The Practical Aspects

Can Diabetic Neuropathy be Prevented?

Diabetic neuropathy is a nerve disorder caused by diabetes Symptoms of neuropathy includes numbness and sometimes pain in the hands, feet, or legs. Nerve damage caused by diabetes can also lead to problems with internal organs such as the digestive tract, heart, and sexual organs, causing indigestion, diarrhea or constipation, dizziness, bladder infections, and impotence. In some cases, neuropathy can flare up suddenly, causing weakness and weight loss. Depression may follow. While some treatments are available, a great deal of research is still needed to understand how diabetes affects the nerves and to find more effective treatments for this complication.

Scientists do not know what causes diabetic neuropathy, but several factors are likely to contribute to the disorder. High blood glucose, a condition associated with diabetes, causes chemical changes in nerves. These changes impair the nerves' ability to transmit signals. High blood glucose also damages blood vessels that carry oxygen and nutrients to the nerves. In addition, inherited factors probably unrelated to diabetes may make some people more susceptible to nerve disease than others.

More recently, researchers have focused on the effects of excessive glucose metabolism on the amount of nitric oxide in nerves. Nitric oxide dilates blood vessels. In a person with diabetes, low levels of nitric oxide may lead to constriction of blood vessels supplying the nerve, contributing to nerve damage. Another promising area of research centers on the effect of high glucose attaching to proteins, altering the structure and function of the proteins and affecting vascular function.

Scientists are studying how these changes occur, how they are connected, how they cause nerve damage, and how to prevent and treat damage.

A 10-year clinical study that involved 1,441 volunteers with insulin-dependent diabetes (IDDM) was recently completed by the National Institute of Diabetes and Digestive and Kidney Diseases. The study proved that keeping blood sugar levels as close to the normal range as possible slows the onset and progression of nerve disease caused by diabetes.

People with diabetes need to take special care of their feet. Neuropathy and blood vessel disease both increase the risk of foot ulcers. The nerves to the feet are the longest in the body, and are most often affected by neuropathy. Because of the loss of sensation caused by neuropathy, sores or injuries to the feet may not be noticed and may become ulcerated.

To prevent foot problems from developing, people with diabetes should follow these rules for foot care:

• Check your feet and toes daily for any cuts, sores, bruises, bumps, or infections--using a mirror if necessary.
• Wash your feet daily, using warm (not hot) water and a mild soap. Dry your feet carefully with a soft towel, especially between the toes.
• Cover your feet (except for the skin between the toes) with petroleum jelly, a lotion containing lanolin, or cold cream before putting on shoes and socks
• Wear thick, soft socks and avoid wearing slippery stockings, mended stockings, or stockings with seams.
• Wear shoes that fit your feet well and allow your toes to move. If you have difficulty finding shoes that fit, ask your doctor to refer you to a specialist, called a pedorthist, who can provide you with corrective shoes or inserts.
• Examine your shoes before putting them on to make sure they have no tears, sharp edges, or objects in them that might injure your feet.
• Never go barefoot, especially on the beach, hot sand, or rocks.
• Cut your toenails straight across, but be careful not to leave any sharp corners that could cut the next toe.
• Use an emery board or pumice stone to file away dead skin, but do not remove calluses, which act as protective padding. Do not try to cut off any growths yourself, and avoid using harsh chemicals such as wart remover on your feet.
• Test the water temperature with your elbow before stepping in a bath.
• If your feet are cold at night wear socks.
• Avoid sitting with your legs crossed. Crossing your legs can reduce the flow of blood to the feet.
• Ask your doctor to check your feet at every visit, and call your doctor if you notice that a sore is not healing well.
• If you are not able to take care of your own feet, ask your doctor to recommend a podiatrist (a foot-care specialist) who can help.