What Is Diabetic Neuropathy?
Diabetic neuropathy is the damage to nerves caused due to improperly-managed diabetes. It happens to almost 50 percent of diabetics. The complications of diabetes are especially rampant in those over the age of 40 who have poor blood sugar control and are overweight. Nerves are wires that connect different parts of the body. They have a protective sheath, an insulation of sorts. When this insulation is damaged by excess blood sugar, classic symptoms of neuropathy, like tingling and numbness in the hands and feet, are felt. At times, sufferers may not be able to tell the difference between hot/cold and room temperature objects. When nerves of the digestive tract are damaged, diarrhea or constipation could occur. Diabetic neuropathy treatment, when done on time, could save years of suffering.
Symptoms of Diabetic Neuropathy
- Hands and feet: Tingling, numbness, burning sensation and pain.
When one is unable to feel things properly, or tell whether an object is hot/cold by touch, it is called sensory neuropathy. - Digestion: Bloating, diarrhea, constipation, nausea and vomiting.
Digestion, heart rate and other involuntary actions are affected in autonomic neuropathy. - Urinary tract: Incontinence, frequent bathroom visits.
This kind of damage is included under autonomic neuropathy. - Reproductive: Impotence, vaginal dryness.
This, too, is a part of autonomic neuropathy. - Muscular: Wasting of muscles, weakness in the limbs.
Simple muscle movements seem difficult and one finds it difficult to walk with balance as well. This kind of damage comes under motor neuropathy. - Vision: Blurred/double vision.
When the optic nerves (nerves that support the eyes) are damaged, it leads to vision trouble.
Types of Diabetic Neuropathies
There are four types of neuropathies classified according to the organs and systems it affects.
Peripheral neuropathy
Feet and legs are affected in this type of neuropathy. In rare cases, arms, abdomen and back are also affected. Tingling, numbness, burning sensation and pain are the chief symptoms.
Autonomic neuropathy
The digestive system (especially the stomach) is affected. Blood vessels, sex organs and the urinary system can also be affected. Bloating, diarrhea, constipation, heartburn, nausea, vomiting, dizziness, low blood pressure, fungal infections of the sex organs, incontinence, burning sensation while passing urine, etc. are symptoms of this type of neuropathy.
Proximal neuropathy
Pain (usually on one side) in hips, thighs and buttocks and weakness in the legs is usually caused due to this type of neuropathy.
Focal neuropathy
Thus type of neuropathy can appear suddenly and affect specific nerves in the head, legs and torso. It causes pain and weakness of muscles. Symptoms may include Bell’s palsy (paralysis on one side of the face), eye pain, double vision, severe pain in certain areas of the body, pain in the chest or belly (this might lead one to think that the pain is due to another condition, like a heart attack).
Treatment for Diabetic Neuropathy
The current standard treatment for diabetic nerve pain includes:
1. Pain relief medication
Some doctors use anti-epileptic or seizure medications. The following drugs are used to prevent seizures, but are also prescribed for nerve pain.
- Gabapentin (brand names include Gralise and Neurontin)
- Pregabalin (brand name – Lyrica)
- Carbamazepine (brand names include Carbatrol and Tegretol)
The side effects of these drugs are quite serious in the case of long term use.
Antidepressants like Imipramine (brand name – Tofranil) and Desipramine (brand name – Norpramin) are, also, used to interfere with the pain signal from the nerves to the brain. Once again, they have several unpleasant side effects, including causing a dry mouth, constipation, weight gain and balance issues. Selective Serotonin Reuptake Inhibitors or the infamous SSRIs (including brand names like Prozac, Celexa and Zoloft), which are used for clinical depression, are also given to patients with diabetic nerve pain. The same side effects of nausea, appetite suppression, dullness and brain fog could be a result of medicating with them.
2. Medications to manage nerve damage to different organ systems
Your doctor may suggest different drugs depending on which organ system the nerve damage has occurred in. They include:
- Digestive problems: Nerve damage to the autonomous nervous system can cause gastroparesis. Symptoms of this include excessive belching, feeling nauseous and, also, a feeling of heaviness after meals. You may be asked to reduce the fiber in your diet. You could also be asked to take antacids, like Nexium, and occasionally, may be prescribed digestive enzymes.
- Urinary tract problems: The primary problem is the leaking of urine due to loss of conscious control. Irregular nerve signals may be tempered by using anti-spasmodic medications called anticholinergics (like Oxybutynin). Brand names of anticholinergics include Ditropan XL and Oxytrol.
- Sexual issues: When there is nerve damage to sexual organs, it affects the ability to sustain erections in men and feel sexual arousal in women. Drugs such as Sildenafil (brand names – Revatio and Viagra), tadalafil (brand names – Adcirca and Cialis) and vardenafil (brand name – Levitra) may be prescribed for addressing these issues. But, you must discuss the side effects of such medications with your doctor before you start taking them.
3. Diabetic Neuropathy Treatment: Deeper Solutions
- Despite being on medication, your blood sugar may be poorly controlled. This, most probably, means that you will have to change your drug, and that, your doctor can do for you. Make sure you get tested regularly. That way, you can catch such increases in blood sugar early on and take corrective action.
- Certain anti-diabetic drugs like Metformin could also lead to neuropathy. Metformin interferes with the absorption of Vitamin B12 in the body. This, in turn, causes a gradual breakdown of the insulation of these nerve fibers. This leads to numbness and tingling in the hands and feet. As ironic as it sounds, the very drug that you’ve been taking to control your diabetes could be causing diabetic neuropathy, or other nerve problems. The solution is to supplement with B Vitamins, including Vitamin B12.
- The dietary supplements that can help you deal with diabetic neuropathy have been listed below. Other dietary supplements that can help you lower your blood sugar and deal with the oxidative damage caused by diabetes are listed in this article as well.
- The real solution to diabetes begins with the right diet. Following the right diabetes diet can make a huge difference. Intermittent fasting, which could be as simple as eating 3 meals a day instead of 6, and fasting between dinner and breakfast, should be followed. It can also contribute to making your body more sensitive to insulin, reducing the need for medication.
- Exercise, even a little of it, can go a long way in reducing the blood sugar load, just as stress management solutions like meditation and yoga do.
- Since the hands and feet are those parts of the body that are easily affected by diabetic neuropathy, foot care becomes critical. Since your feet may be numb, you may not realize that they may have developed cuts, blisters or sores. Poor nerve quality also means poor blood supply, which means that your feet could get very dry. Use a lotion, if necessary. You can also avoid injuries by wearing comfortable shoes that fit well.
Dietary Supplements for Diabetic Neuropathy
Alpha Lipoic Acid (600mg per day)
Alpha Lipoic Acid, found in spinach, broccoli and potatoes, has been shown to slow the progression of diabetic neuropathy in humans. It works in the hands, feet and in other places. Alpha Lipoic Acid has been successfully used in studies to treat constipation caused by diabetic nerve damage to the autonomous nervous system.
Vitamin B12: (1000-1500 mcg per day)
Vitamin B12 deficiency causes nerve damage in non-diabetics too. However, with diabetics, both, the underlying disease and the medicines prescribed for it (Metformin) are known to eventually lead to B12 deficiency. It is hardly surprising that diabetics show fantastic improvement in diabetic neuropathy symptoms when they are given Vitamin B12 in the right doses in research studies. Experts prefer to administer intramuscular injections, if patients are found to be highly deficient, as per blood tests. Oral supplementation is also effective, especially if Methylcobalamin or Hydroxycobalamin, the more absorbable forms of Vitamin B12, are used.
Vitamin D3 (800-2000 IU per day)
Vitamin D deficiency is quite often found in patients with diabetes. The mechanisms through which Vitamin D positively influences diabetic nerve issues is not clear. But, in studies when patients found to be deficient with Vitamin D were given Vitamin D supplements, they had substantial improvements in their diabetic nerve pain too.
Magnesium: (360-1000 mg per day, depending on severity of deficiency)
Another factor that is associated with diabetic neuropathy is a low level of magnesium in the blood. Studies show that most diabetics have reduced magnesium levels in their blood. Found in dark, leafy green veggies and whole grains, magnesium improves insulin resistance and helps influence the course of neuropathy.
Biotin (5-10mg per day)
Found in eggs, organ meats and legumes, biotin induces an enzyme called glucokinase, which plays an important role in the metabolism of glucose. When combined with chromium (600 micrograms per day), it significantly reduces blood sugar levels. It is not clear why diabetics are unable to use the Biotin made available to them from their diet. However, when they were given biotin through intramuscular injections, followed by oral Biotin supplements, they reported substantial improvement in nerve-related symptoms.
Acetyl-L-Carnitine (500-1000 mg, 2-3 times per day)
Due to its ability to regenerate damaged nerves, as well as the fact that it is often found to be deficient in diabetics, Acetyl-L-Carnitine has been successfully used on people with diabetic neuropathy, in research studies. In a year-long study, patients receiving supplementation reported substantial relief from nerve pains. Carnitine also helps reduce the risk of Alzheimer’s. This is an added benefit for diabetics who have a greater risk of suffering from the dreaded cognitive disease.
Diabetic Neuropathy Treatment: Our Final Summary
Finally, diabetes is a metabolic and dietary disorder. The real solution lies in metabolic changes, achieved by eating the right LCHF diet and by losing weight. Research is increasingly showing that merely using prescription medications (that come with side effects) is not the right way to deal with your diabetes. If you’re facing diabetic complications, including issues like diabetic kidney damage and hypoglycaemia, it’s time to consider finding a functional medical practitioner you can work with. There are M.D.s that work with patients to reverse Type 2 Diabetes. So, don’t lose hope. Take back charge of your health and stay strong!
Mahesh Jayaraman
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