Diabetic Peripheral Neuropathy (DPN) is a type of nerve damage that can occur in people with diabetes. High blood sugar levels can injure nerves throughout your body, but DPN most often damages nerves in your legs and feet. Symptoms of DPN can range from pain and numbness to severe complications, such as foot ulcers and infections.
Peripheral neuropathy is nerve damage caused by chronically high blood sugar and diabetes. It leads to numbness, loss of sensation, and sometimes pain in your feet, legs, or hands. It is the most common complication of diabetes.
About 60% to 70% of all people with diabetes will eventually develop peripheral neuropathy, although not all suffer pain. Yet this nerve damage is not inevitable. Studies have shown that people with diabetes can reduce their risk of developing nerve damage by keeping theirblood sugar levels as close to normal as possible.
What causes peripheral neuropathy? Chronically high blood sugar levels damage nerves not only in your extremities but also in other parts of your body. These damaged nerves cannot effectively carry messages between the brain and other parts of the body.
This means you may not feel heat, cold, or pain in your feet, legs, or hands. If you get a cut or sore on your foot, you may not know it, which is why it’s so important to inspect your feet daily. If a shoe doesn’t fit properly, you could even develop a foot ulcer and not know it.
The consequences can be life-threatening. An infection that won’t heal because of poor blood flow causes risk for developing ulcers and can lead to amputation, even death.
This nerve damage shows itself differently in each person. Some people feel tingling, then later feel pain. Other people lose the feeling in fingers and toes; they have numbness. These changes happen slowly over a period of years, so you might not even notice it.
Because the changes are subtle and happen as people get older, people tend to ignore the signs of nerve damage, thinking it’s just part of getting older.
But there are treatments that can help slow the progression of this condition and limit the damage. Talk to your doctors about what your options are, and don’t ignore the signs because with time, it can get worse.
Drugs associated with Diabetic Peripheral Neuropathy
Gabapentin for Diabetic Peripheral Neuropathy
Gabapentin is an anticonvulsant medication that is also used to treat nerve pain. Here’s how it relates to DPN:
Mechanism of Action:
Gabapentin works by modulating the activity of neurotransmitters and decreasing abnormal excitement in the brain. It is thought to inhibit the release of excitatory neurotransmitters, which can help alleviate pain.
Efficacy:
Several studies have demonstrated that gabapentin can be effective in reducing the pain associated with DPN. It is often used when other pain management strategies have not provided sufficient relief.
Dosage:
The typical starting dose for gabapentin in treating neuropathic pain is 300 mg per day, which can be gradually increased based on the patient’s response and tolerability. The maximum dose can go up to 3600 mg per day, divided into three doses.
Side Effects:
Common side effects of gabapentin include:
- Dizziness
- Drowsiness
- Fatigue
- Peripheral edema (swelling in the extremities)
- Weight gain
Less common but more severe side effects can include mood changes, difficulty with coordination, and severe allergic reactions.
Considerations:
- Gabapentin needs to be used with caution in elderly patients or those with kidney impairment, as it is excreted through the kidneys.
- It is important to monitor for any signs of abuse or dependence, as there is potential for misuse.
Management of Diabetic Peripheral Neuropathy
In addition to pharmacologic treatments like gabapentin, managing DPN involves a comprehensive approach:
- Blood Sugar Control:
- Maintaining good glycemic control is critical to prevent further nerve damage.
- Lifestyle Modifications:
- Regular exercise, a healthy diet, and smoking cessation can help manage symptoms.
- Foot Care:
- Regular foot inspections and proper foot care are essential to prevent complications like ulcers and infections.
- Other Medications:
- Other medications for DPN may include antidepressants (e.g., amitriptyline, duloxetine) and other anticonvulsants (e.g., pregabalin).
- Pain Management Strategies:
- Physical therapy, topical treatments, and alternative therapies (such as acupuncture) may also provide relief.