PEOPLE with diabetes can develop nerve damage over time. It is well documented that about 70 per cent of people with diabetes have some form of neuropathy.

Neuropathy is damage to the nerves and can occur in any organ of the body. The risk of developing nerve damage increases with age and the duration with which you have had diabetes. If you struggle to control your blood glucose level, are hypertensive and overweight, you are more likely to suffer with nerve damage.

The actual cause of neuropathy is due to a combination of factors, including:

* Lifestyle, for example smoking and drinking alcohol;

* Metabolic factors, for example high blood glucose levels, high blood fat levels, low insulin levels;

* Neurovascular factors that cause damage to the blood vessels that feed the nerves;

* Mechanical injuries to the nerves; and

* Autoimmune factors.

The main types of neuropathy that affect the lower limbs are peripheral, focal and proximal. Peripheral is by far the most common and can cause pain, burning, stinging, numbness, and pins and needles in the feet and hands.

Focal results in weakness in one nerve or a group of nerves, leading to muscle weakness or pain, and any nerve in the body can be affected.

Proximal neuropathy causes pain in the thigh, hip or buttocks, and weakness in the legs.

For the purpose of this article we will focus on peripheral neuropathy, as this is by far the most common I see in my surgery. As mentioned before, you will know that you have peripheral neuropathy if you experience any of these sensations.

* Burning, tingling or pricking;

* Pins and needles;

* Hypersensitivity to touch;

* Poor coordination and loss of balance;

* Numbness; and

* Weakened sensitivity to temperature and pain.

There may also be muscle weakness and a loss of reflexes at the ankle and knee. Due to poor sensation, people often end up injuring their feet. These injuries may go unnoticed and lead to infection. Charcot joints may occur — this is where a foot deteriorates because of nerve damage. There is swelling, instability and joint deformity. Early treatment can promote healing and prevent further damage.

Any infection left untreated for too long can spread to the bone and lead to amputation. However, it is important to note that if caught early, most amputations are preventable.

To diagnose peripheral neuropathy, a clinical examination is done. The skin, muscles, bones, circulation, and sensation of the feet are all assessed. Patients will describe the sensations they have in their feet and this will give a clear picture as to whether peripheral neuropathy is present or not.

TREATMENT

There is no cure for diabetic peripheral neuropathy. Treatment focuses on slowing the progress of the disease, pain relief, and managing the complications.

Blood glucose levels need to be controlled. Once achieved, this may improve symptoms. Follow a healthy eating plan and get a lot of exercise. Do not smoke or drink alcohol, and keep your blood pressure under control. If you are overweight, lose it.

Your doctor may choose to prescribe medication to relieve your pain and discomfort. He or she will consider carefully what to give you as the medication available doesn’t work for everyone and often has side effects.

Some people find acupuncture very helpful, and it can be used alongside conventional medicine.

Here are a few natural remedies that patients might find useful:

* Massage the feet daily with castor oil.

* The dietary supplement Alpha Lipsic Acid is a powerful antioxidant. Studies show 600mg daily may reduce the symptoms of peripheral neuropathy.

* The dietary supplement CoQ10 may also reduce symptoms.

* Omega 3 fatty acids found in cold-water fish and flaxseed are “food” for the nervous system.

* Oat seed is a mineral-rich herb that is thought to reduce numbness.

* Vitamin B6 deficiency can aggravate peripheral neuropathy, so consider introducing B6-rich foods into your diet; for example, sunflower seeds, salmon, bananas, lean chicken, and avocado.

* Capsicum pepper, as the active ingredient in a cream, has been found to reduce neuropathic pain.

The most important thing you can do to relieve your symptoms is to keep active and get good control of your blood glucose. But, before embarking on any treatment, it is essential that you consult your doctor.

Angela Davis BSc (Hons) DPodM MChS is a podiatrist with offices in Montego Bay (293-7119), Mandeville (962-2100), Ocho Rios (974-6339), and Savanna-la-Mar (955-3154). She is a member of the Health and Care Professions Council in the United Kingdom.