If you have been diagnosed with diabetes, you already understand the challenges that lie ahead. One of the most frustrating and painful challenges is diabetic leg pain. Here are nine tips for preventing and managing the pain of diabetic peripheral neuropathy.

What is diabetic leg pain?

Diabetic neuropathy is a nerve disorder that originates as a comorbid condition of diabetes and the word “neuropathy,” which indicates a condition of the nerves. Also known as diabetic peripheral neuropathy, this condition is unfortunately common in patients with poorly controlled diabetes.

There are two types of diabetes: Type 1 and Type 2. Type 1 diabetes is a congenital condition (present at birth). Type 2 can develop over time in susceptible people. For both, blood sugar must be controlled either through medication or diet (or a combination of the two).

If blood sugar is not properly controlled, the small capillaries that deliver blood to the nerves become damaged. This damage occurs mainly on the periphery of the body—the legs and feet, most commonly—but it can occur anywhere. When the nerves are damaged, diabetic leg pain can occur.

The condition can affect several nerves in the limbs including sensory nerves, motor nerves, and autonomic nerves. Sensory nerves are those that receive sensations like pain or touch. Motor nerves control movement. And autonomic nerves control functions like blood pressure.

Risk factors

An estimated 50% of people with diabetes experience neuropathy. The condition is most common in individuals who have difficulty controlling their blood sugar levels.

While diabetes, especially with uncontrolled blood sugar, is the most common cause of peripheral neuropathy there are other risk factors. These include:

• Alcoholism
• Vitamin deficiencies
• Infections, such as Lyme disease or shingles
• Autoimmune diseases
• Repetitive motions

What does diabetic leg pain feel like?

We explore more of the symptoms in an earlier post here, but in general, symptoms can impact not only feeling but also movement. Diabetic neuropathy typically begins gradually with numbness or tingling in feet or hands, which then spreads throughout the limbs. Burning and sharp pains are also common.

Other symptoms that occur as the syndrome progresses are varied and can include the following.

• There may be changes in the skin, hair, or nails
• People often experience muscle weakness
• Sharp, shooting, or burning pain occurs
• Paralysis can also occur if the motor nerves are affected
• Changes in blood pressure causes dizziness or digestive problems (depending on the affected nerves)
• Wounds heal more slowly
• Some patients experience gastrointestinal issues
• Others have an increase in urinary tract infections

Symptoms follow a progression, but everyone who suffers from diabetic leg pain may experience them to different degrees. The progression depends on being alert for symptoms early on and taking action to slow the damage.

Can diabetic neuropathy be reversed?

Your body is incredibly resilient. There are many types of nerve damage that can be healed. In fact, one of the most frustrating things about some chronic pain treatments (e.g., radiofrequency ablation) is the fact that nerves heal and begin sending pain signals again!

But when it comes to leg pain caused by diabetic peripheral neuropathy, the damage is usually permanent and irreversible. This is why blood sugar control, weight management, and other preventative treatment is so important.

Recent research into diabetic leg pain

Over 100 million adults in the U.S. are either living with diabetes (or heading that way). Researchers have been hard at work in the past two decades trying to untangle a standard of care for diabetes and related diabetic leg pain.

It’s clear from the following studies that there are ways to better prevent and manage diabetic peripheral neuropathy. Here are five of the key findings.

1. Management and prevention of diabetic leg pain: It depends

Research in 2016 debunked other studies that focused on aggressive management of blood sugar. It appears that successful prevention strategies depend on the type of diabetes a person has.

Blood sugar control is most important for Type 1 diabetes, while controlling weight is the focus for Type 2.

2. Monitoring at-risk people is key

Because diabetes relies on patient compliance with treatment protocols, one of the best ways to prevent diabetic peripheral neuropathy is to monitor patients who might not comply with care.

Using better diagnostic tools and paying close attention to at-risk patients can prevent diabetic leg pain from developing or worsening.

3. Management of symptoms is multi-pronged approach

The symptoms of diabetic neuropathy are challenging to manage. Because of this, researchers are finding that the best treatment approach is a multi-pronged one. Crucial aspects include:

• Early diagnosis
• Prompt intervention
• Pain treatment

4. Exercise can reduce symptoms

Even if you are experiencing diabetic leg pain, exercise has been shown to relieve some of the most disturbing symptoms (e.g., pain, numbness, difficulty with movement).

In the simplest terms, exercise appears to prevent pain-inducing triggers from occurring and increase positive nerve signaling when it comes to movement.

5. Quitting smoking dramatically lowers your risk

One of the healthiest things you can do in general is quitting smoking.

It turns out that smokers with diabetes have a much higher risk of developing diabetic peripheral neuropathy than those who do not smoke. Smokers also have trouble regulating blood sugar and are more likely to be obese.

How to prevent, treat, and relieve diabetic leg pain

Our bodies are wonderfully individual, so your treatment path won’t be the same as every other patient. The best approach is to talk to your doctor to find the best way to prevent, treat, and relieve diabetic leg pain for you.

Here are nine tips to help manage and relieve diabetic leg pain.

1. Use exercise to promote overall health

Physical activity remains one of the most basic lifestyle modifications recommended to patients with diabetes. For patients with Type 2 diabetes, one of the key benefits of exercise may be prevention of diabetic leg pain.

Physical activity helps cells develop greater sensitivity to insulin. This helps the body better process it. Exercise also activates a special cellular activity that involves absorbing blood glucose, according to the American Diabetes Association.

Other benefits of exercise include:

• Weight loss
• Stress relief
• Reduced risk of heart attack and stroke
• Better circulation

These all improve health and reduce the likelihood of complications from diabetes, including diabetic leg pain.

2. Eat a diabetic-friendly diet

Very few people get excited when they hear the word “diet,” but focusing on food as medicine can be a way to prevent diabetic leg pain. In a 20-week pilot study of diet for patients with Type 2 diabetes, participants who switched to a plant-based diet had less pain, better nerve conduction, and weight loss.

But you don’t have to become a vegetarian to improve your diet. Following Michael Pollan’s “eater’s manifesto” can help:

• Eat food
• Not too much
• Mostly plants

Whole grains, lean proteins, and lots of fruits and vegetables are key here. Limiting processed foods, sugar, and excessive dairy can all help manage inflammation in the body and keep blood sugar levels stable.

Nutritional counseling can help you understand how simple changes to your diet can help.

3. Manage weight

Related to lifestyle changes that include diet and exercise are all of the steps you take to lose weight. Losing weight is an important step for reducing any types of leg pain, but especially diabetic leg pain.

Lower weight simply reduces the amount of pressure on the legs. Because obesity is a risk factor for developing Type 2 diabetes, weight loss can also help with prevention. Once a person is diagnosed with Type 2 diabetes, though, weight loss can also help to manage diabetes symptoms.

4. Maintain appropriate blood sugar levels

Maintaining stable blood sugar levels is key to preventing nerve damage that occurs with wild blood pressure spikes.

Work with your doctor to figure out an appropriate strategy for this. Some people with diabetes benefit from several small meals a day (instead of three big meals). Others might manage their weight and stabilize their blood sugar with a standard breakfast, lunch, and dinner.

Each person’s best practice will be different. Work closely with your doctor to find your most appropriate strategy.

5. Practice daily foot and leg care

Because early detection is key, proper foot and leg care is crucial in preventing diabetic peripheral neuropathy.

Check your feet and legs every day for cuts, scrapes, blisters, swelling, or redness. Apply moisturizer (massage for good circulation!). Keep your feet clean and dry. Wear clean socks every day, and invest in high-quality, properly fitted footwear.

6. Build healthier habits for compounded prevention

If you can only manage one change at a time (i.e., you can only change your exercise habits), that is certainly better than nothing. But the most powerful prevention and treatment occurs when you use each of these strategies together.

Changing your diet and adding exercise will help you with weight management. Symptom management plus diet and exercise magnifies the effects of each one of those tools.

Change is hard. It may seem like an insurmountable obstacle. But every step you take to prevent further damage from diabetic peripheral neuropathy means a better quality of life.

7. Try physical therapy

As diabetic leg pain progresses, it may become harder and harder to maintain the motivation to exercise. This is where physical therapy can be a lifesaver.

Physical therapists design a tailored set of exercises that help increase circulation, relieve pain, and stretch and strengthen the muscles of the legs. These sessions can also help manage both weight and blood sugar—two keys to easing leg cramps and other diabetes leg pain.

Another benefit of physical therapy is that it can ensure proper posture and gait training. If you have been walking off-balance due to leg pain, that can affect your whole body. A physical therapist can help you recognize that and work to fix it for better overall health and prevent other related pain issues.

8. Look into topical treatments and medications

Topical treatments can help relieve diabetic leg pain with few side effects or drug interactions. Consider using lidocaine patches and capsaicin cream to alleviate your pain.

Although opioids are not suggested for diabetic leg pain, over-the-counter pain relievers may provide relief when pain flares up. Other medications to treat this type of chronic pain may include tricyclic antidepressants.

9. Talk to your doctor about diabetic leg pain treatments

If more conservative approaches do not work and your pain is progressing, there are other options. Interventional strategies that can help relieve diabetic nerve pain include:

• Pain-relieving injections
• TENS unit therapy
• Nerve blocks

Get help with your diabetic leg pain

At Arizona Pain, or goal is to help you get your life back. We recognize the challenges that people with diabetes face, and we want to help you meet them head on.

If you are experiencing diabetic leg pain (or want to explore comprehensive strategies to prevent it), get in touch to schedule an appointment today. We can help.

Diabetes is a complex chronic condition that comes with a host of symptoms if not properly managed. One of the most complicated and challenging symptoms to treat is diabetic peripheral neuropathy. Also referred to a peripheral neuropathy or diabetic foot pain, this complicated condition requires thoughtful diagnosis and comprehensive treatment. What is peripheral neuropathy, and what does diabetic nerve pain feel like? Here’s what you need to know.

What is diabetic nerve pain, or diabetic neuropathy?

Neuropathy is an over-arching term that means nerve pain. There are four types of neuropathy, including:

• Peripheral neuropathy
• Autonomic neuropathy
• Radiculoplexus neuropathy
• Mononeuropathy

Peripheral neuropathy refers to nerve pain that is experienced on the periphery of your body, like the hands and feet. This area is enervated by the peripheral nervous system (instead of the central nervous system, which deals only with the brain and spinal cord).

There are many conditions that can result in nerve pain in the farthest reaches of the body, including:

• Vitamin deficiencies
• Alcoholism
• Autoimmune diseases
• Certain medications

The most common cause of peripheral neuropathy, though, is poorly controlled diabetes.

The hallmark of diabetes is a nearly constant fluctuation of the blood sugar, with spiky highs and cavernous lows. This constant fluctuation damages the capillary walls (small blood vessels) responsible for delivering blood to the nerves, especially in the hands and feet. As the capillaries become more damaged, diabetic neuropathy symptoms begin to appear.

What does diabetic nerve pain feel like?

So what does diabetic nerve pain feel like? There are many symptoms, including early onset symptoms that may be mild and challenging to diagnose. Diabetic neuropathy symptoms usually begin in the toes and work their way towards the head.

The first symptoms you may experience are tingling and numbness in the toes or fingers. This may resemble the feeling of “pins and needles” when a foot that has fallen asleep begins to wake up. You may also experience cramping in the feet, poor reflexes, and poor balance or coordination. Some people experience hypersensitivity and feel painful sensations with the slightest touch (even of the bedsheet grazing your toes at night).

In one of the few visual symptoms of diabetic peripheral neuropathy, a person may develop what is known as a hammertoe. This foot deformity causes the toes to begin to curl under and develops as a result of unconscious modification of the gait due to pain or other symptoms.

As the condition progresses, symptoms become more pronounced and more challenging to treat.

11 common diabetic neuropathy symptoms

Left untreated, diabetic neuropathy symptoms increase in intensity as the condition worsens. Wondering what does diabetic nerve pain feel like? Here are 11 symptoms to watch out for.

1. Increased numbness

This feeling can worsen to the point where a patient is unable to feel their feet as they walk. This becomes especially dangerous when feet lose all feeling.

The patient is then unable to tell if their feet have been injured or if the bathwater they are about to step into is too hot. Serious scalds, burns, and cuts can result from this numbness.

2. Burning in the feet

Diabetic foot pain is often accompanied by tingling and burning in the feet.

Ranging in intensity from barely perceptible to full-blown unbearable, this is the nerves’ way of communicating distress even further.

3. Sharp, shooting pain

This is the type of pain that can leave a person breathless. Almost like an electrical shock, this pain can occur without any particular stimulus or prompt.

4. Increased pain at night

Whether it’s because you are no longer distracted by the concerns of the day or the hypersensitivity and pain caused by even the sheet touching your feet, diabetic nerve pain is often much worse at night, making sleep impossible.

Because poor sleep and increased pain are bidirectional, one makes the other more intense in a cycle that is hard to break.

5. Slow-healing wounds

An adequate blood supply is important for good circulation that helps heal wounds.

For patients with peripheral neuropathy, even the slightest wound may be slow to heal (or may not fully heal).

6. Muscle weakness

As peripheral neuropathy progresses, muscle weakness may develop.

The peripheral nervous system is not just responsible for sensory information. Signals for movement and coordination are also delivered via these nerves. Nerves that are damaged rely on inadequate or incomplete information to the muscles and may result in poor coordination and weakness.

7. Gastrointestinal issues

Most people don’t think about the gastrointestinal system when considering peripheral neuropathy, located as it is in the center of the body.

However, as peripheral neuropathy continues to progress, this system can also be affected. Nausea, vomiting, diarrhea, and constipation can all occur.

8. Sexual dysfunction

Men with peripheral neuropathy may experience erectile dysfunction related to decreased blood flow and poor nerve signaling.

Women may experience increased vaginal dryness and a lack of desire.

9. Urinary tract infections

Men and women both may experience urinary tract infections.

The body may be overwhelmed with infections elsewhere in the body, and other gastrointestinal issues can lead to issues in the urinary tract as well.

10. Postural hypotension

Also known as orthostatic hypotension, this condition occurs when a person’s blood pressure drops dramatically, even when sitting, causing them to faint.

This can be potentially serious if it occurs while driving or even when simply standing up.

11. Amputation

Diabetes is responsible for approximately 70,000 amputations of the lower limbs annually in the U.S.

When feeling leaves the lower extremities and wounds or sores go undetected, they can become infected and even gangrenous. In these cases, amputation must be performed to prevent further damage or even death.

Can diabetic neuropathy go away?

Without treatment, diabetic neuropathy will not resolve itself and can, in extreme cases, lead to death from infection. It is crucial to get a proper diagnosis first and then proceed with treatment.

In the beginning stages of diagnosis, your doctor will conduct bloodwork and lab tests to rule out other potential causes of your symptoms.

Once your doctor eliminates other conditions, they may perform additional tests, including:

• Nerve conduction studies: Measures nerve response to electrical stimulation
• Electromyography (EMG): Measures electrical discharge from the nerves
• Filament tests: Looks for hypersensitivity that is the hallmark of peripheral neuropathy
• Quantitative sensory testing: Measures the nerve response to sensory changes including vibration and temperature

How to treat diabetic peripheral neuropathy

Once you have a diagnosis, there are many treatment options to ease symptoms and prevent worsening of nerve pain.

1. Manage diabetes

Since diabetic nerve pain is caused by poorly managed diabetes that causes damage to the blood vessels, the first thing to do is to get your blood sugar under control.

Talk to your doctor about changes to diet, exercise, and insulin administration that can help.

2. Keep an eye on your feet

Early warning signs occur most often in the feet. Check your feet daily for blisters, cracks, ingrown toenails, or wounds that are slow-healing or getting worse.

The American Diabetes Association recommends an annual foot exam, but daily foot checks are crucial for early detection and treatment. If you are unable to bend down to see the soles of your feet, use a mirror or ask a family member to help.

3. Practice proper foot care

In addition to daily checks, taking care of your feet can help improve health.

Daily foot massage improves circulation and feels relaxing at the end of a long day. Keep feet clean, dry, and moisturized to maintain skin health, too.

4. Stop smoking and limit or avoid consumption of alcohol

Health begins with what you put in your body. Tobacco products in any form inhibit the body’s healing response and narrow already challenged blood vessels. Alcohol has a similar effect on the immune system, dampening the body’s response to infection.

Some people are able to consume a daily glass of red wine or two, but talk to your doctor. In acute stages of infection, avoid alcohol.

5. Get active

The prime risk factor for both Type 1 and Type 2 diabetes is obesity. Extra weight places a huge burden on your joints and feet, which can make self-care challenging.

To combat this, exercise maintains a healthy weight, slows nerve damage, and naturally manages blood sugar, all of which can help alleviate symptoms of peripheral neuropathy.

6. Investigate medication

There are some medications that can assist in pain relief. Anticonvulsant drugs and tricyclic antidepressants, although not well understood in how they work on this condition, do seem to help relieve diabetic foot pain by changing the way the brain senses pain.

Tricyclic antidepressants include:

• Amitriptyline
• Clomipramine (Anafril)
• Desipramine (Norpramine)
• Doxepin
• Imipramine (Tofranil)
• Nortriptyline (Pamelor)

Finding the right medication may take some time, so be patient with this treatment approach.

Non-opioid pain relievers may also help for acute cases, but opioids are not generally recommended for peripheral neuropathy.

7. Use topical creams and supplements

Capsaicin is the compound found in spicy peppers that can provide topical pain relief.

Alpha-lipoic acid (ALA) is a supplement that may help lessen the advance of diabetic peripheral neuropathy.

8. Try physical therapy

Physical therapy exercises for diabetic peripheral neuropathy can help provide relief from tingling, burning, and pain in the feet. These exercises also improve muscle strength and physical coordination. They may also help with sexual dysfunction by improving blood flow and circulation.

For patients who have injured their feet by changing the way they walk, consciously or unconsciously, gait training is a type of physical therapy that helps people learn how to walk again. It is also used for people who have a prosthesis to help them walk properly so as not to transfer injury or pain to another part of the body (e.g., the hips).

Some physical therapy is combined with electrical nerve stimulation, which may help with stiffness in the feet and speed healing of ulcers or other wounds on the feet.

9. Manage other conditions

If you are experiencing gastrointestinal side effects including nausea, constipation, or diarrhea, managing these is important. Focusing on a supportive diet can help.

Similarly, it is important to treat urinary tract infections promptly, as increased nerve damage may result eventually in urine leakage.

For patients with sudden drops in blood pressure, compression stockings for the abdomen and legs can help, as can simply taking care when changing position.

10. Research advanced care

Other pain-relieving injections and therapies can help with more advanced cases, such as TENS unit therapy or nerve blocks.

This complex condition also remains the focus of much research and study. For example, a recent non-viral gene therapy study offered promising results in the dramatic pain relief of diabetic peripheral neuropathy with low doses of medication, well into a year after the treatments.

Diabetic peripheral neuropathy is a challenging condition that needs a comprehensive approach to treatment. If you are experiencing this side effect of diabetes or another pain condition, give Arizona Pain a call today. We can help.

People with neuropathy looking for relief may want to try a vegan diet, according to a study completed by doctors with the Physicians Committee for Responsible Medicine (PCRM).

Vegan diets not only exclude meat, they are also devoid of eggs, cheese, chocolate, and other foods containing animal byproducts such as milk. Unhealthy vegan diets do abound—doughnuts and French fries cooked in vegetable oil technically follow the rules—but eating a balanced vegan diet rich in vegetables and fruits could help reduce pain from neuropathy, the study found.

People with neuropathy benefit from meat-free diet, study says.

Keep in mind that strict vegan diets are separate from vegetarian diets, which typically include eggs, milk, and cheese. However, both vegan and vegetarian diets have been found to be helpful for people with neuropathy.

Neuropathy involves nerve pain that may develop as a consequence of an underlying condition, including diabetes. About 50% of people with diabetes have the condition, and unfortunately effective treatment is extremely limited. Existing treatments only attempt to mitigate pain and aren’t able to offer a cure.

To uncover the benefits of a vegan diet on diabetic neuropathy, PCRM doctors assigned two groups with a total of 15 patients to a meatless diet low in fat and high in fiber. Diets included at least 40 grams of fiber each day and no more than 30 grams of fat, even if the fat came from healthy oils or nuts.

The foods also had to have a low glycemic index, which means they don’t lead to spikes in blood sugar. Examples of low glycemic foods include barley, grapefruit, and chickpeas, according to Harvard Medical School.

One group of study subjects received B12 supplements, and the other did not. In the groups, patients were a mean age of 57, and males and females were equally represented.

Transitioning to a vegan diet often requires support, and so the patients were required to attend weekly classes over the course of 20 weeks where they learned about nutrition and watched cooking demonstrations. They also sampled healthy vegan cuisine and connected with others living on a vegan diet.

Social support and learning new recipes helps people stick to a vegan diet.

The results showed strong support for the vegan diet’s potential for managing neuropathic pain, particularly those patients who took B12 supplements.

Researchers plan to continue studying the patients for one year to examine the long-term health effects of meat-free eating and its impact on neuropathy.

The PRMC research came on the heels of an earlier study conducted by doctors at California’s Weimar Institute. Scientists found that 81% of patients who abstained from meat experienced dramatic pain relief from neuropathy in as little as four days. Patients also lost on average 11 pounds.

Most patients in the study were also able to reduce the amount of medicine for diabetes and blood pressure they were taking. Patients’ cholesterol levels also dropped.

After four years, 71% of 17 patients studied continued to eat a vegan diet, and most experienced lasting relief from neuropathic pain. Researchers attributed the improvement to the meat-free diet, and not the better controlled glucose levels that also occurred.

Following a vegan diet can have wonderful health benefits, but risks include not ingesting the proper amount of required nutrients.

The American Dietetic Association (ADA) says “appropriately planned” vegan or vegetarian diets can provide health benefits or even prevent certain diseases.

Benefits of eating a meat-free diet, according to the ADA, include:

• Lower cholesterol
• Decreased risk of heart disease
• Lower blood pressure
• Lower risk of type 2 diabetes
• Lower risk of cancer
• Healthier weight

The key, according to ADA, is making sure that vegan or vegetarian diets are low in saturated fat and cholesterol while staying high in fiber and vital nutrients such as magnesium and potassium. Risks of eating a meat-free diet include lower levels of vitamins B12 and D, calcium, zinc, and omega 3 fatty acids, found in fish, which help protect the heart in addition to offering benefits for those experiencing neuropathy.

A potential B12 deficiency is especially important for those with neuropathy to stay aware of since deficiencies have been identified as a cause of the condition. The vitamin is integral to basic bodily functions, such as making DNA and red blood cells. Taking supplements or eating fortified foods is the best way for vegans to avoid deficiencies.

Soy or rice milk comes in B12 fortified options, as do some health food formulas developed specifically to meet vegan and vegetarian nutritional needs. Vegetarians can eat eggs, yogurt, or other dairy products to meet intake requirements of B12.

Fortified foods also help vegans take in enough calcium. An Oxford study cited by ADA found vegans were at a 30% greater risk of fracturing a bone, possibly because of lower calcium levels. To ingest enough calcium, some vegans take supplements or eat calcium-fortified foods, such as soy milk. Plants high in calcium include kale, bok choy, broccoli, and collard greens. Dried figs and sunflower seeds are also high in the important mineral.

Eating enough protein is another factor to consider during meal planning for vegans or vegetarians. However, the ADA says plant-based diets can provide enough protein for even athletes.

Protein from soy products, including tofu, is as effective at meeting the body’s requirements as animal products, according to ADA, although people eating protein solely from vegetables and grains may need to increase their daily intake to meet recommended levels.

No. 1 tip for a healthy meat-free diet? Mix it up. Eat a variety of fruits, vegetables, and grains.

If you’re looking to try a vegan diet, but are nervous to try, start small. Consider declaring one day each week meat-free. Knowing which foods to eat is also half the battle. Consider investing 30 minutes on a weekend and researching new recipes or buying a vegan cookbook.

Vegan meals can be tasty, healthy, and affordable. By using hearty foods like beans and experimenting with fun, colorful vegetables, your dinner plate will never be the same.

And hopefully, the diet will help you reduce pain from neuropathy.

Have you ever tried a vegan diet?

Image by Sonny Abesamis via Flickr