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Diabetic Neuropathy: Nerve damage in the feet.

November is Diabetes awareness month. This blog highlights peripheral neuropathy, which affects up to half of people with Diabetes and 1 in 10 people over 55 in the UK.

What is peripheral neuropathy?

Peripheral neuropathy is a type of nerve damage that affects the body’s extremities. It typically affects the feet and legs, and sometimes hands and arms. The most common cause of peripheral neuropathy in the UK is Diabetes.

Symptoms of neuropathy depend on which nerves are affected.

Types of nerves:

Sensory nerves transmit sensations such as pain and touch. When these nerves are affected, you may feel:

  • Pins & needles or numbness

  • Sharp or burning pain

  • Less sensitivity to pain or temperature

  • Altered sensation

  • Loss of balance or co-ordination

Motor nerves control movement. If these nerves are affected, symptoms may include:

  • Muscle twitching and cramps

  • Muscle weakness or paralysis

  • Thinning/wasting of muscles

Autonomic nerves regulate automatic functions performed by internal organs. Damage can cause:

  • Feeling faint or dizzy

  • A rapid heartbeat (tachycardia)

  • Excess sweating

  • Lack of sweating

  • Problems with bowel or bladder control

  • Digestive problems

  • Erectile disfunction

What causes diabetic neuropathy?

Over time, high blood sugar levels associated with diabetes can damage small blood vessels that supply nerves in the body. This stops essential nutrients reaching the nerves. As a result, the nerve fibres can become damaged.

How does this affect the feet?

Autonomic neuropathy can reduce sweating and lead to dry, cracked skin which is more vulnerable to infection.

Sensory neuropathy causes numbness and people may not notice a minor injury such as a blister from ill-fitting shoes or stepping on something sharp. This can lead to infection and ulcers (wounds). In a worse case scenario, ulceration can lead to loss of a toe, foot or leg.

Motor neuropathy causes weakness in the muscles of the feet or legs. This can lead to difficulty lifting the forefoot when walking, known as 'foot drop'.

Charcot foot is a rare but serious condition affecting people with diabetic neuropathy. This is caused by restricted blood flow to the feet which leads to fragile bones which easily break or dislocate. When combined with neuropathy, pain from the broken bones may not be felt, and the person may walk around on the injury, unknowingly causing further damage. If you have diabetes and notice your foot has suddenly become red, hot, swollen whether painful or not, seek medical advice.

Prevention and treatment

Nerves cannot repair themselves once damaged. However, symptoms can be treated with medication and pain killers.

Neuropathy can be prevented by managing diabetes. This means keeping blood sugars within target range and managing cholesterol and blood pressure levels.

Diabetes can sometimes be controlled by lifestyle changes, such as stopping smoking, cutting down on alcohol, maintaining a healthy weight and exercising regularly.

If you have diabetes it is important to check for foot problems every day and attend diabetic foot checks at least once a year.

A diabetic foot check may include discussing symptoms, checking skin and nails, a vascular (circulation) check and neurological examination. This can be provided by a podiatrist or practice nurse. You should be informed of your risk level which will determine how often you need to have these checks.

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