Diabetes can affect an individual from head to toe. Perhaps itsmost noticeable consequence is on the peripheral nervous system.These are the nerve fibers that lie under the skin, outside of thespinal cord.
Nerves are like wires, which allow the brain to communicate withthe body. they are involved in most body functions, such asproviding sensation, controlling muscles, and regulating skintemperature and perspiration.
About 40 percent of diabetics will experience symptoms involvingthe nerves in the arms and legs, often referred to as diabeticperipheral neuropathy, or DPN. These symptoms can be especiallynoticeable in the foot, because the foot contains the longestnerves in the body.
Diabetics often complain that their skin does not feel normal,and they describe a sense of tightness or the skin feeling likeleather. Patients have a hard time describing the symptoms, butthey often say it’s like walking on marbles or gravel. Manydiabetics are unable to wiggle or fan their toes.
These symptoms tend to be annoying but usually require notreatment. But the sensations may worsen, and the patient oftenwill develop sharp pains, burning and a “pins and needles” feeling,often worsening in the evenings and disrupting sleep.
Perhaps the most serious consequence of DPN is numbness in thefoot. Diabetics who have loss of protective sensation (LOPS) are athigh risk of developing ulcers, or sores in the skin frompressure.
Pressure from shoes or the ground may actually rub a hole in theskin that the patient is unaware of. These ulcers often becomeinfected and lead to about 85 percent of all amputations in thelower extremities.
There is no cure for diabetic peripheral neuropathy. Tightcontrol of blood sugar will reduce symptoms, but it is not aguarantee of success.
Multiple medications are available for diabetic neuropathy.These medications are designed to control the painful symptoms ofneuropathy. they do not cure the condition and do not reverse lossof feeling.
The B vitamins, vitamin D and a nutritional supplement calledalpha lipoic acid have been shown to be beneficial for somepatients. Other therapies such as nerve stimulation, infrared lighttherapy and surgical nerve decompression appear to be of limited orno value.
As loss of protective sensation is very serious, all diabeticsneed to be aware of their sensory status. this can be easilydetected using a soft piece of plastic called a monofilament thatis pressed against the foot. a diabetic who cannot feel thisplastic on the bottom of his or her foot is considered to haveLOPS.
Although sensation cannot be increased, the foot can beprotected to prevent diabetic sores from forming. Proper careincludes moisturizing the skin to keep it supple, wearing diabeticshoes (usually paid for by insurance companies), conducting dailyinspections of the foot and scheduling regular visits to apodiatrist.
Dr. Jeffrey Boberg is a podiatrist on staff at SSM DePaul HealthCenter. His offices are located at 12255 DePaul Drive, Suite 100,in the North Medical Office Building. you can reach him at314-739-7100.