Nerve damage due to diabetes is also called diabetic neuropathy. This is a common complication of both type 1 and type 2 diabetes, with up to 26 percent of people with type 2 diabetes having evidence of nerve damage at the time that diabetes is diagnosed.

Persistent poorly controlled blood sugar levels is linked to nerve damage and the degree of nerve damage in diabetics decreases with proper blood sugar control, coupled with life style changes.

Other known factors that can further increase the risk of developing nerve damage in diabetics include; having coronary artery disease, high cholesterol levels in blood, being overweight (a body mass index >24), smoking, high blood pressure

The most common symptoms of nerve damage in diabetics include pain, burning, tingling, or numbness in the toes or feet, and extreme sensitivity to light touch. The pain may be worst at rest and improve with activity, such as walking. Some people initially have intensely painful feet while others have few or no symptoms.

Diabetes associated nerve damage usually affects both sides of the body. Symptoms are usually noticed first in the toes. As the disease progresses, symptoms may gradually move up the legs; if the mid-calves are affected, symptoms may develop in the hands. Over time, the ability to sense pain may be lost, which greatly increases the risk of injury.

As one loses the ability to sense pain or hot and cold, the risk of injuring one’s feet increases. Injuries that would normally cause pain (e.g., stepping on a sharp object, fire, wearing shoes that create a blister, developing an ingrown toenail) may not cause pain once one has nerve damage. Unless one inspects their feet on a daily basis, a small injury has the potential to develop into a large ulcer. People with longstanding diabetes also have poor wound healing, usually due to damage to blood vessels caused by exposure to high blood sugars, hence a small ulcer from these unnoticed injuries can easily progress into a big wound which can eventually lead to need for amputation of a toe, foot or leg depending the level of spread of the wound and other patient factors at the time of intervention

Nerve damage in diabetes is usually diagnosed based upon a medical history and physical examination of the feet. During an examination, there may be signs of nerve injury such as; loss of the ability to sense vibration and movement in the toes or feet (e.g., when the toe is moved up or down), loss of the ability to sense pain, light touch and temperature in the toes or feet, loss of or decreased reflexes

To prevent development of diabetic nerve damage and its complications, one needs to; control blood sugar levels well with both medications and lifestyle changes as advised by the health practitioner, taking good care of the feet to prevent complications, and some medications to control both pain and progression of nerve damage caused by diabetes can be prescribed.

Care for the feet is very essential in all diabetics as diabetes associated nerve damage may not present any bothersome symptoms initially until one notices a wound injury coincidentally.

It is recommended that people with diabetes should have a comprehensive foot examination once per year, and a visual examination of the feet at each hospital visit (usually every three to four months).

Some activities increase the risk of foot injury and are not recommended, including walking barefoot, stepping into the bathtub before testing the temperature with the hand. One needs to use extra care when trimming the nails.

Diabetics need to wash and inspect their feet daily. Use lukewarm water and mild soap to clean the feet. Gently pat feet dry and apply a moisturizing cream or lotion. Check the entire surface of both feet for skin breaks, blisters, swelling, or redness, including between and underneath the toes where damage may be hidden. Using a mirror or asking a family member or caregiver to help if it is difficult to see the entire foot may help.

Select cotton socks that fit loosely, and change the socks every day. Wear shoes that fit correctly and that are not tight. There are special shoes for diabetics are cushioned well to reduce the risk of blistering and injury to the feet and these can be used.

Dr. Ian Shyaka is a General Practitioner at Rwanda Military Hospital.