Diabetic Nerve Pain & Diabetic Wounds

    
Kiah Connolly, MD

One of the most common sequelaes of diabetes is a condition called neuropathy. While not in itself life-threatening, neuropathy can tremendously impact people’s lives in a variety of ways and frequently leads to wounds. 

Diabetic wounds can cause many problems - and can even be deadly if not cared for promptly and aggressively.



What is Diabetic Neuropathy? 

Diabetic neuropathy is nerve damage caused by diabetes.

Neuropathy happens when the levels of sugar (glucose) and fat (ie: triglycerides) in your blood are too high for too long. 

Peripheral Neuropathy

The most common diabetic neuropathy (nerve damage), is peripheral neuropathy. It occurs in about 1/3rd to ½ of all people with diabetes (1). These are the nerves that control the feeling and sensation in our arms and legs. 

People with diabetic peripheral neuropathy may experience numbness, tingling, and pain. Most people experience some level of decreased sensation - meaning they can’t feel things as well as they used to. The symptoms are most often equal on both sides however sometimes one extremity can be more affected than the other, called focal neuropathy. 

Other Diabetic Neuropathy Symptoms

Unfortunately, neuropathy isn’t only limited to the extremities. There are many types of diabetic neuropathy.

Almost any nerve in the body can be affected by diabetic nerve damage. 

Other symptoms of diabetic neuropathy can include (but are not limited to): 

  1. Abdominal Pain, Nausea, and Vomiting (gastroparesis) 
  2. Sexual Problems (erectile dysfunction) 
  3. Vision Problems (diabetic retinopathy) 
  4. Problems Urinating (urinary retention or incontinence) 
  5. Muscle Weakness 
  6. Chronic Pain
  7. Heart Problems 
  8. Proximal Neuropathy 
    TrifectaHealth_Diagrams_Symptoms of Diabetic Neuropathy

Cause of Diabetic Neuropathy 

The detailed causes of diabetic neuropathy are complex. However, all of the suspected causes are rooted in blood glucose levels being too high. 

Diabetic Neuropathy Treatment & Prevention 

Like almost every other diabetic complication, the best way to prevent neuropathy is to successfully control your blood sugar. 

Diabetic Neuropathy Prevention 

Effective blood glucose control means as little fluctuation in blood sugar throughout each day as possible. Consistently eating the right diet and exercise are critical to achieving this goal. It’s also very important to take all of your medications as prescribed, check your blood sugar regularly and work closely with your doctor to ensure you’re consistently reaching your glucose goals.  

Diabetic Neuropathy Treatment

So what if you already have neuropathy? Well, controlling glucose is still the mainstay of therapy - again by diet, exercise and medications. Your doctor may also give you medications that can help the uncomfortable sensation of neuropathy. 

Bottom Line: The best way to deal with diabetic neuropathy is to consistently control your sugars and protect yourself from any injuries - especially on your feet. 

Diabetic Wounds 

So why are we so paranoid about protecting your feet? 

Diabetic wounds can literally be deadly. And while any injury can cause a wound, the feet are most commonly affected by neuropathy and they’re also usually exposed to the most potential injuries. 

These wounds have a much harder time healing and are more likely to become infected. 

Causes of Diabetic Wounds 

People with diabetes have a perfect storm for developing chronic and complicated wounds. 

  • Decreased Sensation (can’t feel injuries occurring) 
  • Poor Circulation (decreased blood flow)
  • Impaired Wound Healing (high glucose) 
  • Increased Risk of Infections (immunocompromised) 

Decreased Sensation

Peripheral neuropathy makes it easier for people to develop wounds as it limits them from  feeling when injuries occur. This is true for mild acute traumatic injuries (ie: stubbing a toe, cuts, scrapes) as well as for more long term injuries. 

An example of a longer term injury is a foot blister from a shoe. People with diabetes may not be able to feel it develop and become progressively worse. 

Poor Circulation

Because people with diabetes are also at an increased risk to have problems with their blood vessels (atherosclerosis), they also often have poor circulation.

Without adequate blood flow, there is not enough nutrients and oxygen circulating to the wound for optimal healing conditions. 

Impaired Wound Healing & Increased Risk of Infections

The elevation in blood sugar innate to people with diabetes limits how well the immune system can work and how well the body can heal. This has lead to many health care professionals thinking about people with diabetes as being ‘immunosuppressed’.

Because diabetes compromises the immune system, these infections are more likely to occur and also harder to get rid of. Both the poor circulation and impaired immune system makes the wound harder to heal. 

Bottom line: It’s easier for people with diabetes to sustain injuries and it’s harder for these injuries to heal. People with diabetes are also more likely to get infections, and they also have a harder time fighting off these infections. 

Diabetes Amputations

Unfortunately, wounds commonly get out of control. Sometimes diabetic patients keep getting worse despite aggressive wound care and antibiotics.

Even a simple diabetic foot ulcer can keep getting deeper until it reaches bone - and becomes a dangerous condition called osteomyelitis (bone infection). The infection can also get into the bloodstream - another dangerous condition called bacteremia (blood infection).  

If wound care and antibiotics aren’t working for these conditions, the last remaining option is to cut off the body part that is the source of the infection (amputation). 

Amputations are used as a last resort - but they can be life-saving in these severe cases. 

Diabetic Wound Care 

As you can see, even the smallest diabetic wounds deserve to be taken seriously. 

Basic Principles of Wound Care

Diabetic wound care can be complex and vary between individuals and their wounds. Complex wounds often require a wound care specialist for close management. 

1. Early Identification of Wounds

Many large wounds can start out with very small injuries - such as a stubbed toe, or a small scratch. Prevention is key. However, if you do have even a small injury starting wound care early can prevent it from developing into a devastating wound in the future.

2. Prevent Additional Injuries 

Being cautious to prevent any additional trauma to an injury can give the wound the best chance of healing. 

3. Keep the Wound Clean and Dry

While wound care often involves additional interventions, it’s important to keep it clean. Unless you’re told otherwise by your doctor or wound care specialist, using simple soap and water to clean the wound, patting it dry and applying a clean dressing can go a long way in successful wound care. 

4. Diabetic Shoes

An excellent way to both prevent and care for wounds is to utilize diabetic shoes. These offer additional protection and support to help prevent even the smallest injuries - that we know can have devastating consequences.

5. Antibiotics (if infected) 

If your wound becomes infected, your doctor may put you on antibiotics. It’s important to finish the whole course of antibiotics to make sure the infection goes away - even if it seems better before you’ve finished taking all of the medication. 

6. Glucose Control

Glucose control is paramount. Check your sugars regularly and working with your doctor to manage your medications, diet and exercise to ensure your glucose is kept in check. 

HealthBlog_Headers-01Diabetic Nerve Pain and wounds






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