8diabetesPins & Needles:Are You At RiskFor PeripheralNeuropathy?Peripheral neuropathy is nervedamage caused by chronically highblood sugar and diabetes. Despitemany recent advances in diabetestreatment, neuropathy remainscommon. According to A PositionStatement by the American DiabetesAssociation as published in ‘DiabetesCare’, approximately 50% of peoplewith type 2 diabetes and 20% of thosewith type 1 diabetes develop this kindof nerve damage. Diabetes-relatednerve damage worsens with age andwith advancing diabetes. Accordingto research published in the journal‘Diabetologia’, about one in threepeople with type 1 diabetes had signsof diabetic neuropathy 25 years aftertheir diabetes. According to a 2014University of Michigan review in thejournal ‘Current Diabetes Reports’,half of those with type 2 diabeteshave neuropathy ten years after theirdiagnosis. According to the AmericanDiabetes Association, 10-20% ofpeople with prediabetes have signs ofdiabetic neuropathy.DPN can cause burning, stabbingor electric-shock-like pain or tinglingin your feet, legs, hands or arms. Thepain may be worse at night.According to a 2017 review inthe ‘Journal of Diabetes Research’,metabolic changes associated withdiabetes and related health problemsmay damage nerve cells by boostinglevels of rogue oxygen moleculescalled free radicals that attackthe DNA inside cells, by zappingantioxidant compounds that normallyprotect cells from free radicals andby increasing inflammation. DiabeticPeripheral Neuropathy (DPN) cancreate disastrous and even lifethreateningproblems like foot ulcers,amputations, heart attacks, digestionproblems and difficulty recognisinglow blood sugar episodes. Despite thecomplications it can cause, knowingits risk factors and taking precautionscan go a long way.Risk factors• Obesity & hypertriglyceridemia:According to 2013 researchpublished in the ‘Journal ofDiabetes and its Complications’,obesity and hypertriglyceridemiasignificantly increase riskfor peripheral neuropathy,independent of glucose control.• Smoking: Says a 2015 studypublished in the ‘Journal ofInternal Medicine’, smoking maybe associated with an increasedrisk of DPN in people withdiabetes. Smoking restricts bloodflow to the nerve cells. It also hasan adverse effect on your bloodsugar levels, which can lead to thedevelopment of diabetes. Addsa 2015 Harvard Medical Schoolreview of 38 studies on tobaccouse and diabetic peripheralneuropathy that included morethan 5,000 people, smokingincreased DPN risk by as muchas 42%.• Hypertension: Says a 2010study by the University ofBirmingham, “Hypertension isstrongly associated with diabeticneuropathy and the observedsensory loss may be aggravatedby hypertension-induced nerveischaemia and hypoxia.”• High levels of ‘bad’ cholesterol:In a 2015 study published in thejournal ‘Medicine’ that looked atmore than 37,000 people with type2 diabetes for up to nine years,researchers found that low levelsof “good” HDL cholesterol andhigh levels of heart-threateningLDLs also boosted risk for diabeticperipheral neuropathy by up to67%.• Inability to control blood sugar:Says ‘Diabetic Neuropathy:A Position Statement by theAmerican Diabetes Association ascarried in ‘Diabetes Care’, 2017,“For people with type 1 diabetes,tight glucose control can cut riskfor DPN by 78%; for those withtype 2, it may reduce risk 5-9%.”Diabetic NeuropathySymptoms• Numbness, tingling, or pain in thetoes, feet, legs, hands, arms, andfingers• Indigestion, nausea, or vomiting• Diarrhea or constipation• Dizziness or faintness due to adrop in blood pressure, especiallywhen suddenly getting up to stand• Problems with urination• Erectile dysfunction or vaginaldryness.Diabetic NeuropathyTreatment– Over-the-counter pain medicationfor mild pain. Regular use ofprescription drugs for peripheralneuropathy– Keep blood sugar levels in normalrange– Get regular exercise– Maintain a healthy weight– Take foot care seriously; inspectyour feet daily for injuries– Wear special therapeutic shoes.diabetesmatters - express
9Dr. MaheshPadsalgeMD (Medicine),DFID (CMC,Vellore),Navi Mumbai.diabetesmatters - express
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