How to Manage Diabetic Peripheral Neuropathy

If you or a loved one are living with diabetes, you know the fear of a surgical amputation of a toe, foot or leg. Unmanaged diabetes and infected ulcers triggered by diabetic peripheral neuropathy (nerve damage caused by diabetes) can lead to these scary but life-saving amputations. Neuropathy may affect the hands and arms, as well.

Why does diabetes affect the feet and limbs?

Over time, high blood sugar caused by diabetes can damage the nerves. High blood glucose levels can also damage the blood vessels that give your nerves the oxygen and nutrients needed to function properly. Nerve damage and reduced blood flow (especially to the feet) can cause tingling, numbness (loss of sensation), and pain in the affected digit or limb. Other complications include shifts or fractures in bones of the toes or feet that affect the shape of the foot and the person’s mobility.

Once you lose feeling in your foot, you may not feel a minor injury like a cut, sore or blister that can become an infected ulcer. Reduced blood flow caused by diabetes can slow down or prevent such an infection or injury from healing. This can lead to gangrene, which is the death of bodily tissue, often requiring amputation to prevent the infection from spreading and affecting other parts of the body.

Who is at risk of developing diabetic peripheral neuropathy?

If you have diabetes, your chance of developing nerve damage increases as you age and the longer you have diabetes. According to the American Diabetes Association, as much as 50% of people with diabetes develop peripheral neuropathy.

You are more likely to develop nerve damage if you have diabetes and:

• are overweight
• have high blood pressure
• have high cholesterol
• have advanced kidney disease
• over-consume alcohol
• smoke tobacco
• carry certain genes

The most effective way to avoid peripheral neuropathy? Manage your diabetes.

This means addressing your: 

• blood glucose (blood sugar) levels
• blood pressure
• cholesterol levels
• weight

Work with your primary care provider, endocrinologist, and cardiologist to learn how best to manage these risk factors. Keep your diabetes in check with diet/nutrition guidance, regular exercise, diabetes and cholesterol medication management, glucose monitoring, stress reduction, smoking cessation programs, and alcohol abuse treatment (if needed) and improving your sleep.

Foot care is essential for anyone with diabetes.

Inspect your feet every day.

Check your feet and between your toes every time you remove your shoes — especially if you have lost sensation in your feet or toes. This will help you see any problems before they worsen, spread, or get infected.  

Look for any changes in your foot, like:

• cuts or sores
• red spots
• swelling
• blisters
• ingrown toenails
• corns or calluses
• plantar warts
• athlete’s foot
• warm spots

Protect any foot wounds with a bandaid. Ask your podiatrist if taking the temperature of your feet may help detect warm spots that can lead to blisters.

Wash, dry and powder your feet daily.

Keep your feet clean and dry to help prevent infection. Use warm (not hot) soapy water. Avoid soaking your feet, which dehydrates the skin. After washing and drying your feet, apply talcum powder or cornstarch between your toes to absorb moisture. Before bed, you can apply a thin coat of sensitive skin cream or petroleum jelly to the tops and bottoms of your feet to soften the skin. But, do not put any moisturizers between your toes.

Smooth any corns and calluses.

Corns and calluses are thick patches of skin on the feet, which can turn into ulcers, especially if you have nerve damage. After washing and drying your feet, use a pumice stone to gently smooth down these patches by rubbing in only one direction to avoid tearing the skin. Do not cut corns/calluses, use medicated corn plasters/pads or liquid removers — all of which can damage the skin and lead to infection.

Trim your toenails carefully.

When needed, use toenail clippers to cut your toenails straight across, being careful to not cut the skin or into the corners of the nails. Use a nail file or emery board to carefully smooth each nail. The goal is to avoid any hangnails, ingrown nails and cuts to the skin. If you have difficulty trimming your own toenails for any reason, see a podiatrist regularly for this service.

Choose the right footwear. 

To avoid stepping on something, bumping or banging your toes or foot, or dropping something onto unprotected feet, always wear shoes and socks. Wearing dry socks or stockings and well-fitting shoes can also help prevent blisters. Do not walk barefoot or in socks alone, even in your home.  

Ensure that your shoes are comfortable, supportive and made of breathable fabric, with enough room to wiggle your toes. If you have a bunion or a hammer toe, choose shoes with a wide/deep toe box. Don’t wear high heels or pointy-toe shoes.

Protect your feet from severe heat to avoid burns. Wear shoes at the beach to avoid contact with hot sand and pavement. Keep your feet away from space heaters, open fires, heating pads, and hot water bottles. 

Similarly, protect your feet from the cold by wearing lined, waterproof boots during the winter and socks while you sleep.

Encourage blood flow to your feet.

• Elevate your feet while sitting.
• Throughout the day, wiggle your toes for a few minutes to improve circulation. 
• Move your ankles. Use motions that go up and down or in and out.
• Wear socks, stockings or tights that do not tighten around the ankles or squeeze the feet. Shop for “diabetic socks” that are designed to be looser.
• Stand up and walk more throughout the day.
• Get more physical activity like dancing, stretching, swimming and bike riding.
• Quit smoking.

Get support from your health care providers.

Regularly monitor your blood glucose, diabetes medications and related bloodwork under the supervision of your primary care physician or endocrinologist. Take all medications as prescribed. See your primary care provider or endocrinologist at least once a year for a foot exam. If you need additional care for your feet, see a podiatrist for regular exams, nail trims and treatment for any foot or ankle issue, such as corns, athlete’s foot, pain, wounds, trauma or deformity.

Medically reviewed by Diana Soliman, M.D., MHS, an endocrinologist, and Jason Levine, D.P.M., a podiatrist, both with the University of Miami Health System.

Dana Kantrowitz is a contributing writer for UHealth’s news service.

Tags: diabetic foot care, diabetic neuropathy treatment, Dr. Diana Soliman, Dr. Jason Levine, Miami endocrinologist, podiatry