Written by Amy Gan

Diabetic neuropathy is a common complication of diabetes and can affect many aspects of life and severely limit patients’ daily functions. Diabetic neuropathy is defined as “the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes.”

Neuropathic pain is often described as a burning sensation and affected areas are often sensitive to the touch. Symptoms of neuropathic pain include excruciating pain, pins and needles, lack of coordination and falling, muscle weakness and numbness. Some people may find it hard to wear thick clothes as even slight pressure can aggravate the pain. Neuropathic pain is caused by damage or injury to the nerves that transfer information between the brain and spinal cord from the skin, muscles and other parts of the body.

In more than 50% of people with type-1 diabetes mellitus will experience nerve damage (neuropathy). Diabetes neuropathy may lead to impotency and foot ulcer, which the latter will further lead to infections and amputation. The direct effect of long-term hyperglycaemia which is seen in Type I diabetes or common poor sugar control in Type-II diabetes causing decreased blood flow will damage nerve.

Algorithm of Management of Diabetic Peripheral Neuropathy (DPN)

DPN refers to a group of progressive, degenerative conditions involving autonomic, motor and sensory peripheral nerves due to poor glycaemic control and long-term hyperglycaemia. Extent and severity of neuropathy heavily correlates with patients’ glycaemic control.

Supplements

 

  • Vitamin B12

Vitamin B12 (methyl cobalamin) supplement is frequently prescribed by physicians in order to alleviate symptoms of pain, numbness, tingle and other nerve damage related sensation. Mechanism of action is such that is promotes repair, regeneration and protection of damaged nerves in patients suffering from DPN. Usual doses: 500mcg once to thrice daily, depending on the damage of extent to nerves; based on symptoms patients experience and also glycaemic control (via blood glucose text/HbA1c)

 

  • Antioxidant

Anti-oxidants such as alpha-lipoic acid, glutathione, grape seed extract, astaxanthin, vitamin C and E have been thought to reduce or retard cellular damage by scavenging compounds known as free radicals; notably Reactive Oxygen Species (ROS) that are produced from oxidation. In DPN, a constant spike or increase in blood glucose levels leads to profound glucose oxidation; which in turn causes elevation in ROS that induces cellular damage; essentially the nerves which then lead to DPN as a common complication suffered in diabetics. Therefore, consumption of anti-oxidants may provide slight benefit in retarding the progress of DPN.

Reference:

  • Boulton AJ, Gries FA, Jervell JA: Guidelines for the diagnosis and outpatient management of diabetic peripheral neuropathy. Diabet Med 15 : 508-514,2002
  • Chong MS, Bajwa ZH. Diagnosis and treatment of neuropathic pain. J Pain Symptom Manage 2003:25:s4-11
  • Argoff CE. Manage neuropathic pain: New Approaches for Today’s Clinical Practice. Available at: hhtp://faculty.uca.edu/Fletcher/electro/Readings/neuropathic_pain.pdf. Accessed October 5,2019.
  • International Coalition on Neuropathic Pain. Changing the course of neuropathic pain management: an ICNep program. Non-pain specialists’ guide. Internal file, Pfizer Inc.
  • Attal N, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Beural 2010: 17(9):1113-e88
  • Ward SP. Neuropathic pain. In: Dolin SJ, Padfield NL Eds. Pain Medicine Manual 2nd ed. London: Butterworth-Heinemann, 2004:11-20
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