Patient guidelines for treatment of diabetic peripheral neuropathy
Treatment of diabetes and diabetic peripheral neuropathy requires a team approach to your care. You and your doctor need to work together to control your blood sugar levels and treat the pain in your legs and feet called diabetic peripheral neuropathy. Management of your blood sugars is the most important part of your diabetic peripheral neuropathy treatment.
Based on your symptoms of diabetic peripheral neuropathy, your doctor may choose to use a number of different medications to treat your symptoms. Each of these medications have had a history of helping patients with diabetic peripheral neuropathy pain, but none of the medications are considered universally successful. That’s why it’s so important for you to work to treat your diabetic peripheral neuropathy with recommendations in these guidelines.
Causes of diabetic peripheral neuropathy
Why do you have pain in your legs and feet? There are a number of different theories that describe the causes of diabetic peripheral neuropathy. (1) The primary reason for your pain is elevated blood sugar. The duration and the degree of elevated blood sugar results in changes in the nerves in your legs and feet. These changes contribute to loss of sensation and pain. The longer you wait to treat your diabetes, the more severe the pain in your legs and feet will become. So let’s roll up our sleeves and find ways that you as the patient can help to manage your diabetic peripheral neuropathy.
Five ways patients can work to treat diabetic peripheral neuropathy
1. Know your A1c - know what the hemoglobin A1c (HbA1c) test means, know your numbers. Have the test performed regularly (most often every three months). (2,3)
Monitoring daily blood sugars has been a standard of care for years. HbA1c improves upon daily testing by creating an average of your daily blood sugars over the course of 90 days. A HbA1c of 5% represents an average daily blood sugar of 100 mg/dl. Each increase of percentage is approximately 30 points on your daily blood sugar (e.g. 6%=130 mg/dl, 7%=160mg/dl)
2. Weight loss and physical exercise – It’s a well known fact that weight loss has a direct impact on regulation of your blood sugars. Weight loss and physical exercise can also have a direct impact on your diabetic peripheral neuropathy? Microvascular disease (small vessel disease) is a significant contributing factor to diabetic peripheral neuropathy. A syndrome called metatbolic syndrome describes a group of symptoms that includes diabetes, high blood pressure, elevated blood lipids and truncal obesity. Metabolic syndrome is directly tied to diabetic peripheral neuropathy. Regular exercise and weight loss can do more than just regulate your blood sugar levels. Regular exercise and weight loss can also prevent diabetic peripheral neuropathy.
3. Focus on diet – part of the team approach to treatment of diabetes is recognizing foods that contribute to elevated blood sugars. But did you know that certain foods can actually improve your symptoms of diabetic peripheral neuropathy? Foods that elevated levels of aldose reductase contain luteolin, a flavonoid found in the leaves of certain foods. Foods that are high in luteolin include Indian gooseberry, spinach, cumin seed, fennel seed, basil leaves, lemon, black pepper, orange, curry leaves, cannabis and cinnamon.(4)
4. Treat oxidative stress – one of the theories that describes the cause of diabetic peripheral neuropathy discusses the formation of free radical as the byproduct of glucose metabolism. Although the efficacy of ‘chelation’, or removal of these free radicals is controversial in the literature, over-the-counter anti-oxidants are used to treat oxidative stress. These anti-oxidants include glutathione 250 mg/day and alpha lipoic acid 600 mg/day.(4)
5. Treat nitrosative stress – Nitric oxide (NO) is a chemical that regulates the lining of arteries and vascular tone, controlling the amount of flow through the artery. Decreased levels of NO can result in decrease vascular flow. NO regulated loss of circulation to the peripheral nerve contributes to painful diabetic neuropathy. Natural dietary sources of NO come from foods that are high in arginine. Those foods include kale, spinach, broccoli, brussel sprouts, beets, legumes, nuts, beans, salmon, chicken, beef, cheese and eggs.(4) Additional NO can come from exercise and outdoor activities. NO can be formed as the result of cardiovascular exercise and the UV light in sunshine can provide an additional source of NO.
Summary –
If you are just beginning to treat your diabetic peripheral neuropathy, you’ve likely been through dietary counseling for your diabetes. Is the treatment of your diabetic peripheral neuropathy appreciably different from your treatment of your diabetes? In many respects, the treatment of diabetes and diabetic peripheral neuropathy are similar with a focus on blood sugar regulation, weight loss, control of high blood pressure (if needed) and control of lipids.
The treatment of diabetic peripheral neuropathy goes one step further in diet. Rather than focusing on foods that reduce blood sugar, the foods mentioned in this article are actually used to treat your neuropathic pain by altering the pathways of oxidative stress, nitrosative stress and aldose reductase inhibitors. You don’t need a background in chemistry and physiology to get started. You just need to carve out some time to take care of yourself.
Your diabetes and diabetic peripheral neuropathy can significantly change with one simple lifestyle change - taking time for yourself. Taking a walk out in the sunshine may seem like a selfish act when you feel the pressures of family and work. Change is hard. But change can start today – right now, with a new, healthy you.
1. https://www.myfootshop.com/diabetic-peripheral-neuropathy-exam-guidelines-for-practitioners
2. https://www.myfootshop.com/diabetic-wound-care#Tab3
3. https://en.wikipedia.org/wiki/Glycated_hemoglobin
This article was written by Jeffrey Oster, DPM. Dr. Oster is a board certified podiatrist and medical advisor to Myfootshop.com. This article was most recently updated on 1/20/2021.