The Reality of Diabetic Peripheral Neuropathy in the Feet

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The Reality of Diabetic Peripheral Neuropathy in the Feet

Dear CDE,

Lately my feet are feeling weird – like they are being squeezed tight inside my socks, but I am not wearing any socks. Then at night I get sharp sudden pains that just shoot into my ankles, heels and feet from nowhere that feels like an electric shock. It wakes me up, and keeps me awake. What is going on? Do I have that diabetes nerve pain like they show on TV? I am 36 years old, an active mom (2 kids ages 11 and 9), work part-time, and go for walks with my kids and the dog. I have been diabetic for 17 years.

- Sarah

Hello Sarah –

What you are describing are typical signs and symptoms of nerve damage caused by peripheral neuropathy, which is the most common and well-known form of neuropathy that happens to people with diabetes (PWDs). Diabetic peripheral neuropathy (DPN) affects the transmission of biochemical-electric nerve signals from the brain to the spine to the peripheral nerves in the extremities, such as the lower legs, feet and toes, and arms, hands and fingers. The electric shock “pricks” you describe feeling are the result of the nerves trying to fire signals from your brain to your feet, but the transmission gets interrupted through wiring that has been damaged by the chronic fluctuations of hyper- and hypoglycemia that happens over the years when you have diabetes.

With DPN sensation is altered and can be either increased or decreased. For example, nerve damage from DPN causes diminished or loss of feeling in the feet and hands. However, it can also increase sensation that feels like pin pricks, tingling, stinging, jabbing, throbbing, short quick electric shock-like pain, and a tight squeeze “stocking glove” sensation such as you describe of wearing socks when you aren’t wearing any socks.

You are not alone – peripheral neuropathy happens to approximately 70% of all PWDs and occurs in both T1 and T2 diabetes.  It develops progressively and insidiously over time, is more likely to affect PWDs who have had diabetes for 10 to 15 years or more, especially in those who have lived through extended periods of high glucose levels. This does mean you are a “ bad diabetic” – DPN is just one of those things that develop as a result of the chronic nature of the diabetes disease process. Many PWDs learn ways to manage and cope with peripheral neuropathy and go to live long, happy lives.

What can you do about it? First of all, do your best to keep your BGs in a target range that is as close to normal as you can manage for as long as you can. By keeping one’s BG and A1c in good control, it can prevent or delay the onset of DPN. Once DPN has started to progress, there is little that can be done to reverse nerve damage that has already been done, but good BG control can keep it from progressing further and getting worse. 

It helps to know what to expect, and to know how to recognize the initial symptoms and warning signs to discuss with your doctor and diabetes treatment team. The painful stage of DPN is a temporary condition that might last for a few months up to two or three years while the nerves are trying to send signals to their target destinations in your hands and feet. Medications such as pregabalin (Lyrica), gabapentin (Neurontin), or duloxetine (Cymbalta) may offer temporary relief to quiet the irritating pain or quell the discomfort, but they do not heal the nerves nor stop the progression of neuropathy. The good news is that once you pass the active inflammatory stage of progressive neuropathy, the acute stabbing, stinging, and electric shock pain eventually subsides and stops.

The other side of the progressive neuropathic process is that your feet may become quite numb with diminished ability to feel and interpret sensory signals like heat, cold, pressure, texture, pain, sense of location or balance. For example, not being able to feel a foreign object in your shoe or on the bottom of your foot may cause irritation and eventual tissue breakdown. This is where all that practical diabetes self-care knowledge comes into play – like to examine your feet and wear sensible well-fitting shoes to protect your feet from injury. You can preserve the health and function of your feet by paying attention to what they feel like and look like everyday.

A very important tip about dealing with diabetic neuropathy in your feet is this – if you find you have unknowingly injured your foot, and one or the other foot doesn’t look or feel quite right, DO NOT WAIT OR HESITATE to get it checked out promptly by a doctor or podiatrist who is familiar with the progressive nature of neuropathy caused by diabetes. If you sustain an injury that requires urgent care, be sure to tell the treating clinician that you have diabetes for over 15 years and neuropathy in your feet.

It is always a good idea for you and your doctors to err on the side of caution by screening you early, often, and carefully to detect progressive neuropathic changes in your feet.  Having DPN in your feet puts you at risk to develop a Charcot foot injury that is much too often misdiagnosed or untreated until it is too late and irreparable nerve, joint and bone damage has been sustained. Charcot foot when left untreated in the earliest stages can end up with devastating deformities and consequences that are best to avoid. It is therefore extremely important to pay attention to your feet and seek prompt medical treatment for any possible injury that might compromise the health, structure, and function of your feet.  

I hope this is information is useful and helpful to you and all the sisters who read it. I wish you a lifetime of healthy feet in spite of neuropathy!