Painful Diabetic Neuropathy

The toes burn and tingle and sharp pains shoot into the legs. The bed sheets feel uncomfortable on your feet and you toss and turn, hoping to drift away into a pleasant slumber. But, the "fire-like" sensation in your toes keeps you awake. You switch positions, wiggle the toes, prop a pillow under the legs, but nothing seems to help. You can only lie in bed and watch the hours on the clock pass by.

Background
Burning, numbness, tingling, hot and cold sensations, shooting and electrical pain are common sensations felt in the feet in individuals with painful diabetic peripheral neuropathy (PDN). Neuropathy is an abnormality of the nervous system. Diabetic neuropathy is nerve damage caused by diabetes and is described as a loss of sensation that starts in the tips of the toes and gradually works its way up the legs. Diabetic neuropathy is sometimes referred to as a stocking glove neuropathy because it progresses as if one was pulling on a stocking. Diabetic neuropathy can affect both the hands and the feet.

There are three types of nerves affected in diabetic peripheral neuropathy, sensory, motor and autonomic. Sensory nerves allow people to feel sensation, like pain, hot or cold or touch. Motor nerves control the muscles and allow movement. Autonomic nerves control bodily functions without our awareness or control. In the feet, an autonomic nervous response would be sweating. Neuropathy can affect all of these nerve group types, but sensory nerves are typically the first and most often affected.

Statistics
Almost twenty-one million Americans have diabetes. About sixty to seventy percent of diabetics have some type of nerve damage and about thirty percent of diabetics over forty years of age have diabetic peripheral neuropathy (CDC, 2005). Five percent of diabetics will experience painful diabetic neuropathy and the incidence increases with age. Over forty five percent of individuals who have had diabetes for over twenty five years will experience some symptoms of PDN.

The Cause
The exact cause of diabetic neuropathy is not clearly understood. Many theories exist, but the general school of thought is that high blood sugar causes chemical changes in the nerves and damages blood vessels carrying oxygen and nutrients to the nerves, impairing nerve function. A not so new theory, which is gaining in popularity is the idea that diabetics are susceptible to nerve compression. The susceptibility is thought to be due to the increased volume of the nerve from the abnormal glucose metabolism within the nerve. In layman's terms this is as if the nerve is swelling and the surrounding tissues and ligaments are pressing on the nerves, resulting in a loss of function.




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