What is diabetes-related neuropathy and what can be done about it?
By Wendy Haaf
A popular feature in Good Times magazine is Your Health Questions, where we answer questions submitted by our readers about health, nutrition, and well-being:
I’m 80 and I’ve been diagnosed with neuropathy. It affects my balance and causes burning and cramping in my feet. Could you please discuss possible treatments?
Caused by long-standing high blood sugar and other changes that can accompany diabetes, neuropathy is damage to the nerves, which can cause symptoms such as tingling, burning, a pins-and-needles sensation, and numbness, as well as problems such as weakness in the toes and difficulty walking. (Apart from high blood sugar, risk factors include high triglycerides, excess weight, smoking, and high blood pressure.)
Unfortunately, it’s very common: about half the people with diabetes will eventually develop neuropathy, and of those, about half will have pain as a result. And while taking steps such as exercising regularly and eating a healthy diet can help slow further progression, the damage is irreversible. “There’s no cure, so you’re left trying to control symptoms,” says Dr. Vera Bril, a neuropathy researcher and the medical director of the Krembil Neuroscience Centre, part of the Toronto-based University Health Network.
For pain, the main treatments are “a series of different medications to try to blunt how the nerves send signals,” Bril explains. These include certain antidepressants and antiseizure drugs. (Opioids generally aren’t recommended because they cause constipation, something people with neuropathy are often already struggling with.) And since different people respond differently to different drugs, finding a medication that helps you, with side effects you can tolerate, is a trial-and-error process (a lot of these medications can cause drowsiness, difficulty thinking, unsteadiness, and weigh gain, Bril notes).
Typically, your doctor will start with a low dose and gradually build up. When successful, medications “reduce pain from severe levels to more tolerable levels,” Bril says. “Very rarely is the pain eliminated completely.”
A few people also find that topical treatments (such as creams and ointments) and/or a device called a “transcutaneous electrical nerve stimulator” (a TENS machine) offer temporary relief. A number of non-drug approaches may help short-circuit physical responses (such as muscle tension) that otherwise would worsen pain: these include cognitive behavioural therapy, yoga, meditation, and simple breathing exercises.
Numbness, on the other hand, can’t be treated in itself, but there are ways to reduce the risk that it will lead to further problems, such as ulcerations, infections, and falls. One type of health professional who can help with numbness is an occupational therapist (OT). (If your doctor, hospital, or community health centre can’t connect you with an OT, the Canadian Association of Occupational Therapists website, caot.ca, has a searchable database.)
For instance, an OT can advise you on how to eliminate tripping hazards in your home (where the majority of falls occur), suggest exercises to improve your balance and stability, and recommend strategies to enable you to do certain tasks more easily—such as using an extra-long shoehorn to put on footwear. (You can also find exercises to help with balance at diabetes.ca; search for “How is your balance?”).
Since the shuffling gait that often results from numbness in the feet increases the risk of a fall, Vancouver OT Mandy Shitani recommends consciously making an effort to pick up your feet and plant them firmly when walking.
Another measure that can help correct your gait? Shitani says, “Using Nordic walking poles improves your balance, posture, and confidence,” while simultaneously increasing the calorie-burning effectiveness over plain walking “by anywhere from 20 to 46 per cent.” (Shitani is also an entrepreneur and the founder of Urban Poling, a company that sells walking poles.)
For more information on living well with diabetes, including a resistance-exercise program and other resources, visit diabetes.ca.