Diabetic Neuropathy latest treatment 

Neurological Disorders

Neuropathy: An Overview

Neuropathy damages or malfunctions nerves in the peripheral nervous system, which includes all nerves outside the brain and spinal cord. Neuropathy may affect neurons that control sensation, muscle movement, and autonomic functions, including heart rate and digestion.

Symptoms of neuropathy

Symptoms in common

• Tingling, numbness, or “pins and needles”
• Burning or stabbing pain in hands or feet
• Poor coordination or muscle weakness
• Touch or temperature sensitivity
• Autonomic nerve disorders can include digestive issues, disorientation, and excessive sweating.

What Are Common Neuropathic Pain Symptoms?

Neuropathy feels distinct from injury or inflammatory pain. The symptoms generally result from nerve signal misfiring caused by nervous system damage or dysfunction. Here are some popular ones:

Main Symptoms

• Burning or shooting pain: Electric shock or stabbing.
• Hands, feet, or limbs tingling or “pins and needles”
• A sense of “deadness” or lack of touch
• Allodynia: Pain from harmless stimuli like gentle touch or clothes brushiness
• Hyperalgesia: Exaggerated pain response—what should feel little hurts much.
• Dysesthesia: Abnormal crawling, itching, or buzzing sensations

Perhaps Other Signs

• Poor coordination or muscle weakness
• Nighttime pain gets worse
• Temperature sensitivity
• Poor sleep due to discomfort

These symptoms can be chronic or intermittent and follow a “stocking-glove” pattern, starting in the toes and fingers and rising. If you see any of these indicators, especially with diabetes, chemotherapy, or nerve injury, investigate.

Types of Neuropathy

• Peripheral neuropathy affects the arms, legs, feet, and hands.
• Internal organs are affected by autonomic neuropathy.
• The brain nerves affected by cranial neuropathy
• Focal neuropathy affects one or more nerves.

Treatment varies based on the underlying reason and may include:

• Controlling blood sugar in diabetes can help manage the root cause.
• Gabapentin or duloxetine for pain
• Physical treatment
• Nutrition (particularly B vitamins)
• Eliminating alcohol or enhancing ergonomics

What causes neuropathy?

Many factors can cause neuropathy. Here are the most prevalent causes, categorized for clarity:

First, metabolic and endocrine causes

• Diabetes is the most prevalent cause, as high blood sugar destroys nerves over time.
• Thyroid disorders, especially hypothyroidism
• Vitamin deficiencies: B1, B6, B12, E, niacin

2. Infections

• The shingles
• HIV/AIDS
• Hep C
• Lyme illness
• Leprosy

3. Inflammatory and Autoimmune Conditions

• Lupus
• Rheumatoid arthritis
• GBS
• Syndrome Sjögren. 
• In these settings, the immune system may assault neural tissues.

4. Toxins

• Direct nerve damage and nutritional deficits result from alcohol misuse.
• Lead, mercury, arsenic
• Drugs used in chemotherapy
• Certain antivirals/antibiotics

5. Genetic/Hereditary illnesses

• CMT disease
• Ataxia Friedreich. These are rare yet crucial in early-onset or familial instances.

6. Physical Injuries and Nerve Compression Trauma: vehicle accidents, falls, fractures

• Repeated stress: carpal tunnel or sciatica
• Nerve damage after surgery

7. Paraneoplastic and Cancer

• Tumors and cancer immune responses can damage neurons.

8. Blood and Vascular Diseases

• Reduced blood flow caused by vasculitis or diabetes leads to nerve ischemia.

9. Neuropathy

• Testing sometimes fails to identify a reason, especially in elderly individuals.

How does diabetes cause neuropathy?

Long-term high blood sugar damages nerves and small blood vessels, causing neuropathy in diabetes. How it goes:

1. Glucosetoxicity

• Chronic hyperglycemia impairs neuronal metabolism. Too much sugar:
• Disrupt nerve signals.
• Increase oxidative stress, damaging nerve cells with free radicals.
• Sorbitol and fructose build up in nerves, causing swelling and malfunction.

2. Vascular Damage

High blood sugar damages nerve-nourishing capillaries. The condition deprives nerves of oxygen and nutrients, limiting their function.

3. Immune dysfunction, inflammation

Low-grade inflammation and immunological responses from diabetes harm nerve tissue over time.

4: Lipid Imbalance

Diabetes's high triglycerides and other blood fats cause inflammation and oxidative stress, which can damage nerves.

Up to 50% of diabetics develop diabetic neuropathy due to metabolic, vascular, and inflammatory damage. Starting in the feet and legs, it may proceed silently before numbness, tingling, or pain appears.

Neuropathy diagnosis:

Neuropathy is diagnosed step-by-step using clinical evaluation and focused testing to determine nerve damage type, etiology, and extent. It usually goes like this:

1. Medical History Detail

• Doctors inquire about:
• Symptom onset, duration, and pattern (numbness, tingling, pain)
• Diabetes, autoimmune disorders, and infections
• Medication, alcohol, and toxins
• Neurological disease family history
• This helps identify causes and direct tests.

2. Physical/Neurological Exam

• The exam may assess:
• Strength and tone
• Neuropathy reduces reflexes
• Touch, vibration, temperature, and pain
• Balance and coordination
• These data assist in identifying damaged nerves—sensory, motor, or autonomic.

3. Blood Tests

• To find root causes like
• Blood glucose (HbA1c) diabetes or prediabetes
• Lack of vitamins (B12, B6, E)
• Misfunctioning thyroid
• HIV, hepatitis C, or autoimmune markers

4. NCS and EMG

• Important tests:
• NCS measures nerve signal speed and strength.
• EMG measures muscular response to nerve stimulation.
• Together, they confirm neuropathy and identify nerve and muscle problems.

5. Select skin or nerve biopsy

• A skin biopsy can detect small fiber neuropathy by measuring nerve fiber density.
• Occasionally, nerve biopsy is needed for vasculitis or amyloidosis.

6. Imaging (if needed)

• MRI or ultrasound can rule out nerve compression or spinal problems.
• Preventing nerve damage and tailoring treatment requires early diagnosis. Those who are inquisitive are welcome.

What works to prevent diabetic neuropathy?

Preventing diabetic neuropathy requires maintaining healthy blood sugar levels. It goes beyond glucose management. Well-rounded strategy:

1. Tight Blood Sugar Control

This process is the foundation. Track daily levels using a glucose meter or CGM and undergo regular A1C testing to assess long-term control.

2. Regular Exercise

Try 150 minutes of moderate exercise like brisk walking, swimming, or cycling every week. It enhances circulation and insulin sensitivity and promotes nerve health.

3. Healthy Eating

Eat veggies, fruits, whole grains, lean proteins, and healthy fats. Cut back on sweets, processed meals, and alcohol.

4. Foot Care

Examine your feet every day for cuts, blisters, and infection. Apply moisturizer (not between toes), wear comfortable shoes, and never walk barefoot.

5. Stop smoking

Smoking impairs nerve oxygenation and circulation. Quitting dramatically lowers neuropathy progression risk.

6. Control BP, cholesterol

High blood pressure and cholesterol harm nerve-supplying blood vessels. You may need to modify your lifestyle and medication.

7. Weight Control

Obesity causes insulin resistance and inflammation. Slimming down even slightly improves metabolic health and nerve stress.

8. Supplement Well

Maintain vitamin B12 and D levels for nerve function. Lacks can aggravate or resemble neuropathy.

9. Early Symptom Reporting

Report early tingling, numbness, or burning. Treatment can halt or reverse nerve deterioration.

What are the new diabetic neuropathy treatments?

The video explains the new treatments to neuropathy

Beyond painkillers, diabetic neuropathy treatment is improving with targeted and regenerative methods. New medicines with high potential include

1. Neuromodulation Tech

The FDA-approved spinal cord stimulation (SCS) can treat the discomfort associated with diabetic neuropathy. The treatment modifies spinal cord pain signals before they reach the brain by using modest electrical pulses. Patients who don't respond to drugs benefit most.

2. Qutenza Capsaicin 8% Patch

Researchers are studying this EU/UK-approved high-concentration topical patch for diabetic neuropathy. This investigational medication desensitizes skin pain receptors, providing relief without systemic adverse effects.

3. Chemokine Receptor Inhibitor DF2755A

Neuroinflammation-related CXCR1/2 receptors are targeted by this investigational medication. Calming hyperactive sensory neurons may reverse peripheral neuropathy.

4. Nonopioid Designer Molecules

Researchers are discovering new chemicals to calm overactive pain-sensing neurons without causing damage to the heart or brain. One HCN ion channel-targeting drug has shown substantial pain alleviation in preclinical tests without sedation or addiction.

5. TENS devices with high frequency

Researchers are refining advanced TENS devices for home use. Non-invasive technologies control nerve activity and alleviate pain.

6. Sodium Channel Blockers

Researchers are exploring lacosamide and cenobamate, two newer nerve hyperexcitability blockers, as alternatives to gabapentin and duloxetine.

What lifestyle changes assist diabetic neuropathy?

Lifestyle adjustments can alleviate symptoms, decrease progression, and enhance quality of life for diabetic neuropathy. Well-rounded approach:

1. Improve Blood Sugar Management

Keeping blood glucose levels within the goal is most important. Work with your doctor to alter drugs or insulin using a CGM or regular testing.

2. Eat Nerve-Friendly.

Eat whole grains, leafy greens, berries, lean meats, and omega-3s from fish or flaxseed.

Limit refined carbs, sugary snacks, and processed foods to avoid glucose rises.

To maintain nerve health, consume enough B vitamins (particularly B12), vitamin D, and antioxidants.

3. Exercise regularly

Use walking, swimming, or cycling to get 30 minutes of moderate activity most days. Circulation, inflammation, and insulin sensitivity improve with exercise.

4. Quit smoking

Smoking decreases nerve blood flow and worsens neuropathy. Quitting improves circulation and nerve function greatly.

5. Drink less

Alcohol can harm nerves and affect blood sugar. Drink moderately or quit.

6. Take Foot Care Daily

Check your feet for wounds, blisters, and infection. Clean and moisturize them, wear well-fitting shoes, and avoid barefoot walking to avoid injury.

7. Control BP, cholesterol

High blood pressure and cholesterol damage nerve-nourishing blood vessels. Lifestyle and pharmaceutical adjustments may be needed to control them.

8. Weight Control

Even a slight weight loss reduces inflammation and blood sugar, relieving nerve strain.

9. Dealing with Stress

Pain and blood sugar control can deteriorate with chronic stress. Both can be regulated by mindfulness, yoga, or breathing.

Neuropathy symptoms after chemotherapy may last or not.

Chemotherapy-induced peripheral neuropathy (CIPN) might be transitory or permanent depending on numerous circumstances.

• CIPN starts in the hands or feet and may include:
• Stinging, burning, or “pins and needles”
• Absence of sensation
• Electric shock-like or stabbing discomfort
• Poor coordination or muscle weakness
• Touch or temperature sensitivity
• Trouble buttoning or writing

Also, read https://www.footcaremd.org/foot-and-ankle-conditions/the-diabetic-foot/neuropathy

Why It Happens

Taxanes, platinum-based medicines, and proteasome inhibitors can harm peripheral neurons. This damage might develop during therapy or months afterward.

Outlook and Duration

Some symptoms improve weeks or months following treatment.

Others may suffer long-term or irreversible nerve damage if treatment continues despite early neuropathy symptoms.

Helpful medications:

Duloxetine is a rare medicine that alleviates CIPN pain.

Vitamin B12, glutathione, and alpha-lipoic acid may help, but see your doctor first.

Physical therapy boosts balance, strength, and coordination.

Lifestyle: Gentle exercise, foot care, and no drinking or smoking may help improve symptoms.

Neuropathy Complications and Treatment

If you don't address the source of neuropathy early, it can lead to modest or life-altering problems. Here is a list of common problems and their respective treatments:

1. Cuts, wounds, ulcers

• Lack of sensation, especially in the feet, can make minor injuries like blisters or cuts go undiagnosed and worsen. This is prevalent in diabetic neuropathy.
• Treatment: Regular foot inspections, wound treatment, debridement, antibiotics, and unloading pressure with specific shoes or mobility aids.

2. Infection/gangrene

• Untreated wounds can cause cellulitis, osteomyelitis, or gangrene.
• Treatment: Antibiotics, surgery, and amputation in severe cases. Healing can also be achieved using hyperbaric oxygen therapy.

3. Amputations

• Prolonged infections or non-healing wounds may require partial or whole limb amputation, especially in diabetic neuropathy.
• Preventing this outcome requires early identification, foot care, and blood sugar control.

4. Mobility, Balance Issues

• Falls and fractures can result from muscle weakening and proprioception loss.
• We provide physical treatment, balance training, assistive equipment, and home safety adaptations.

5. Digestion, Bladder Issues

• Autonomic neuropathy can cause bladder control and digestion issues like constipation and diarrhea.
• Nutrition, motility medicines, bladder training, and catheterization may be used.

6. Joint and Bone Deformities

• Repeated, unrecognized traumas might damage foot joints (Charcot joint).
• Orthotics, immobilization, and surgery may be needed.

Conclusion

Effective care includes:

Controlling diabetic blood sugar is one example of root cause treatment. Relieving symptoms using drugs, physical therapy, and neuromodulation. Weight loss, exercise, foot care, and smoking cessation. 

We are actively monitoring and preventing ulcers, falls, and digestive disorders. New treatments give hope for chronic or treatment-resistant cases.