Ejaz A. Shamim, M.D., M.S., MBA, FAAN, shares his expert advice for diabetics on how to live a healthier lifestyle.
By Ejaz A. Shamim, M.D., M.S., MBA, FAAN
Ejaz A. Shamim, M.D., M.S., MBA, FAAN is a board-certified neurologist with the Mid-Atlantic Permanente Medical Group. He sees patients at the Kaiser Permanente Largo Medical Center.
As a neurologist, I treat many people who suffer from neuropathy—nerve damage that commonly causes numbness, tingling and burning, most often in the feet and hands. In the wake of today’s diabetes and obesity epidemic, more and more patients are coming in with neuropathy caused by diabetes. In addition to causing discomfort, neuropathy can interfere with your ability to walk and, if left untreated, can result in amputation and even organ failure.
Nearly one in 10 Americans is diabetic, and that number jumps to one in four among people over 65, according to the National Institute of Diabetes and Digestive and Kidney Diseases, and most people with diabetes eventually develop some form of neuropathy. The good news for all of our patients is that diabetic neuropathy is preventable, treatable and in many cases, reversible. The key is to treat the underlying diabetes and the risk factors for diabetes, which include obesity, a sedentary lifestyle and poorly controlled blood sugar and triglycerides.
While we have begun to see types of diabetic neuropathy we once considered extremely rare or attributed to other causes, by far the most common type of diabetic neuropathy is peripheral neuropathy, which is nerve damage that affects the smallest nerves in the extremities, usually the feet. The symptom we see most often is a loss of feeling in your feet. This is dangerous for a couple of reasons. For one thing, if you can’t feel your feet, it can be tricky to walk, putting you at risk for a fall. In addition, some of my patients develop foot injuries and infections that they end up ignoring, leading (in extreme cases) to amputation of the toes or the entire foot. That’s why it’s important for anyone with diabetes to have a thorough annual foot exam and to control their blood sugars well.
Another type of peripheral neuropathy that is much less common in patients with diabetes is known as small fiber neuropathy. It is very painful and causes burning and tingling that often starts in the feet and progresses upward in the body.
Autonomic neuropathy is damage to the nerves that control your internal organs. This can lead to problems with heart rate and blood pressure, digestion, bladder control, sexual function and even the ability to sense when your blood sugar is low. We have limited treatment for these symptoms, but, the ultimate treatment is blood sugar control.
Focal neuropathy is damage to a single nerve, usually in the hand, leg, torso or head. This type of neuropathy can involve entrapment of a nerve, as in carpal tunnel syndrome. If it does not involve entrapment, focal neuropathy usually resolves without treatment. If it does involve nerve entrapment, treatment strategies can include anything from treating the inflammation with medication to, in extreme cases, surgery. Patients who have diabetes and peripheral neuropathy are more likely to get focal neuropathy from pressure points, so it’s best to avoid leaning your elbows on hard surfaces or crossing either one of your legs over your knee.
Proximal neuropathy is very rare, but causes disabling nerve damage in your hip, buttock or thigh. Most people with diabetes who develop this type of neuropathy recover in a few years, even without treatment.
Preventing Diabetic Neuropathy
Diabetic neuropathy is a lifestyle disease, which means you have the power to prevent, control and even reverse it. Unhealthy levels of blood sugars can damage your nerves, so anyone with diabetes is at risk. This includes people who are pre-diabetic, whose blood sugar levels are high, but not high enough to qualify them as fully diabetic, and patients with metabolic syndrome, a cluster of conditions that includes high blood pressure and blood sugar, abnormal cholesterol and triglyceride levels, and excess body fat around the waist.
Diagnosis of diabetic neuropathy is fairly straightforward. We do a physical exam and look at your medical history—diabetes does tend to run in families, which seems to involve a combination of genetics and lifestyle. If your blood sugar is high and we’ve ruled out other causes, including certain chemotherapy drugs, aging, some autoimmune illnesses and alcohol, we can safely ascribe your neuropathy to diabetes.
The treatment is very simple. All forms of diabetic neuropathy can be controlled and even reversed by controlling your diabetes, which means monitoring and controlling your blood sugar, lowering your triglycerides and maintaining a healthy weight. A heart-healthy diet is important, but exercise is even more important: I recommend to my patients at least 30 minutes a day. Because it increases blood flow to all parts of the body, including the brain and nerves, exercise is the one thing we know of that has the power to improve nerve damage. So, it’s important to get moving.
For patients who need immediate pain relief, we can prescribe a range of medications that include anticonvulsants and antidepressants or a topical medicine like lidocaine. But I tell my patients these drugs are not a good long-term solution and some have their own serious side effects. Physical therapy can be helpful if you need help working through the pain of beginning an exercise program. So can nontraditional therapies such as tai chi, qi gong, yoga, acupuncture and meditation. In a recent study, we used magnetic stimulation to the feet to help with the pain of peripheral neuropathy. This is a new type of investigational therapy with no side effects and we are now looking into this therapy further as part of a clinical trial.
Of course, nerve regeneration takes time, so the best thing you can do is to prevent it from happening in the first place. The key is to stay active. It’s always easier to prevent neurological problems than to treat them once they show up.
For more information on diabetic neuropathy, visit the website of the National Institute of Diabetes and Digestive and Kidney Diseases.
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