Diabetic Peripheral Neuropathy

Diabetic neuropathy surgery Sydney

Diabetes is a common disease, and it’s estimated that more than one million Australians are currently experiencing either type 1 or type 2 diabetes. People with diabetes may experience a variety of long-term health consequences, including loss of vision, reduced kidney function, and a higher risk of events like heart attack and stroke. 

One of the possible consequences of diabetes is diabetic peripheral neuropathy. Studies show that over time, about half of all people with diabetes will develop some degree of this condition. It can cause significant pain for many patients, and also increases the risk of losing a limb.

What is diabetic peripheral neuropathy? How do you know whether you have it? Most importantly, how can you treat this painful condition?

What is diabetic peripheral neuropathy?

Neuropathy means nerve damage. In people with diabetic neuropathy, the nerve damage is caused by high blood sugar. Over time, repeated spikes in blood sugar cause damage to many different tissues throughout the body, including nerves. Neuropathy is an extremely common complication of diabetes, and a majority of patients with diabetes will eventually develop it. 

Keeping blood sugar under control is the best way to prevent diabetic neuropathy. Those who have good blood sugar control have a much lower risk of developing this condition. In addition, certain other patient factors can lead to an increased risk of neuropathy, including high levels of cholesterol and triglycerides (fats) in the blood as well as high blood pressure. Various genetic factors are believed to play a role as well.

There are a few different forms of diabetic neuropathy. By far the most common form is called diabetic peripheral neuropathy. This affects the limbs, including both the legs and the arms. The longest nerves are typically affected first, and so the symptoms usually appear first in the legs and feet. Later, the arms and hands may also start to experience symptoms.

What are the symptoms of diabetic peripheral neuropathy?

Patients may notice the following symptoms in the affected area(s):

• A tingling or burning sensation
• Sharp or jabbing pain, which is often worse at night
• Areas of numbness
• Reduced ability to feel pain
• Reduced sensitivity to heat and cold
• Increases in sensitivity to touch (even a light touch may feel painful)
• Muscle weakness

Diabetic neuropathy creates an increased risk of limb loss, especially when it affects the feet. Patients who have lost sensation in the feet are at a higher risk for getting an injury that they don’t notice. For example, they may have a small rock in their shoe. While most people would notice the rock and remove it right away, people who can’t feel their feet very well may not realize that the rock is there. It can create a wound on the foot. If the wound becomes infected, there is a risk that the body will not be able to heal this infection. Diabetes also affects blood flow to the feet, and so healing a wound is harder for the body. Small wounds can more easily become chronic infections, and the person may lose their leg or even their life because of what started as a small issue.

What are the treatment options?

The best way to treat diabetic peripheral neuropathy is to treat the diabetes that is causing it. When blood sugar is brought under control, this will often help to stop the progression of peripheral neuropathy. However, it cannot reverse damage that has already occurred.

If you have diabetic peripheral neuropathy, then it’s very important that you closely monitor your feet for any signs of a wound or an infection. This can allow these issues to be treated earlier, which in turn reduces the risk that they will progress and lead to amputation or even death.

For many people, the pain of diabetic neuropathy interferes with their daily lives. There are various medications available that can help to manage neuropathic pain. These include pain medications that are taken by mouth, as well as creams and lotions that can be applied to the feet to help with pain.

For some patients, a surgical procedure may be helpful. There are a few different surgical procedures that may offer some relief to a person with diabetic peripheral neuropathy.

Peripheral nerve stimulation

A peripheral nerve stimulator is a small device that’s used to help treat pain, and it may help patients with diabetic peripheral neuropathy. A very small wire is surgically implanted under the skin. This is connected to a small battery-powered device, which sends electrical signals through the wire. By stimulating nerves, this helps to change how the brain perceives pain.

The placement of a peripheral nerve stimulator takes only a few minutes. It can be done under ultrasound guidance through a very small incision. This is a minimally-invasive way to address the pain of diabetic peripheral neuropathy. However, this method can’t restore lost sensory or motor functions to the affected area.

Nerve decompression surgery

There are a variety of different factors that can contribute to nerve damage in patients with diabetes. However, it’s believed that compression of the nerve may be one of them. High blood sugar leads to thickening and stiffening of connective tissue structures, including those that surround nerves. This can cause the nerve to become compressed. In addition, increased blood sugar levels lead to swelling of the nerve, which may lead to the nerve being compressed at points where it passes through a small anatomical area.

In some cases, nerve decompression surgery can help. For patients with diabetic peripheral neuropathy, the most common technique uses a small incision in the top of the foot. The surgeon then cuts certain ligaments, in order to relieve pressure on the nerves. More research is needed to confirm that this technique is effective, but some studies have shown good results. 

Nerve transfer surgery

Nerve transfer surgery uses a piece of a healthy nerve to restore function to a damaged one. This can be helpful for some patients. A piece of a different nerve is rerouted, in order to restore sensation and/or motor function to the foot and lower leg. This is a cutting-edge surgical option, and research is showing that it can offer good results for those suffering from diabetic peripheral neuropathy.

It’s important to note that if your blood sugar remains high, you will likely continue to experience further nerve damage. It’s important to get blood sugar under control before considering a nerve transfer procedure.

Diabetic neuropathy surgery Sydney

We strongly recommend that all people with diabetes have regular appointments with a general practitioner, in order to monitor their diabetes and keep blood sugar under control. This is by far the best way to prevent further nerve damage. However, for those who have already experienced nerve damage, a surgical procedure might help to reduce pain, improve function, and reduce the risk of limb loss.

If you have diabetic peripheral neuropathy and you’re interested in discussing one of these procedures, we invite you to schedule an appointment with Dr. Sungaran. After examining you and learning about your medical history and your goals, he’ll be able to let you know what results you could realistically expect from a surgical procedure. He’s a recognised expert in the field of microsurgery who has presented about nerve transfer surgery at major conferences, so you’ll know you’re in the best possible hands to discuss your options. You’ll have a chance to ask all of your questions, so you can decide whether surgery for diabetic peripheral neuropathy is right for you. To schedule your appointment, please contact our front desk.