Neuropathy refers to peripheral nerve damage resulting in numbness, tingling, muscle weakness and pain. It’s sometimes described as a burning or electrical sensation. The symptoms a person has depends on which nerves are damaged, both in type, location and severity. Some types of neuropathy develop suddenly, while others happen slowly over time. 

What is diabetic neuropathy?

Peripheral neuropathy is defined as damage or progressive loss of nerve fibers in the peripheral nervous system. It is among the most common and disabling complications of diabetes. Diabetic neuropathy is the most common form of neuropathy in the Western world, occurring most often in the legs and feet. While people's experiences with diabetic neuropathy can vary, the condition can be both impactful and very painful.

This is partly because high blood sugar, or hyperglycemia, can injure nerves throughout the body over time. This is why diabetics are at a much higher risk of developing neuropathy. In fact, between 60 to 70 percent of diabetics will get some form of neuropathy in their lifetimes. Due to this increased risk, diabetics should stay educated about the risks, causes and treatments of diabetic neuropathy.

The nervous system: a quick refresher

The nervous system is the information superhighway of the body. It sends signals and messages at incredible speed between the brain, muscles and organs. Its main function is to collect sensory information from the environment and the body to initiate appropriate responses. 

The nervous system consists of the central nervous system (CNS) and peripheral nervous system (PNS). The CNS includes the brain and spinal cord. The PNS consists of all of the other nerves outside of the CNS that extend to the organs and limbs. 

The CNS is the main command center of the body. The PNS serves as a relay between the CNS and the rest of the body. Peripheral nerves send information from the brain to other parts of the body, and from the body back to the brain.

The peripheral nervous system (PNS)

The peripheral nervous system can be divided into two main parts: the somatic nervous system and the autonomic nervous system. 

The somatic nervous system relays information from the sensory organs to the brain. It also controls the voluntary movements of the body like walking as well as fine motor skills like buttoning up a coat. 

It is made up of two kinds of nerves: motor neurons and sensory neurons. Motor neurons convey commands from the brain and spinal cord to the skeletal muscles, driving movement. Sensory neurons send signals in the other direction, from the skin, muscles and sensory organs (such as eyes, ears and fingers) back to the CNS. Their primary function is to tell the body how to respond to its surroundings. 

The autonomic nervous system is the primary relay between the CNS and the organs. It regulates involuntary physiological processes such as breathing, heart rate, digestion, sweating and sexual arousal. It also regulates the smooth muscles, or non-skeletal muscles, which control involuntary movements like the beating of the heart.

Symptoms of neuropathy

Damage can occur to any of the nerves of the PNS, interrupting signaling. This results in a variety of neuropathic symptoms. The most commonly reported early symptom of neuropathy are numbness and tingling (a “pins and needles” feeling). And, in rare severe instances, weakness in the affected area of the body as well.

In the case of sensory neuropathy, sensory nerve damage can lead to pain, numbness and sensitivity to touch. Damage to the motor nerves can result in muscle weakness, poor coordination and cramps. 

In rare cases of autonomic neuropathy, the automatic processes of the body are harmed. This can lead to all kinds of problems. Symptoms may include: a heartbeat that is faster or slower than normal, high or low blood pressure and dizziness upon standing. 

Neuropathy can affect one nerve, a combination of nerves in a specific area, or many peripheral nerves throughout the body. Symptoms can range from mild in some people to quite painful in others.

How common is neuropathy?

Neuropathy is very common, affecting an estimated 25 to 30 percent of Americans. Because it can be difficult to diagnose, some professionals think these numbers are even higher. Overall, peripheral neuropathy is more common in Western countries than in developing countries. This is probably because many Western countries have higher rates of obesity and diabetes, which increase the risk of peripheral neuropathy.

What are the risk factors?

Risk factors that increase the incidence of neuropathy include diabetes, heavy alcohol use and chemotherapy. 

Drinking lots of alcohol drains the body of thiamine and other essential nutrients needed for healthy nerve function. This can be damaging because nerves are sensitive to levels of Vitamin E and certain Vitamin B types. Alcohol may also be toxic to peripheral nerves, which leaves heavy drinkers more vulnerable to developing neuropathy. Indeed, neuropathy is one of the most common negative effects of chronic alcohol consumption.

Diabetic neuropathy

Neuropathy is a common complication of both Type 1 and Type 2 diabetes. Chronic hyperglycemia, or high blood sugar, can damage nerves, interfering with their ability to send signals. It also weakens the walls of small blood vessels that supply nerve cells with the oxygen and nutrients they need to function.

As we mentioned, diabetic neuropathy is the most prevalent type of neuropathy in the Western world. It usually affects the nerves in the legs and feet. It can also affect any peripheral nerves, including sensory neurons, motor neurons and the autonomic nervous system. 

Diabetic neuropathy therefore has the potential to impact nearly any organ system and can cause a range of symptoms. Depending on which nerves are affected, symptoms can range from pain and numbness in the legs and hands to problems with bodily functions such as digestion. The likelihood of developing nerve damage increases the longer a person has diabetes. Most neuropathy develops over many years, and some people may not notice symptoms of mild nerve damage for a long time.

The most common type of diabetic neuropathy is called peripheral neuropathy. It affects the feet and legs first and then the hands and arms. This type of neuropathy will affect around 50 percent of all diabetics in their lifetimes and can become very painful. 

Symptoms are usually worse at night and include numbness, tingling and burning or stabbing pains. And as the condition progresses, it can also cause serious foot problems such as ulcers and infections.

Autonomic neuropathy is also quite common. It is estimated to affect 30 percent of diabetics, and can impact different organ systems and autonomic processes of the body. 

Complications of diabetic neuropathy

Diabetic neuropathy can lead to a number of serious complications. Here we cover a few, but know that diabetic neuropathy can affect almost any nerve or organ system.

Hypoglycemia unawareness 

Blood sugar levels that get too low can be dangerous, and is a risk for diabetics who take insulin or other drugs. Low blood sugar normally causes symptoms like shakiness, sweating and an increased heart rate. These symptoms sound the alarm that action is required before levels become dangerously low. But, if a person has autonomic neuropathy, these autonomic processes may not work as well, decreasing the occurrence of warning signs.

Chronic pain

Neuropathic pain can reduce quality of life by interfering with work, sleep and life events. In some people with diabetes, neuropathy causes chronic pain, which can lead to anxiety and depression. Chronic neuropathic pain affects about 26 percent of diabetic patients.

Loss of a foot, toe, or leg

Nerve damage can lead to numbness and a loss of feeling in the extremities. This makes it easy to overlook injuries such as scrapes, cuts, bruises and even ulcers. Injuries can become infected without being noticed. The infection can also spread to surrounding tissues or the bone, leading to necrosis. 

In severe cases, removal of a toe, foot, or leg may be necessary if the infection has spread. Unfortunately, lower limb amputations due to complications of diabetic neuropathy are not uncommon and are on the rise. Every year, around 200,000 Americans with diabetes will receive an amputation.

Preventing diabetic neuropathy progression

Because nerve damage usually develops over time, it is important to consult with a doctor when you first notice symptoms. This lets you create a plan to address the cause of the neuropathy and manage your symptoms. Early intervention will also slow the progression of the damage. 

Attending routine screenings for neuropathy is essential once you have been diagnosed with diabetes. Usually, the first goal of treatment is to address the underlying condition that's causing the neuropathy. In the case of diabetes and diabetic neuropathy, this means addressing your blood sugar levels.

Reducing blood sugar levels is the cornerstone of managing diabetic neuropathy. If you have diabetes but have not yet developed diabetic neuropathy, it is possible to prevent it. What you need is strict blood sugar management and a healthy lifestyle. 

If you have already developed symptoms of neuropathy, keeping blood glucose levels low can slow its progression. Without strict blood sugar management, other treatments to manage the symptoms of diabetic neuropathy, including pain, will not be as impactful. Blood sugar management is achieved primarily through a healthy diet, regular exercise, and maintaining a healthy weight.

Foot problems, including sores and ulcers, are common complications of diabetic neuropathy. They can also become chronic. That’s why it’s important to take care of your feet at home and to schedule regular foot exams at your doctor’s office. Preventing foot infections and complications from diabetic neuropathy is critical, especially for those with more advanced neuropathy. 

Natural supplements for diabetic neuropathy

Natural supplements that support healthy nerve function and have anti-inflammatory properties may help mitigate nerve damage. They can also support the downstream inflammation that contributes to neuropathic pain. 

Most people can use natural supplements along with pain medications and other modalities. For diabetic neuropathy, the below ingredients have shown promise in mitigating neuropathic pain:

Alpha-lipoic acid

Alpha-lipoic acid is an antioxidant used by the body to manage or prevent oxidative stress. This type of stress contributes to nerve fiber damage in neuropathy. Studies show that alpha-lipoic acid may relieve diabetic neuropathy symptoms, possibly by improving blood flow to the nerves. It can especially reduce burning and stabbing pains.

Vitamin B12

Vitamin B12 is essential for nerve health, and low levels can cause peripheral neuropathy. A lack of B12 can damage the myelin sheath that surrounds and protects nerves, making them unable to function properly. B12 can also help restore the structure and function of nerves, providing relief to people with diabetic neuropathy.

Vitamin E

Vitamin E is important for the movement of signals up and down nerves, and has shown much promise for diabetic neuropathy. In one study of Type 2 diabetics with peripheral neuropathy, taking Vitamin E improved nerve conduction versus the placebo.

Thiamine

Also known as Vitamin B1, thiamine is critical for proper nerve function. The peripheral nerves that run down the arms and legs rely very heavily on thiamine. They can become damaged in cases of deficiency, leading to peripheral neuropathy. In fact, studies have shown that thiamine may have both protective and therapeutic properties against diabetic peripheral neuropathy.

Pain management

From tingling sensations to burning pains to extreme sensitivity to touch, diabetic neuropathy can be very painful as it progresses. If you want to relieve neuropathic pain, there are a number of things you can try. 

Over-the-counter pain medications like NSAIDs or acetaminophen are widely used in the management of neuropathic pain. Topical creams and gels that deliver pain medications directly to the source of the pain may also bring some relief. They are also generally safe, without many of the side effects of oral medications, but should never be used on irritated or broken skin. It's always wise to consult your doctor before starting any new oral or topical medications. 

In recent years, CBD has sprung up as a popular ingredient in pain-relieving topicals and ingestibles. Pain research has shown that CBD may have strong anti-inflammatory properties. These may help pain conditions like arthritis and back pain. 

CBD may also help relieve neuropathic pain. One study showed that patients who applied CBD oil felt less sharp pain compared to the control group. 

Finally, physical therapy can also be an effective component of a pain management plan for diabetic neuropathy. Exercises, stretches, and massages can help increase strength, balance and range of motion, as well as blood flow to the nerves. Talk to your doctor to find out if physical therapy can help you.

If you have severe pain, a doctor may recommend a non-opioid based prescription strength medication. This will help manage chronic pain symptoms associated with diabetic neuropathy. Examples of these types of medication include gabapentinoids and various classes of antidepressants.  

How Clearing can help

For many diabetics with chronic pain, Clearing’s customized prescription-strength topicals may be useful in managing their pain symptoms. A quick consultation with a chronic pain expert at Clearing can help you find out if this treatment is right for you. Additionally, CBD cream to help provide soothing relief may also be available.

Through Clearing, people with chronic pain may also choose to take a nutraceutical blend that supports joint, nerve and bone health. This blend includes alpha-lipoic acid, Vitamin B12, thiamine, Vitamins D and E and anti-inflammatories. 

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