Now I know?*

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I’ve been a type 2 diabetic for many years now and each time I’ve visited my endocrinologist (my diabetic doc), he asks me about neuropathy and do I need more meds for it. I have never really known what he was talking about because as I wrote in a previous post, I’ve kept really good care of my feet and aside from some numbness occasionally in a couple of my toes on the left foot and a rare kind of sharpe pain up a foot, I’ve never experienced any neuropathy.
However, the past two months have educated me greatly on what neuropathy is and the pain it can cause.

Just what is Neuropathy?

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I’ve been studying and reading a lot about diabetic peripheral neuropathy (PN) for weeks now and have found that it is one of the more painful neurological complications of diabetes.

Neuropathy is basically nerve damage.  Sometimes peripheral neuropathy is called “Stocking Glove syndrome.”  This is because it mostly affects the feet and hands.  When your feet are affected, there is a great danger that the numbness will cause you to not notice an injury to your feet as you walk about.  An injury that is not noticed and taken care of can lead to infection and gangrene and then to a dreaded amputation.

“Distal polyneuropathy” is another term for the most frequent form of diabetic neuropathy.  Distal, meaning far away from the center of the body (i.e., feet and hands)  Poly means many and neuropathy is disease in nerves.  This disease can affect many nerves and is moslyt noticed in the feet and hands.  Here is a link to a great article on neuropathy. 

Symptoms

Symptoms of PN are:

• A feeling of “pins and needles”
• Tingling and/or burning sensations
• In some people, pain
• Numbness
• Balance problems (if PN is in your feet)
• Reflex problems and muscle weakness

Symptoms of Distal polyneuropathy are:

• Diminished ability to feel pain and heat/cold from loss of small nerve fibers.
• Diminished+ability to feel light touch (or numbness) or feel the position of the foot, whether bent back or forward, from the loss of large nerve fibers.
• Insignificant weakness
• Tingling and burning
• Extreme sensitivity to touch
• Loss of balance or coordination

There are other kinds of neuropathy also:

Polyradiculopathy-diabetic amyotrophy.

This is pain of loss of muscle strength in the muscles of the upper leg so you cannot straighten the knee.  Often only time an improve this.

Radiculopathy nerve-root involvement.

In this, the root of the nerve as it leaves the spinal column is damaged.  Pain is distributed in a horizontal line around one side of the chest or abdomen.  Pain can be very severe and can be confused with an abdominal emergency.  Time can resolve this along with good glucose and pain control

Mononeuropathy.

Nerves to the various muscles can be affected, causing you to lose the ability to move those muscles.  Depending on which nerve is affected, you can lose the ability to move an eyeball, eyelid, facial muscle, etc.  Usually time resolves this disorder.

Autonomatic nerves.

Nerves over which you have no control can be affected and depending on which nerve is involved, you can experience bladder abnormalities, sexual dysfunction, intestinal abnormalities, gallbladder problems, diarrhea, heart abnormalities, sweating problems, pupil problems and more.

Entrapment neuropathies.

These are caused when individual nerves are squeezed when they pass through bony or ligamentous areas of the body.  Examples are carpal tunnel syndrome, ulnar entrapment, radial nerve entrapment, peroneal entrapment, Tarsal tunnel syndrome, lateral femoral, and cutaneous nerve entrapment

What causes neuropathy?

Nerve disease or neuropathy can be caused in diabetics by smoking,  poor blood glucose control, being over the age of 40, and long time diabetes.  Damage to nerves can be caused by vascular damage from being cut-off from the blood supply to the nerve or metabolic, from chemical toxins produced by the metabolism of too much glucose.

Neuropathy can also be caused by other diseases and events, such as allergic reactions, infections, and injuries.

My neuropathy

In my case, I began to feel the stings and burning of neuropathy when I developed vasculitis and subsequently many foot ulcers on my feet and lower legs.  The pains I felt and still do resemble what one man described as falling into a “fire ant” hill and being stung over and over again.  The pains are burning and sharp and run up my legs from toes to knee area. Sometime on my left foot, I have what I call a “pain spasm” where my foot begins to have a Charlie-horse type drawing up along with extreme pain.  This is very uncomfortable and hard to bear.

These pains currently stay with me both day and night, although I must say, the night pains are the worse and keep me awake most if not all of the night.  The pains are easier to ignore during the day when I can be more easily distracted with other things.

So far, my hands only have a slight swollen and numb feeling; sometimes I fumble and drop small things.  But no pains to speak of in my hands.

 

Treatment of Neuropathy

 

How is neuropathy treated?  There are several things you can do to treat the pain of neuropathy:

• Get tight control of your blood glucose to control the damage (I’m working on this)
• NSAIDs or Nonsteroidal anti-inflammatory agents, such as ibuprofen and sulindac to reduce inflammation. (I’m using some creams on my ulcers).
• The use of certain antidepressants, like amitriptyline and imipramine can reduce the pain.  Cymbalta can also be used (I use Cymbalta once daily 60 mg).However Cymbalta can also cause suicidal thoughts.  I’m not worried about that so much because extreme pain all day can cause these also.  I’d rather deal with the thoughts and have less pain.
• The drug Neuroton or Gabapentin can help (I use 600 mg of this each day).  However it can cause dizziness and sleepiness.
• Isosobide dinitrate spray can help.
  Alpha Lipoic acid given via iv can help.  I’m trying the oral version but not sure it will help.
• A new treatment called anodyne therapy uses pads that emit an infrared light that increases circulation under the pad of the food can improve sensation and balance and reduce pain.

I’m fairly sure my ulcers and sudden bout with neuropathy is caused by one of the chemo drugs I take to treat my essential thrombocytosis.  I use hydroxyrea, which has a rare complication in long term users like myself of causing leg and foot ulcers and neuropathy.

The main treatment is to discontinue use for the ulcers to heal.  However, my oncologist is not totally convinced that the hydrea is causing this yet, so we have just reduced my dose for now.

I’m personally ready to stop it altogether and try another poison to treat the ET and platelets but will wait a little longer to make a point to the doc of the pain I’m going through with these unhealed wounds and the increased chance of amputation.  I won’t wait very much longer though before we have a heart to heart talk.

However, never again will I underestimate the discomfort when people talk about their neuropathy pain.  This pain is not small or easy to discount.  It is literally the worse pain I have ever endured in my entire life.  It has lasted over 8 weeks for me and I’m so ready to be past it.

 

Comments

Thanks for looking at my site and coming to this page. I would love for you to leave any questions or comments below.  In addition, I’m open to new topics to research and comment on as they pertain to my own health and experience living with diabetes.  Please share your interests and questions in your comments.  I also love to hear others stories about how they handle their own diabetes issues.

– Shirley