People with diabetes have an abnormal elevation of their blood sugar and lack adequate insulin to metabolize the blood sugar. As consequence blood, glucose (sugar) may enter certain nerve tissue and damage extremity nerves. This can occur in any type of diabetes. It does not matter if the patient is on insulin, is taking pills, or is diet controlled. The nerve damage that occurs is considered to be permanent.
As the nerve damage occurs, the protective sensations are affected. These include a person’s ability to determine the difference between sharp and dull, hot and cold, pressure differences, and vibration. These senses become dulled and/or altered. The process begins as a burning sensation in the toes and progresses up the foot in a “stocking distribution”. As the condition progresses, the feet become more and more numb. Some people will feel as though a pair of socks are on their feet, when in fact they do not. Other patients will describe the feeling of walking on cotton or a water-filled cushion. Some patients complain of their feet burning at night, making it difficult to sleep. The feet may also feel like they are cold, however, to the touch, they have normal skin temperature. Diabetic peripheral neuropathy is not reversible. The progression of the condition can be slowed or halted by maintaining normal blood glucose levels.
As patient develops diabetic neuropathy, they have a greater risk of developing skin ulcerations and infections. Areas of corns and calluses on the feet represent areas of excessive friction or pressure. These areas, if not properly cared for by a foot specialist, will often break down and cause ulcerations. Ulcerations and infections can form under the callused area. These callused areas may not be painful. As a result, they can progress to ulceration without being noticed. Ingrown toenails can progress to severe infections in people with neuropathy. Simple things like trimming the toenails present a risk to these patients because they may accidentally cut the skin and not feel it. People with neuropathy must be very cautious and inspect their feet daily. They should not soak their feet in hot water or use heating pads to warm their feet. This can result in accidental burns to the skin. Barefoot walking should be avoided because of the risk of stepping on something sharp and not being aware of it. The inside of the shoes should be inspected before putting the shoes on to ensure that no foreign object is inside the shoe.