Talking About Diabetic Peripheral Neuropathy

Diabetic Peripheral Neuropathy (DPN) is nerve damage that affects the feet, legs, arms and hands.  It’s a potential complication of diabetes, and it’s a frightening one which most people know very little about.  People experience DPN in a variety of ways. They may feel burning, shooting pain, throbbing, pins and needles, sometimes a deep itch, or have no sensation at all in their extremities.  At least 20% of people with diabetes are reported as having DPN, but that figure may be higher because many people don’t realize that what they’re experiencing is DPN and they don’t realize it’s related to their diabetes.

To help people better understand and manage diabetic nerve pain, Pfizer has teamed up with the non-profit organization, Taking Control of Your Diabetes (TCOYD), founded by Dr. Steven Edelman.  TCOYD holds one day health events across the country where patients can learn more about diabetes and take a more active role in managing their condition. The program sponsored by Pfizer is called “Take the Next Step: Get Motivated” and is led by fitness and nutrition expert Kim Lyons and diabetes author, coach, and member of the American Association of Diabetes Educator, Riva Greenberg. You can catch Kim and Riva at TCOYD in San Diego, November 12.

We had the opportunity to talk to both Riva and Kim to find out more about DPN and how to manage it.

 A conversation with Riva Greenberg about DPN:

What can be done to lower the risk of DPN?

You should follow the same general advice as for staying healthy with diabetes: keep your blood sugar in range as much as possible, eat healthy, maintain a normal weight, get active. Unfortunately, many people already have DPN when diagnosed with type 2 diabetes because they’ve been living with diabetes for some years without knowing it.

Is DPN reversible?

 I don’t know if we’d say DPN is reversible but sometimes the symptoms can be minimized, or slowed. Again it takes keeping blood sugar in range as much as possible. There is also medication that helps relieve the pain and I’ve been told by some CDEs about a supplement called alpha lipoic acid (ALA) that you can find in your health food store that may minimize the symptoms of diabetic neuropathy. They’ve been using ALA in Europe for many years with success.

What do you talk about in your TCOYD presentations?

Kim and I help patients understand what DPN is, what they can do to live with it more comfortably and I share a few stories of people I’ve interviewed who live very active lives with diabetes and DPN. For instance the story of Tom who told me he was a couch potato before he was diagnosed with type 2 diabetes at the age of 52. It was a burning in his toes that brought him into his doctor’s office where he discovered he had diabetes. His doctor told him he wasn’t going to get better but Tom made a commitment to turn his health around and he began bicycle riding. On his 70^th birthday he rode his bicycle 70 miles, even with DPN!

How do you encourage people to follow Tom’s lead?

I tell people six things in the presentation to help them learn what they need to know and do what they need to do.

1. Take your symptoms seriously and talk to your doctor.
2. Manage your blood sugar and diabetes as best you can.
3. Learn about diabetic peripheral neuropathy.  You can’t do better if you don’t know better.
4. Find your personal reason why it’s important to you to be healthy. It doesn’t work when our doctors tell us to go out and exercise, we have to find a reason why it’s meaningful for each of us personally to do the work, like being able to play with your grandkids.
5. Just take a first step. Most things we’re successful at started with one baby step.
6. Do more of what you love. This is really funny, but I ask the group I’m talking to, “How many of you have had your health care provider prescribe, along with eating healthy and getting exercise, to do more of what you love?” They laugh, and not a hand goes up. But when we do more of what we love, we’re happier. When we’re happier we have more strength, more hope, a brighter outlook and more capability to do things, including manage our diabetes.

Why did you decide to get involved with this project?  Do you suffer from DPN?

I had symptoms of DPN a few years after I was diagnosed with type 1 diabetes. Every night pulling the blanket up over my legs to go to sleep I felt a burning sensation in my right calf. It was awful. Over the years as I got my blood sugar in better control the burning became more of an intermittent tingling and now I hardly notice anything at all. Of course, diabetes affects us all differently, but keeping your blood sugar well managed is one of your best ways to reduce and prevent diabetes complications.

If people think they have DPN what should they do?

The first thing they should do is talk to their doctor and impress upon him the symptoms they’re having. Many diabetes patients see doctors who are not specifically trained in diabetes and may not know DPN is a complication of diabetes. Some doctors may not really listen when you talk about a pain in your feet because there are so many other things they need to get through in the short time allowed for an office visit. But if you think you suffer from DPN, get your doctor to pay attention and don’t be embarrassed or ashamed, you didn’t cause it. Your doctor may change your treatment plan, or recommend certain activities or medication. No one should have to suffer when there are things that can help.

Riva Greenberg is the author of “50 Diabetes Myths That Can Ruin Your Life and the 50 Diabetes Truths That Can Save It” and “The ABC’s Of Loving Yourself With Diabetes”.  You can catch her blog on the Huffington Post or visit her website Diabetes Stories.

Talking to Kim Lyons about DPN:

What exercises do you recommend for people with DPN? 

There are many exercises and activities you can choose from  if you have DPN. Of course, the exercises and activities you choose will depend on how much pain is involved. I highly recommend riding a bike, either stationary or a regular bike, and swimming. Both are low impact and can be a great cardio workout.

It is also important to do resistance training. For this I recommend using a resistance band. They are very user friendly and are great for beginners or advanced level workouts.

Another element that is important to include is stretching to maintain flexibility and range of motion to prevent injury. Combining all three of these elements makes a perfect exercise program.

What’s special about these exercises?  Are they geared to certain parts of the body?

These exercises are all low impact and combine work all body parts for a complete workout.

How often should a person with diabetes exercise? 

Exercise should be incorporated daily. I recommend 30-60 minutes of activity every day. It is important to change up the routine and have as much variety as possible. It is important to listen to your body and if you need a break, take a slow walk, do some abdominal work, or simple stretches. Take advantage of days that you are feeling great and take a water aerobics class at a local community center or gym.

Of course you should always consult with your doctor prior to any exercise to see if there are any special limitations he/she recommends.

 How often should a person with DPN exercise?

Same answer as above.  Another option is to do a daily exercise/ activity and break up the exercise into 2-3 shorter time increments. For example, 15 minutes in the morning and 15-20 minutes later in the day.

What about nutrition?  How does it affect DPN?

DPN is a consequence of poorly controlled blood sugar so nutrition is absolutely critical. Although you cannot reverse the symptoms of DPN, you can keep them from getting worse through proper nutrition, exercise and medication. Here are three simple tips to help with proper nutrition:

1. Eat five small meals a day.
2. Stick to natural foods such as nuts, eggs, lean meats, veggies, and fruits and avoid overly processed foods that contain white flour and added sugar.
3. Be aware of proper portion sizes. Your protein should be about the size of the palm of your hand, fats about the size of your thumb, and natural carbs about the size of a tight fist.

You can find more information at DiabetesPainHelp.com including questions to ask your doctor and Kim’s simple exercise videos.

Kim Lyon is the author of  Kim Lyons’ Your Body, Your Life: The 12-Week Program to Optimum Physical, Mental & Emotional Fitness and Kim Lyons Start Fitness Now: Stand Up & Slim Down

Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and has continued to write essays and fiction while raising her three sons (and many pets).

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Jessica Apple

Jessica Apple grew up in Houston. She studied Bible and Ancient Near Eastern Studies at the University of Michigan, and completed an MA in the same field at the Hebrew University. She began to write and publish short stories while a student, and continues to write essays and fiction while raising her three sons (and many pets). Jessica’s work has appeared in The New York Times Magazine, The Financial Times Magazine, The Southern Review, The Bellevue Literary Review, Tablet Magazine, and elsewhere. She is the diabetes correspondent for The Faster Times. In 2009 she and her husband, both type 1 diabetics, founded A Sweet Life, where she serves as editor-in-chief. Jessica loves spending time with her sons, cooking with her husband, playing with her cats, reading, biking, drinking coffee, and whenever possible, taking a nap. Follow Jessica on Twitter (@jessapple)