Complications of Diabetes Mellitus: Nerve Damage

Nerve damage is a particularly common diabetes complication that affects approximately half of all diabetes patients. Symptoms may include loss of sensation, tingling, or pain in the extremities. If severe, nerve damage may lead to joint deformities and infections that ultimately require amputation.

Risk Factors

• Poor blood sugar control
• Long duration of diabetes

Diagnosis

A medical history and a physical examination are used to diagnose nerve damage. A diagnosis can be made by simple tests that measure whether the patient can sense vibration, hot or cold objects, or pain in the extremities.

Treatment

• Diabetic nerve damage is best addressed through prevention, which requires good control of blood sugar. In cases of existing nerve damage, symptoms may improve with diet and lifestyle changes, as noted below.
• In addition to good control of blood sugar, appropriate foot care is essential. Properly fitted shoes, foot hygiene, daily foot inspection for areas of irritation (special mirrors can help), regular nail care, and immediate consultation with a health care provider whenever an abnormality occurs are all important.
• Medications also may help alleviate painful symptoms of nerve damage. These include antidepressants, anticonvulsants (e.g., carbamazepine and gabapentin), and capsaicin cream.

Nutritional Considerations

The following nutritional considerations may help decrease symptoms:

• A combination of a vegetarian diet and exercise may have particular value in treating diabetic nerve damage. One study tested the effects of a vegan diet and regular walking on 21 individuals with pain due to nerve damage; symptoms completely disappeared in 17 study participants and improved in the remainder. Evidence suggests that in addition to the effect of vegetarian diets on blood sugar control, their effect on body weight, blood pressure, and cholesterol are important. Future clinical trials are needed to determine the value of dietary modifications for this condition.
• In addition to the benefits of a diet and exercise regimen, some nutritional supplements have shown potential benefit. Alpha–lipoic acid appears to be safe and effective for improving symptoms of diabetic nerve damage in long–term and short–term clinical trials. Other supplements under investigation include gamma–linolenic acid, carnitine, and magnesium.