About Diabetic Neuropathy

Ask the Doctor
Leslee B. Cochrane, MD.
Medical Director

Ramona Visiting Nurse Association and Hospice

Question: “I have had a terrible burning pain in both of my feet that started several months ago. At first, I thought it was because my shoes were too tight but I replaced my shoes and the burning pain has continued. Other than having diabetes which is well controlled with pills, I am in good condition. What do you think may be causing my problem?”

Answer: The burning sensation in your feet could be due to a number of factors; but given your history of diabetes it is possible you may be suffering from a condition called diabetic neuropathy. Diabetes can cause damage to nerves anywhere in the body; but the longer nerves travelling to your feet are particularly susceptible to damage from diabetes. Neuropathy occurs when the small blood vessels that supply the nerves are damaged as a result of long standing diabetes. This typically results in a variety of symptoms including numbness, tingling, and pain typically described as burning or shooting.

Keeping your diabetes under good control is important in preventing and treating neuropathy. The severity of neuropathy usually correlates with the degree of blood sugar control, the higher the sugar – the more severe the neuropathy. Other risk factors for neuropathy include age, smoking, elevated cholesterol and hypertension. Certain blood pressure medications such as enalapril (an ACE inhibitor) can help improve the blood flow to the small blood vessels surrounding the nerves and thereby slow the progression of the neuropathy.

There are several nutritional supplements and medications that are also helpful in treating the burning and shooting pain associated with neuropathy. Methylcobalamin, a form of vitamin B12, has been shown to be effective in reducing symptoms of neuropathy as has α-lipoic acid, an anti-oxidant. Some commonly used prescription medications to treat neuropathic pain include the tricyclic anti-depressants such as amitriptyline (Elavil) and anti-epileptic drugs such as gabapentin (Neurontin). These types of medicines are typically used in combination with typical analgesics such as vicodin and morphine when the pain is severe.

Patients with neuropathy are susceptible to a variety of complications such as hammertoes and ulcers. You should visit with your doctor and have your condition evaluated to determine the most appropriate treatment. If you have neuropathy, early intervention can help preserve function and prevent complications such as wounds or diabetic ulcers. Special socks and shoes designed to protect the feet from ulcers are also an important treatment consideration.

Although I have sometimes been known to put my foot in my mouth, I don’t recommend this method for treating diabetic neuropathy. If you need help with any general health related issues please contact our HELP line at 1-888-983-5337; or visit us on the web at www.help4elders.info. If you would like to submit a question please contact Jennifer Trebler at jtrebler@ramonavna.org.