Tag: diabetes

Author: Zach Mathews

Do you know of someone who has issues with their feet? Not sure what is wrong but something just feels tingling, numb or hurts? This may be due to an underlying issue called neuropathy. We are going to discuss the background of neuropathy and take a look at potential causes of neuropathy to see how to prevent it as well as how to manage symptoms once neuropathy is present. Quite often neuropathy is referred to as idiopathic neuropathy. In this situation, idiopathic means a disease in which the cause is unknown. Peripheral neuropathy is one of the neurologic issues that primary care physicians see most often and it comes in many different forms with different symptoms making it hard to recognize, evaluate, and treat.¹ Symptoms can range and be present with sensory issues such as loss in feeling, motor functions such as walking or other physical movements, and autonomic functions such as control of urine or other functions that an individual usually doesn’t have to think about controlling. Of the three types of symptoms, sensory signs usually present themselves before the latter two.¹ As Dr Doughty and Seyedsajadi state, sensory fibers can be large diameter fibers which deal with vibration and proprioception (awareness of the body and its positioning) as well as small diameter fibers which deal with pain and sensing temperature. Both of these fibers are affected in most neuropathy so we will primarily focus on sensory symptoms and issues when looking at management possibilities. Motor function symptoms can be present such as difficulty walking, especially when the proprioception is affected in a negative way. Autonomic symptoms such as constipation, diarrhea, loss of bladder control, erectile dysfunction as well as many others can be present with neuropathy.¹ With such a wide range of common symptoms present with neuropathy, it is evident why the reason often goes undiagnosed and termed idiopathic neuropathy.

While contributing factors to neuropathy vary widely, there seems to be a group of issues that are common, relatable and potentially avoidable. When looking at individuals with idiopathic neuropathy, it is shown there is a relationship with these individuals and having impaired glucose tolerance whether that be prediabetes or diabetes;² with diabetes, Type 1 and Type II, being the leading cause of neuropathy.¹ The occurrence of both of these conditions is increased with being overweight and having a high amount of excess fat in the abdominal area. This can in part be explained by the fact that as the thickness of subcutaneous tissue (fat tissue underneath the skin) increases in overweight individuals, there is a reduction in the amount and intensity of sensory nerve responses.³ This is saying that an excess amount of fat will reduce the activation and stimulation of sensory neurons within these individuals. Another association discovered between individuals who already have neuropathy and their prior lifestyle is intense alcohol use over an extended period of time.¹

From looking at the contributing factors above the most basic prevention method would be to not drink alcohol heavily for an excess period of time. However, this is most likely not the most significant prevention method because this is not the leading cause of neuropathy. A prevention method that can affect the most amount of people would be to live a healthy and active lifestyle which would decrease individual’s fat mass. By living a healthy and active lifestyle this can prevent an individual from becoming overweight and having an excess amount of abdominal fat which can lead to pre-diabetes and diabetes, the leading causes of peripheral neuropathy. If someone has pre-diabetes, exercise and healthy eating can keep them from becoming fully diabetic and exercise can also help an individual who already has diabetes prevent or slow the development of neuropathy. As Lee and Kim show in their study, an early induction of exercise could postpone the demyelination (eroding of protective layer surrounding nerve) process in a nerve fiber in diabetic rats by reducing the complications such as hyperglycemia (high blood sugar), dyslipidemia (high or low amounts of fat in the blood) and inflammatory effects of obesity.⁴ The rats were subject to swimming exercise during this study to view the effects.^­

Although exercise can be very beneficial, it is important to know what type of exercise and the intensity that should be completed. Improvements with symptoms of neuropathy as well as re-growth, preventing further damage, and repairing damaged nerves can be obtained through the use of aerobic exercise.⁴ Aerobic exercise is exercise with the presence of oxygen so the intensity should not be too high for the individual but a casual pace. Because the nerves are damaged, exercise with low impact or low stress conditions would be desirable so a great suggestion for this would be an exercise bike for around thirty minutes.⁴ An exercise bike would be beneficial because there is not a ton of impact and this exercise is a pretty basic movement so there is less risk for injury from the general performance of the exercise as well as from losing balance.

Exercise is great for delaying or improving symptoms but in most cases will not completely erase all the symptoms. In this case, individuals with sensory loss in their feet should be aware of caring for their feet and making sure no injuries are present that they do not feel. When individuals have weakness, they can improve their daily functioning from using ankle-foot orthotics to help give them strength and stability. With weakness often comes issues with balance and an individual’s gait. Although this can be a significant risk, these individuals can reduce the risk of injury by participating in balance training and specific exercises like increasing strength in the knee and ankle muscles that correlate with walking such as knee extension and ankle dorsiflexion.¹

As one can see, neuropathy remains a mystery to health professionals to a certain degree. Specific causes of neuropathy are not determined most of the time and this makes it hard to put a definite answer on how to prevent neuropathy. However, most cases of neuropathy can be directly or indirectly traced back to an issue that can be prevented by maintaining a healthy lifestyle. In this instance “healthy lifestyle” means staying eating well and exercising regularly because this keeps your body fat low among other things. The issues that arise solely from being overweight and having a high body fat mass lead to neuropathy and can be prevented in the first place. Therefore, I am stating that in my opinion the most beneficial way to prevent the occurrence of any form of neuropathy is to keep yourself healthy and avoid becoming overweight. Once neuropathy has occurred, treatment should follow the same methods as prevention. This can differ and vary depending on the symptoms present. Eating as close to an all-natural diet as possible, as well as exercising at moderate intensity in a safe environment.

1. Doughty CT, Seyedsadjadi R. Approach to Peripheral Neuropathy for the Primary Care Clinician. The American Journal of Medicine. 2018;131(9):1010-1016. doi:10.1016/j.amjmed.2017.12.042
2. Singleton JR, Smith AG. Neuropathy associated with prediabetes: What is new in 2007? Current Diabetes Reports. 2007;7(6):420-424. doi:10.1007/s11892-007-0070-y
3. Miscio G, Guastamacchia G, Brunani A, Priano L, Baudo S, Mauro A. Obesity and peripheral neuropathy risk: a dangerous liaison. Journal of the Peripheral Nervous System. 2005;10(4):354-358. doi:10.1111/j.1085-9489.2005.00047.x
4. Lee EC, Kim MO, Roh GH, Hong SE. Effects of Exercise on Neuropathy in Streptozotocin-Induced Diabetic Rats. Annals of Rehabilitation Medicine. 2017;41(3):402. doi:10.5535/arm.2017.41.3.402