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DIABETES AND NEUROPATHIC PAIN: IT’S COMPLICATED

By Mark Odlum

Diabetes is the number-one cause in the United States of neuropathy, which is damage to one or more nerves that results in numbness, tingling, muscle weakness, and pain.

Why it’s so complicated

With diabetes, a metabolic disease characterized by elevated levels of blood sugar, there is no cure; there’s only managing the disease. Included in the variety of complications that can result from diabetes are two main types of neuropathies:

  1. The most common diabetic neuropathy affects large-nerve fibers and is characterized by numbness, tingling, weakness, and pain, mainly in the hands and feet.
  2. Harder to diagnose are small-fiber neuropathies, in which only the small sensory cutaneous nerves are affected. Symptoms include tingling and burning sensations in the feet and loss of temperature recognition.

“Unfortunately, [cutaneous] nerves are very hard to see. Even if you did a nerve conduction study, you wouldn’t pick it up,” says Michael April, MD, a physical medicine and rehabilitation specialist with Sarasota Chiropractic and Physical Therapy in Sarasota, Florida. “This makes small-fiber neuropathies extremely difficult to treat. We usually try to manage with a medication like low-dose naltrexone.”

In general, diabetes is a difficult disease, as it affects many organ systems. Controlling blood sugar, exercise, weight loss, and diet will help the neuropathy that accompanies diabetes. “But, even when you treat [diabetes] well and keep your blood sugars and hemoglobin A1C [a form of hemoglobin chemically linked to sugar] down, [diabetes] still affects your body’s ability to do things,” states April.

Stopping the problem before it starts

The best step to take, whenever possible, is prevention. Here are a few tips for preventing diabetes:

—Reduce carb intake, portion sizes, and processed foods
—Eat a high-fiber diet
—Exercise regularly
—Drink plenty of water
—Maintain a healthy weight
—Quit smoking

If you already have diabetic neuropathy


For those already experiencing diabetic neuropathy, it can be frightening. But there are steps you can take to help manage it, such as keeping blood sugar levels and A1C levels down.

“When we think about treating the body for challenging conditions, an integrative approach would be to reduce inflammation as much as possible,” says Deepti Agarwal, MD, director of Interventional and Integrative Pain Management at Case Integrative Health in Chicago. “The best thing to do is to work to get your metabolic health under control, thereby reducing inflammation while considering other [therapeutic] alternatives.”

Options include supplements like alpha-lipoic acid (helps with blood sugar management) and spinal cord stimulation (an implanted device that sends low levels of electricity directly into the spinal cord to relieve pain). Some individuals use cannabidiol (CBD) oil to treat pain, and researchers are also investigating the effects of CBD on diabetes, according to the American Diabetes Association.

The challenge is that not everyone will respond to supplements or CBD. And while spinal cord stimulation may be an option to treat pain, someone with diabetic neuropathy still has to maintain proper glucose levels and regulate bodily inflammation.

As a whole, diabetic neuropathies require an optimization of your internal physiology and a focus on reducing bodily inflammation. Once blood sugar levels have been managed, you can explore treatments to address pain.

Unfortunately, there’s no magic pill. At the end of the day, diabetic neuropathies require basic preventative medication and management of symptoms and pain. Experts also urge those living with diabetic neuropathy to remember that treatments are not one-size-fits-all and may require trial and error for each individual.

“[Diabetic] neuropathic conditions are not black and white, and nerve recovery and repair occurs differently for everyone,” Agarwal says. “You can take medications, but nothing is foolproof or without risks. Many provide symptomatic control and don’t work for everyone. Some people are going to respond to neuropathic drugs, and others are not, which complicates the standard of treatment. This may require thinking outside the box for a treatment plan.”

“[Diabetic] neuropathic conditions are not black and white, and nerve recovery and repair occurs differently for everyone. …
This may require thinking outside the box for a treatment plan."