Diabetic leg and foot pain can be excruciating. It is often caused by diabetic nerve damage (neuropathy). This is a type of damage that is peculiar to people with diabetes. It is one of the most common complications of diabetes. Pain in the legs can affect up to half of people with type 1 or type 2 diabetes.
This nerve damage may be mild initially, but gradually it gets worse. The pain in the feet may become so bad that it gets in the way of everyday activities.
Nerves are specialised tissues that do several things in the body.
- They send information back to the brain about things going on around you through your senses like sight, smell and touch.
- They transmit signals from the brain to other parts of the body. This tells them what to do, for example, to wiggle your fingers.
- Through the nerves, the brain controls your body functions like your heartbeat and digestion that you can’t control directly.
What causes neuropathic pain in the legs in diabetes?
Over time, uncontrolled and persistent high blood sugar causes damage to the nerves. They malfunction and stop firing the way they should.
High blood sugar, over a long period, damages the blood vessels that feed the nerves. How do you feel when you haven’t eaten? You feel hungry, irritable and you can’t function efficiently. That is exactly what happens to your nerves. They become nutrient-deficient, hungry and irritable.
Different types of neuropathy
Peripheral neuropathy
Peripheral neuropathy usually affects the legs and feet but may also affect the hands.
It is the most common type of diabetic neuropathy. It is usually accompanied by:
- sharp pains,
- numbness,
- tingling/burning,
- electric shock sensation and
- increased sensitivity to touch.
Peripheral neuropathy is usually worse at night, although it can occur at any time of day.
Autonomic neuropathy
Autonomic neuropathy affects the internal organs – the heart, stomach, intestines and sex organs. Damage to nerves in these areas can lead to:
- painful swallowing,
- nausea, vomiting and loss of appetite,
- diarrhoea, constipation and faecal incontinence,
- persistent first heartbeat (tachycardia),
- dizziness and fainting when you change position/stand-up (postural hypotension) and
- problems with urination.
Proximal neuropathy
Proximal neuropathy affects the nerves in the buttocks and legs. It can lead to:
- severe pain,
- weakness of the muscles,
- shrinking of the muscles and
- difficulty in rising from a sitting position.
Mono neuropathy
Mono neuropathy affects a single nerve and can occur anywhere in the body. It may manifest as:
- aching behind one eye,
- double vision,
- paralysis of one side of the face and
- weakness of the hands, which may make you drop things frequently.
Risk factors for developing pain in the legs in diabetes
Prolonged, uncontrolled high blood sugar is the biggest risk factor for developing diabetic leg and foot pain.
The longer you have diabetes, the more likely you are to develop nerve damage.
If you have kidney disease, you are at a high risk of developing neuropathy. Being overweight, drinking a lot of alcohol, or smoking puts you at a higher risk.
High blood pressure or high cholesterol increases your risk of developing diabetic nerve damage.
Complications of diabetic nerve damage
Some of the complications of diabetic nerve damage can be worse than the neuropathy itself.
These may include:
- fainting and falls – sometimes these falls can lead to death,
- amputation of the toes all feet from infected diabetic sores on the feet,
- urinary incontinence,
- urinary tract infections,
- digestive problems and
- sexual dysfunction, including difficulty with arousal and erectile dysfunction.
Treatment of foot pain in diabetic nerve damage
In the early stages, you can reverse diabetic nerve damage. This process is excruciatingly slow, but it is possible.
The longer you have had the neuropathy, the worse it becomes. And the harder it is to treat and reverse.
The number one way to slow down the progression of diabetic nerve damage is to bring down and regulate blood sugar.
You’ll need to avoid drastic fluctuations in your blood sugar. Your blood glucose should not be swinging up and down continuously throughout the day, which can also make the pain of nerve damage even worse.
Put some effort into treating the insulin resistance aspect of diabetes and don’t just focus on your blood sugar numbers.
You will need to change the type of food you eat and when you eat. Work on developing good exercise and sleep habits. These and other lifestyle changes will bring down your blood sugar.
Drugs for pain in the legs in diabetics due to nerve damage
Drugs used to treat depression and convulsions can also help with the pain of diabetic neuropathy:
- Anti-seizure drugs – Pregabalin (Lyrica) and gabapentin (Gralise, Neurontin) are used to treat epilepsy. Side effects may include drowsiness, dizziness and swelling.
- Tricyclic antidepressants – These include amitriptyline, desipramine (Norpramin) and imipramine (Tofranil). Side effects may include dry mouth and drowsines.
- Serotonin and norepinephrine reuptake inhibitors (SNRIs) – Duloxetine (Cymbalta) and venlafaxine (Effexor XR) are used commonly. Possible side effects include nausea, sleepiness, dizziness, decreased appetite and constipation.
But these drugs do not actually reverse the nerve damage.
Supplements for diabetic foot pain and nerve damage
Many supplements can help with pain in the legs in diabetes. They may also create an environment that heals the nerves.
Benfotiamine
Benfotiamine is a fat-soluble version of thiamine (vitamin B1). It is better absorbed than thiamine because it is fat-soluble. Therefore, it does a better job of penetrating the fatty myelin sheath that surrounds the nerves.
What does vitamin B1 do? It helps the mitochondria clear glucose from the cell.
Vitamin B12
Vitamin B12 can also help with nerve pain and nerve damage. The methylated form of vitamin B12, known as methylcobalamin, is more effective in non-methylators. Some people cannot methylate cobalamin, so they must take methylcobalamin.
Antioxidants
Antioxidants can be very useful in managing diabetic nerve pain and damage.
- Alpha-lipoic acid exists in two forms – the r-fraction is the one that is active in the body. It is a powerful antioxidant.
- Pycnogenol – this helps with neuropathy but is also necessary for a healthy heart and healthy blood vessels. It is helpful for hypertension and for managing blood sugar.
Magnesium
The cells use magnesium to process glucose, which helps blood sugar control. Magnesium also helps brain and nerve function. You need it for heart function and maintaining normal blood pressure.
There are many different forms of magnesium, some of which are more effective than others. Deficiency in magnesium can worsen blood sugar control and nerve pain.
Acetyl L-carnitine
Acetyl L-carnitine is a fat-soluble nutrient, so it can pass easily into the nerves where others cannot. It helps to protect the nerves from damage and may also help to reduce pain.
All these supplements work in slightly different ways to help with diabetic nerve pain and diabetic nerve damage.
Of course, you should consult your doctor before taking any supplement, no matter how safe it claims to be.
And once again, these supplements will be most effective when you combine them with lifestyle changes that bring down your blood sugar and treat your insulin resistance.
Have you experienced diabetic nerve pain? Have you used any of the supplements I mentioned above? Let me know in the comments.