A link between diabetes and peripheral neuropathy
Find out more about the symptoms and treatment options.
Procter & Gamble (P&G) Health recently announced a campaign called ‘Put Life Back in Your Hands’ across Asia-Pacific, Middle East and Africa to raise public awareness on the connection of peripheral neuropathy and diabetes.
There are 393 million diabetic patients in those campaign regions and about 50 percent of diabetic patients having indicated they have peripheral neuropathy. Furthermore, with the number of diabetic patients projected to rise to 603 million by 2045, representing a significant spike in the number of patients with peripheral neuropathy, Ageless Online wanted to find out more about the link to diabetes and what peripheral neuropathy is. We spoke with Dr Ashley Barlow, senior director and head of medical and technical affairs, Asia, Middle East and Africa at P&G Health:
What is exactly is peripheral neuropathy?
Peripheral Neuropathy (PN) is a clinical condition in which the nerves of the peripheral nervous system are damaged. These are the nerves that carry signals between your brain and your spinal cord (the central nervous system, CNS) and the rest of your body.
Damage to these nerves usually presents itself as numbness, tingling, prickling, and burning sensations in the hands and feet, impacting one’s quality of life when left untreated.
Do you have local data on prevalence, particularly for those older?
In Singapore, over 700,000 Singaporeans live with the disease. The lifetime risk of developing diabetes is one in three among Singaporeans, and the number of those with diabetes is projected to surpass one million by 2045 . An estimated 430,000 (or 14 percent of) Singaporeans aged 18 to 19 years are also diagnosed with pre-diabetes, where their normal blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes. It is estimated that almost more than 50 percent of diabetic patients (one in two diabetic) may suffer from PN during their lifetime.
On the other hand, Singapore’s population is ageing rapidly, with the proportion of citizens aged 65 and above increasing to 18.4 percent in 2022. There are 678,000 seniors over 65 years living in Singapore. Global study has reported prevalence of PN is 17.5 percent in seniors age 60 to 69 years old, and it increases up to 34.7 percent in those 80 years or older.
Is it only associated with those who have diabetes?
Diabetes mellitus is the number one cause of peripheral neuropathy. The increasing prevalence of PN is closely linked to the rise in the number of diabetics. It is estimated that almost more than 50 percent of diabetic patients (one in two diabetic) may suffer from PN during their lifetime.
However, PN is not only associated with those have diabetes. Other high-risk groups include ageing population; excessive alcohol usage; people with special dietary habits such as vegetarian, vegan or fasting; people with nutritional deficiency, especially Vitamin B deficiencies; etc.
What are the risk factors of peripheral neuropathy? Age is one of the risk factors – what age does one get diagnosed or have symptoms?
Patients at high-risk of PN include patients over 50 years of age, those diagnosed with diabetes, those with HIV or TB infection, patients on specific medications (eg. Isoniazid or metformin), patients with chronic kidney disease on dialysis and patients on a restricted diet.
The incidence of PN increases with age. This is due to the high prevalence of chronic diseases like diabetes and renal impairment that are usually associated with ageing. Age-related changes in our body may not only result in nutritional and vitamin deficiency, but may worsen the ability of our peripheral nerves to function properly. As a result, there is an increased risk of PN in older patients.
Early intervention and timely treatment are important in preventing PN from progressing into severe symptoms or irreversible nerve damages.
What are the symptoms? How does it impact those who have it?
Symptoms of PN can be categorised into three issue areas – extremities, body and mind – and patients may experience one or a mix of these symptoms. Patients with sensory PN can feel numbness, tingling, lack of grip, feeling ‘senselessness’, nerve pull, and burning sensation in their hands and feet. For their body, some patients feel restlessness, lethargy and sometimes even frequent infections of the skin, throat, etc. Lastly, PN patients can also suffer from lack of concentration, absent mindedness, movement, response time becoming slow and sleeplessness.
Up to five percent of PN cases are considered severe and irreversible, causing significant impact on the economy, through loss of productivity, disability and increased healthcare costs. These symptoms when not detected and managed early can have a significant impact on one’s quality of life due to chronic pain, loss of sensation and irreversible nerve damage, that negatively impact activities of daily living.
What are the causes of peripheral neuropathy besides diabetes?
There are many potential causes of nerve damage, so it’s not always possible to pinpoint a single factor. However, some of the most common causes of peripheral neuropathy include:
- Diabetes – one in two people with diabetes develop neuropathy.
- Vitamin B deficiency – low levels of Vitamin B can result in peripheral nerve damage.
- Obesity – being overweight increases the risk of diabetes. Bariatric surgery to treat obesity also can affect the absorption of essential vitamins, leading to peripheral neuropathy.
- Toxins – prolonged exposure to toxins like mercury, arsenic or lead can cause nerve damage.
- Long-term alcohol use – drinking high quantities of alcohol for many years is a potential cause of peripheral neuropathy.
- Injuries – physical trauma, for example from an injury or surgery, can result in permanent or temporary damage to nerve fibres.
- Some hereditary conditions – in rare cases, peripheral neuropathy may be caused by disorders such as Charcot-Marie-Tooth (CMT) disease, which runs in families.
It is mentioned that peripheral neuropathy associated to diabetes is often undiagnosed. Why is that? How is it diagnosed?
There are multiple causes leading to PN not being diagnosed. On one hand, patients often neglect the early signs and symptoms of PN. A study in patients with diabetes and PN found 13 percent had never reported their symptoms to their doctors and 39 percent had never received treatment for their painful symptoms. There is also lack of awareness of neuropathy and its symptoms are mistakenly dismissed by patients as muscular or blood circulation-related issues. On the other hand, physician are not proactively checking PN symptoms within high-risk patient, partially due to busy clinic schedule or lack of diagnostic device handy in the clinic.
As a result, neuropathy tends to be misdiagnosed or underdiagnosed, and its lack of awareness and urgency amongst healthcare professionals lead to an underestimation of neuropathy in patients.
To overcome these issues, greater awareness, education and understanding of neuropathy is needed where the collective ecosystem of patients, their caregivers, and healthcare professionals come together to shed light on the importance of nerve health and care.
How is peripheral neuropathy diagnosed?
While identifying a patient with early onset PN may sound challenging, it is not and doesn’t require complex diagnostic tools to diagnose peripheral neuropathy. Simple tools like a validated questionnaire and a sensory test can be a good start. By asking the right questions and listening to the patient, physicians can help patients avoid severe complications and improve their quality of life.
If left undetected, what happens?
If nerve damage is left untreated, it can lead to complications, which is why early diagnosis and treatment is so important for nerve health.
Possible complications of peripheral neuropathy can include:
- Diabetic foot ulcers – one in four diabetic patients develop foot ulcers, leading to amputations in severe cases. Diabetes can damage blood vessels, so less blood reaches the feet. Because blood contains the infection-fighting cells, cuts, scratches – or even just blisters caused by badly fitting shoes – can take longer to heal and may develop into ulcers if untreated.
- Burns and other injuries – if you can’t feel pain or temperature changes, there’s a risk you could get burned, scalded or otherwise injured without being aware of it.
- Falls – impaired balance and coordination can lead to more frequent falls.
- Heart and circulatory problems – diabetes-related neuropathy can damage the nerves that help control heart rate and blood circulation. The most typical symptoms of this kind of neuropathy, known as cardiovascular autonomic neuropathy (CAN), are being unable to exercise for very long, and low blood pressure that causes faintness or dizziness when standing up.
- Infection – if you lose some or all of the sensation in parts of your skin, injuries can go unnoticed and become infected without you knowing. It’s important to check any areas that are numb and treat any small injuries before they get worse. In the most severe cases, an infection could eventually lead to gangrene and the loss of an extremity such as a toe or foot.
What are the treatment options for peripheral neuropathy for those who detect early on to those who detect much later?
Whether you’ve already noticed symptoms or just want to lower the risk of them developing, there’s plenty you can do to help prevent peripheral neuropathy or stop it getting worse. These include:
- Vitamin B supplements – peripheral neuropathy can be treated with Vitamin B supplements. Your doctor may also advise taking a Vitamin B complex in combination with other therapies or lifestyle changes to support your nerve health. Read more about neurotropic vitamins.
- Treating or managing underlying conditions – it’s essential to treat or manage any condition – such as diabetes, heavy alcohol use increases the risk of peripheral neuropathy. For example, with diabetes – the most common underlying cause of nerve damage – it’s vital to keep blood sugar levels under control.
- A nerve-friendly lifestyle – healthy lifestyle choices can help prevent or alleviate peripheral neuropathy symptoms. A healthy balanced diet including plenty of fruits, vegetables, wholegrain foods, and low-fat protein is good for your nerves. Exercising for 30 to 60 minutes three or more times a week (with your doctor’s approval) is another way of boosting your nerve health, as well as your general fitness and well-being. It’s also important to avoid risk factors like repetitive movements, cramped or confined positions, handling toxic substances, smoking or heavy drinking.
Are you able to share a case study from Southeast Asia?
Emma (a pseudonym), a 57-year-old lady, member of a vegan cult for 33 years who has noted that she often feels weakness, sometimes even numbness in her hands and feet. This has led to several falls in the past. Although there was no bad injuries so far, it has significantly impacted her mobility, making it almost impossible for to work.
Emma consulted her physicians and understood that a Vitamin B deficiency is often seen in seniors. While vegan and vegetarian is another risk factor for Vitamin B deficiencies, which may cause nerve damage leading to her symptoms.
With supplementation at the right level of nerve-nourishing Vitamin B, as suggested by her physician, Emma felt her symptoms has been improved and she is now able to get back to herself that she is used to be.