By Beverly Matoney, Medically reviewed by Kyle Aldinger, M.D. Shelby Medical Associates
When she crawls into bed at night, Carolyn finds that her thoughts about the events of the day or the conversations she had with family or friends are thoroughly overwhelmed. She isn’t considering what she may do the next morning or where she may go for lunch.
Carolyn’s thoughts go to her feet.
“It starts as a burning sensation at night. I get into bed and my feet tingle or burn.”
The discomfort stays with her all night and she is starting to notice that it interferes with her sleep.
“During the day, it wasn’t really an issue. I didn’t notice anything. But at night, now that’s a different story…”
Carolyn has diabetic peripheral neuropathy.
Dr. Kyle Aldinger explains,
“Peripheral neuropathy can be caused by several different conditions, such as B-12 deficiency, certain medications, even chemotherapy. But the main cause of neuropathy is typically diabetes or prediabetes.”
In Carolyn‘s case, she has prediabetes. Her laboratories are starting to be off a bit, but not so much as to define her as a diabetic. She has good days. She has bad days. But she’s noticing the burning sensation more and more.
Dr. Aldinger continues,
“When PN starts, that usually means that the elevated sugars and insulin resistance that begin with prediabetes and grow from there are starting to cause the nerves to function irregularly. The brain interprets this as numbness or a burning sensation. The longer the length of the nerves, the earlier the symptoms start. So that’s why [the symptoms] typically begin in the legs and in the feet, because those are the longest nerves in the body.”
Carolyn’s story is typical of patients diagnosed with what is now termed prediabetes.
Personally, Doctor Aldinger doesn’t like that term, “prediabetes”. Diabetes and all of its complications starts somewhere years before the term diabetes is actually applied.
Most patients don’t think they have “real diabetes” when they hear the term ”prediabetes” and they rarely make the necessary lifestyle changes that prevent progression into full-blown diabetes.
They miss the best opportunity they have to avoid the real complications that accompany “real diabetes”.
Dr. Aldinger tells us,
“If your doctor tells you you have ‘prediabetes’ you must realize you are in the best stage to address the complications of diabetes. You can take charge and make real changes to protect yourself from developing a PN that cannot be reversed.”
When Carolyn learned she was prediabetic, she got to work quickly. By working with her doctor and chronic care management nurse, Carolyn was motivated to make significant lifestyle modifications and dietary changes that negated her need for medication.
If you are beginning to experience peripheral neuropathy and have been warned you have prediabetes like Carolyn, it’s time to see your doctor.
Think of it as a warning shot that your body is giving you to tell you something is wrong.
Beth’s nights aren’t much better. She has trouble sleeping and spends many a night waiting for the sun to come up. She rarely feels well rested anymore.
When she opens her eyes in the morning, Beth doesn’t think about her day or notice the sounds she hears outside. Beth’s attention is focused on how the pain of her peripheral neuropathy is creeping up her legs toward her knees.
Summer was Beth’s favorite time of year growing up. Playing at the pool, running barefoot forever outside, riding bikes and just enjoying the long hot days are treasured memories.
But now she jokes about how she gets to feel summer year round, almost all the time.
She explains that her feet feel, “like when I was little and would run across the hot pavement barefoot.” Sure it hurt, but the pain would fade into the fond memories of summer.
This pain doesn’t fade away though. It stays with her. Night and day.
Beth’s story paints a picture of what can happen as peripheral neuropathy progresses, as prediabetes moves in to the realm of diabetes, and the symptoms become very real.
William has lived with full-blown diabetes and the accompanying peripheral neuropathy for years. At first he didn’t understand why he was feeling such pain, or that his lifestyle complicated his pain. After all, he took his medications – most days.
Diabetes was just a part of growing old, and he really didn’t take it very seriously.
William says of his peripheral neuropathy at its worst,
“I feel like my feet are on fire all the time! I can’t sleep from the pain and it’s driving me insane.”
Then the burning sensation moved into his hands.
“The pain felt like it would never end.”
William was miserable.
When the pain got out of control, he realized it was time for action and finally got serious. Fortunately, William made up his mind to work with his doctor beyond just taking medications. His diabetes wasn’t just old age and it was time to take control of his health.
William’s story is extreme, but can serve as a caution to follow your doctor’s recommendations.
He worked with his CCM nurse and walked through his typical diet. Together they worked to put his doctor’s recommendations into action. They talked monthly, refining his lifestyle changes, answering questions, and exploring ways both big and small to make his life enjoyable again.
The hard work paid off. Over the months he noticed he could sleep a little more each night. His balance seemed improved. The pain has lessened and is now barely noticeable in his hands. His feet, though they continue to tingle and burn, have become more tolerable.
The number one way to avoid developing PN is to get serious about keeping your diabetes – especially your “prediabetes” – under control. Sometimes you can’t avoid diabetes, but you can actively manage it.
The food you eat can be your best medicine – or your worst enemy – towards controlling diabetes.
If you are at risk for developing diabetes, either from having a family history or being overweight, now is the time to take control of your health.
Don’t view a healthy way of eating as being restrictive, instead realize all the other delicious foods you can eat and enjoy – foods that do not add to the sugar burden your body is struggling to process.
Look at exercise as a way to get out and enjoy your community, nature, and interesting events. Here are a few suggestions to get you started:
Peripheral neuropathy, when caused by diabetes, is simply a symptom of a bigger picture called sugar toxicity, and your body’s inability to process it properly.
When blood sugar is controlled, the peripheral neuropathy can fade to the background, or ideally, becomes history.
Sometimes you can’t avoid diabetes, but you can actively manage it.
If you’ve been diagnosed with Type 2 diabetes (T2D), continue to focus on healthy eating that lowers the sugars and carbohydrates in your diet and adding moderate activity to avoid complications from T2D.
Doctor Aldinger stressed,
“I know it seems cliché that we always seem to be talking about diet and exercise, but that really is the first, best, and least expensive way to keep diabetes under control and avoid complications like PN.”
Beth worked to improve her diet and exercise regularly. She monitored her blood sugars and kept them in a good range.
But she needed a little more help to relieve her symptoms and control her PN. Working with her doctor, she decided to try a medication that she uses nightly with success.
When diet and lifestyle modifications are not enough, there are many excellent medications that can significantly reduce the symptoms of PN and their impact on your daily life.
Most of these medications are relatively inexpensive, adjustable, and when managed properly can have minimal side effects
If you have been prescribed medication, take it as prescribed. Monitor your blood sugars regularly, first thing in the morning before eating or as recommended by the doctor working with you on controlling your T2D.
Dr. Aldinger adds,
“Medications do help, but when you can take steps that can avoid or delay the onset of PN, listen to your doctor and do them. The old adage is correct. An ounce of prevention is worth a pound of cure. The best way to avoid medication is to not require it in the first place.”
Taking your diabetes seriously and making the necessary lifestyle modifications is the key to treating PN. Together, you and your doctor can manage your conditions to keep you on track to succeed.
“I know it will never be back to normal, but I can live with this.”
If you are worried that some of the above symptoms sound familiar, or if you have questions about diabetes or peripheral neuropathy, then call Shelby Medical Associates to schedule a visit with your doctor to discuss your symptoms and treatment options.
Take care of you, take care of yours. We’ll be there to help you with both