Nerve Damage in Your Hands and Feet From Diabetes
By Hope Warshaw
Having diabetes puts you at risk for nerve damage in your extremities – a condition known as peripheral neuropathy. Here are steps you can take to maintain the health of your nervous system, as recommended in the latest ADA Standards of Care.
Think of the nervous system as your body’s command center.
It’s connected with the body’s endocrine system (hormones), circulatory system (heart and blood vessels), and others. The nervous system controls movement, senses pain, and controls bodily functions like digestion, breathing, and sexual response.
Your nervous system is made up of a network of nerves and nerve cells that constantly transfer messages to and from your brain and spinal cord.
If you have diabetes, you may be at a higher risk for several different types of nerve damage – this is referred to as neuropathy. There are other, non-diabetes related causes of neuropathy, such as those due to alcohol overuse, chemotherapy for cancer treatment, or vitamin deficiency.
The Basics of Diabetes-Related Neuropathy
Your chance of developing diabetes-related neuropathy correlates closely with your age, the number of years you’ve had diabetes and, most importantly, how high your blood glucose levels have been over the years.
High blood glucose levels over time can damage small blood vessels that bring nutrients and oxygen to your nerves. Consistently high blood pressure and abnormal levels of blood lipids, like LDL-cholesterol and triglycerides, may also contribute to neuropathy. Diabetes-related neuropathy is also more likely if you have excess weight or obesity, advanced-stage chronic kidney disease, or you smoke.
There are several types of diabetes-related neuropathy that are accompanied by various signs and symptoms.
This article breaks down the American Diabetes Association’s Standards of Care for the most common type of nerve damage experienced by people with diabetes – peripheral neuropathy. It’s estimated that roughly half of people with diabetes will experience peripheral neuropathy at some point in their lives.
Peripheral Neuropathy
Peripheral neuropathy affects nerves in your peripheral nervous system, which are the nerves outside of your brain and spinal cord. Peripheral neuropathy typically occurs in the hands, legs and feet; however, it can affect other parts of the body as well.
Nearly half of the damage to peripheral nerves can occur without symptoms. The most common early symptoms of peripheral neuropathy include burning and tingling, which occur due to damage to small nerve fibers. Damage to larger fibers can cause numbness and loss of sensation.
People with decreased feeling in their feet due to nerve damage are at risk for injuries to their feet. (Read about how to keep your feet healthy.)
Other Types of Peripheral Neuropathy
Two other, less common, peripheral neuropathies can also occur in people with diabetes.
Focal neuropathies
This is damage to a single nerve, most often in the hands, legs, head or trunk of the body. Focal neuropathies tend to happen when a nerve is compressed or pinched (entrapped) where it passes through bones and tissues. A familiar focal neuropathy is carpal tunnel syndrome, which involves the hand and wrist.
Proximal neuropathies
This is damage to a nerve in the hip, buttock and/or thigh. These are less common but can be quite disabling. Symptoms may include sudden and severe pain in one of these areas, along with weakness and loss of reflexes.
Proximal neuropathies occur more often in men, in people older than 50, and those with type 2 diabetes. Symptoms usually improve over time gradually but may not resolve completely.
Annual assessment
Everyone with type 2 diabetes, and people who have had type 1 diabetes for 5 years or more, should have an annual assessment for peripheral neuropathy conducted by their healthcare provider.
Think about the signs and symptoms of peripheral neuropathy so you can be on the alert and proactively report any of these to your healthcare provider. If you think certain signs and symptoms should be addressed, don’t wait for your annual assessment. Get them evaluated as soon as possible.
Even if you don’t experience any signs or symptoms of peripheral neuropathy, make sure your healthcare provider does the annual clinical checks they should do. If not, ask for them to be done. This is considered to be the Standard of Care by the ADA. As part of these clinical checks, your provider should assess for lack of sensation or numbness by:
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Feeling your skin temperature and/or using a pin to prick (not pierce) the skin on your legs, feet and hands.
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Using a tuning fork that applies vibration to the skin.
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Using a monofilament on several points of your feet or legs. (A monofilament is a thin, yet stiff strand of nylon attached to a plastic base.)
Treatment for Pain
As usual, “an ounce of prevention is worth a pound of cure” when it comes to all diabetes complications. Daily and annual actions can prevent or slow peripheral neuropathy.
If you have peripheral neuropathy, getting and keeping your glucose levels in a healthy target range is critical. Neuropathy can also cause pain. In that case, pain management is important but can be difficult to achieve with current treatments.
Two FDA-approved prescription medications for pain are: Lyrica (pregabalin) and Cymbalta (duloxetine). Another medication, Neurontin (gabapentin), is similar to Lyrica and may be less expensive. However, gabapentin is not currently FDA-approved for treating diabetes-related neuropathy. There are also prescription medications including lidocaine and capsaicin that can be spread on the skin (topically) or used as a patch to relieve pain.
According to the ADA, the use of any opioid for pain management carries the risk of addiction and should be avoided.
Newer Treatments for Pain Beyond Medications
Several newer treatments for pain have recently been approved by FDA for difficult to manage pain (referred to as “intractable pain”) that isn’t relieved with medication or other treatment.
These devices, called spinal cord stimulators, include systems such as Medtronic’s Intellis and Vanta, and the Nevro HFX. Another device, First Relief, was recently cleared by the FDA.
Early recognition and appropriate management is essential. If you have any nerve-related signs or symptoms, make sure you discuss them with your diabetes care provider as soon as possible.
Click this link for more information about healthy targets for glucose, blood pressure and lipids.
Another common form of nerve damage, known as autonomic neuropathy, can affect other bodily functions such as blood pressure and digestion. For a breakdown of the signs, symptoms, and medications for autonomic neuropathy, read Nerve Damage From Diabetes (Part 2).
About this series:
Each year the American Diabetes Association (ADA) updates their Standards of Medical Care in Diabetes. The Standards of Care or Standards, are updated annually by the ADA’s Professional Practice Committee (PPC). ADA publishes their revised Standards each January as a supplement in one of their journals as well as online. ADA also maintains, “Living Standards.” These interim updates are published during the year as necessary based on new science. This series of articles translate the what’s and how to’s on diabetes complications based on the ADA Standards.
