More than 420 million people worldwide have diabetes1, making it the largest global epidemic of the 21st century. Over time, at least 50% of people with diabetes develop nerve damage: often silently, until there are symptoms.
Diabetes affects the ends of the longest nerves first, and so the feet and then the hands. It can feel as though you are wearing stockings and gloves, with sensations of numbness, or tingling, prickling and ‘electric shocks’ along the nerves.
Damaged nerves can elicit a pain that is distressing, debilitating and disabling. Typically worse at night, the pain can be stabbing, burning, constricting, throbbing and freezing. Sometimes skin becomes super-sensitive or even strangely sensitive (when something as soft as a feather-light touch can feel more like a burn from a blowtorch). Painful leg cramping can also arise as a result of poor circulation in diabetes.
Capable of transmitting electrical signals at 268 miles per hour, motor neurons are the nerve cells which make your muscles contract. When they are damaged in diabetes, leg cramp and muscle weakness may result. Other warning signs include deformities such as hammer toe or a flattening of the natural arch2, and a change in the way you walk.
When nerves to your sweat glands are damaged in diabetes, sweating can be suppressed, leaving your legs and feet dry and the skin at risk of cracking and infection. Sweats are usually the first sign of low blood sugar; their loss can leave you unaware of the need to eat something to treat the episode
Pain is not an unpleasantness to be avoided at all costs: its presence can alert you to a problem such as ill-fitting footwear or a stone in your shoe. Loss of sensation (through diabetic nerve damage) coupled with poor circulation (through peripheral arterial disease) can aggravate injury and cause slow healing wounds or ulceration.
Diabetes is the main cause of non-traumatic amputation, with Diabetes AU reporting more than 4,400 diabetes-related amputations each year, the 2nd highest rate in the developed world3. Four out of five amputations are preventable, with daily foot checks and prompt medical attention being essential.
A healthy lifestyle does more than keep your heart healthy – it can also be a lifeline for your legs. Eating regular, balanced meals, avoiding excess alcohol, keeping active and stopping smoking can prevent or delay diabetic nerve damage, by helping to control your blood sugar levels – often alongside prescribed diabetes drugs.
Researchers at the University of Utah reported nerve fibre regeneration in people with diabetes when they engaged in an exercise programme5. Dr Eva Feldman from the University of Michigan writes that “exercise is emerging as a promising prevention strategy in diabetic neuropathy,” with one study “indicating the potential for exercise to prevent nerve injury and even promote nerve regeneration”. It’s already known that exercise can boost blood flow and balance blood sugars. Let’s embrace it.
- World Health Organization (2021) Global diabetes summit. https://www.who.int/news-room/events/detail/2021/04/14/default-calendar/global-diabetes-summit
- Tadashi K, E.D. Thorhauer et. al. (2020) Neuropathy, claw toes, intrinsic muscle volume, and plantar aponeurosis thickness in diabetic feet https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-020-03503-y
- Diabetes AU https://www.diabetesaustralia.com.au/facts-and-figures/
- D Kumar, MS Alvaro, et al (1998) Diabetic peripheral neuropathy. Effectiveness of electrotherapy and amitriptyline for symptomatic relief https://pubmed.ncbi.nlm.nih.gov/9702441/
- Singleton JR, Marcus RL, Jackson JE et al (2014) Exercise increases cutaneous nerve density in diabetic patients without neuropathy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4241811/
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