetes, regular foot inspections and care are vital to prevent complications:

1. Conduct daily foot inspections – if you are unable to do this, then a partner or family member can help. Alternatively, a mirror placed at the end of a bed can help with better inspection
2. Keep your feet clean and dry – moisturise daily to avoid dry skin and/or callus. Avoid moisturizer between your toes, as this skin needs to stay dry to avoid infection
3. Professional foot care – see a podiatrist on a regular basis. They are health professionals trained in the diagnosis, assessment and treatment of a range of foot problems
4. Footwear – wear properly fitting footwear that is stable, protective and cushioned. It is important to check your shoe size regularly because minor blisters caused by rubbing can quickly become ulcers.

Shoe shopping can be a challenge at the best of times. But when you can’t risk a foot injury or sore it’s important to consider the ‘three f’s’.

The three F’s: Fit, Function and Firmness

Fit: This is the first, and most important, consideration when purchasing shoes. It’s vitally important the shoe fits your foot. It sounds obvious, but it’s essential to try the shoes on. Don’t just look at the shoe size and assume it will fit. Manufacturers all tend to be slightly different when it comes to their sizing. That means a size nine in one brand may not be the same size as a nine in a different brand. Make sure your shoe has enough width and depth to accommodate all the lumps and bumps on your feet. Everyone’s feet are different, so it’s best to avoid hand-me-downs.

Function: Ask yourself, what is the shoe designed to do and what will you be doing when you wear the shoe? For example, your running shoe may fit well and is comfortable on long walks, but it’s probably not suitable for the office. It’s important to match what the shoe is designed for with the environment you will be in. There are many good quality, comfortable shoes that are also diabetes friendly. Price isn’t always an indicator of shoe quality, so you don’t need to spend a fortune to ensure you have a good quality shoe. It’s OK to purchase a cheaper, well-fitting shoe. Sometimes the expensive shoes aren’t always the best fit for your foot. Just be aware, you may have to replace a cheaper shoe more regularly than an expensive pair. Also, high heels aren’t out of the question, but it is important to keep their use limited to a few hours at a time.

Firmness: It’s always important to ensure a shoe holds the foot firmly. Shoes like thongs and sandals should be used minimally to avoid blisters and sores. While that can seem restrictive, particularly during the warm summers, there are many shoes on the market that are breathable for those hot days. These shoes also secure the foot firmly and don’t rub against the skin.

What do I do if I have a problem?

If you have any problems with your feet, you should discuss them with your healthcare team. Just because it may not hurt doesn’t mean it isn’t causing damage. This is particularly important if you experience a loss of sensation as a result of painless peripheral neuropathy. If you notice a sore, don’t ignore it.

There are a range of dedicated healthcare professionals such as your doctor, podiatrist, diabetes educator, clinical nurse and pharmacist who can help you with advice about the day-to-day management of your diabetes and diabetic neuropathy.

The important thing to remember is that you are not alone.