Did you know that more than 11% of the U.S. population has diabetes? Despite doctors diagnosing 1.4 million new cases each year, millions of people remain undiagnosed. This leaves countless people at risk for serious complications, including diabetic peripheral neuropathy (DPN).
To do our part in keeping the community healthy, ThedaCare is helping raising awareness for American Diabetes Month this November. We caught up with Dr. Matt Fischer, a board-certified anesthesiologist and Director of Pain Management Solutions for ThedaCare Orthopedic Care, to learn more about DPN.
People who have diabetes are at risk for DPN, but not every person with diabetes experiences the condition. High blood sugar and triglycerides from diabetes can damage nerves, causing DPN. In the simplest terms, it’s nerve damage that causes pain and other uncomfortable sensations in the hands, arms, feet, or legs.
“Patients describe their symptoms as burning, numbness, tingling, stabbing, or electrical shock-like pains,” Dr. Fischer says. “Early on, some patients report intermittent symptoms, such as impaired balance or a sensation that they are ‘walking on pebbles.’”
DPN can accompany other symptoms of diabetes, such as frequent urination, excessive thirst, and unintended weight loss, or it can present in relative isolation.
Advanced cases of DPN can cause more disruptive symptoms and damage to the body, greatly decreasing people’s quality of life. In addition to balance problems and gait changes, individuals may experience a loss of muscle tone in their hands and feet.
“Seeing your doctor and speaking about the symptoms is usually enough to confirm a DPN diagnosis,” Dr. Fischer says. “Other times, we can use electromyography testing, which helps diagnose different types of nerve damage.”
Unfortunately, there isn’t a cure for DPN. Once a person receives a diagnosis, managing the condition is their best option. Keeping blood sugar levels stable and adhering to a diabetes treatment plan can help improve symptoms — or prevent DPN altogether. ThedaCare offers many resources to support people with diabetes.
It’s estimated that around half of people with diabetes have a diagnosis of DPN. Many of these individuals experience severe pain from their DPN on a daily basis. Since DPN is a progressive disease without a cure, treatment efforts focus on making patients comfortable and preventing symptoms from worsening.
“Once diagnosed, patients need to work with their regular doctor or endocrinologist to keep blood sugar well-controlled — and to continue surveillance of other body systems that can be affected, such as the eyes, kidneys, feet, skin, brain, and heart, among others,” Dr. Fischer says.
Treatment protocols vary but usually begin with topical ointments like lidocaine and capsaicin, Dr. Fischer says. Many studies have also looked at the efficacy of supplements like alpha lipoic acid for DPN patients. Oral medications like duloxetine, gabapentin, pregabalin, or nortriptyline — specifically formulated for neuropathy treatment — are also common.
Advanced Pain Therapies
“People whose symptoms continue to be problematic can receive in-office application of Qutenza, a concentrated capsaicin available through ThedaCare Pain Management,” Dr. Fischer says. “We can also offer spinal cord stimulation. Both of these therapies can be very impactful for patients.”
It takes about 30 minutes to administer Qutenza. A physician applies the treatment topically to the affected areas of the feet while monitoring the patient’s heart rate. After treatment, people experience up to three months of pain relief. Capsaicin, the active ingredient in Qutenza, is what makes chili peppers spicy. It interrupts nerve signals, effectively desensitizing them to reduce pain.
Spinal cord stimulation also disrupts pain signals, but in a different way. The device, which is placed through a minimally invasive surgery, uses electricity to interrupt pain signals before they reach the brain. It’s highly effective for people experiencing pain from a variety of conditions.
Dr. Fischer says these treatments decrease pain in most cases. There’s also a small subset of patients who experience improved sensation in the affected areas with the spinal cord stimulator implant.
A Preventable Condition
Although many diabetic patients experience DPN and cope with searing pain on a daily basis, others can prevent the condition. Managing diabetes so blood sugars and triglycerides don’t have a chance to damage nerves is a great way to prevent DPN.
Screening for diabetes is also important so people can manage their symptoms sooner rather than later. If you’re due for a wellness visit or diabetes care, you can schedule an appointment with your primary care provider using MyThedaCare.
“Most patients have lab work at their annual checkups with the goal of diagnosing diabetes early in its course,” Dr. Fischer says. “That way, we can treat the disease promptly — ideally, preventing progression of symptoms and complications like DPN.”