Diabetic Neuropathy is one of the most common complications associated with diabetes, affecting at least 30-50% of people with diabetes at some point in their lives.
This condition results from damage or malfunction to the peripheral nerves and can be extremely debilitating, with many people experiencing constant excruciating pain. There are different kinds of neuropathies associated with diabetes, affecting different areas and presenting with different symptoms.
How do I know if I have it?
The most common type of diabetic neuropathy affects the peripheries (up to 75% of cases) and it tends to start in the toes, feet and lower legs, then in the fingers, hands and arms, usually following a symmetrical pattern. This is also known as small fibre neuropathy. The symptoms are mild at first, with many noticing pins and needles and numbness, that can possibly worsen over time. As the condition progresses, you may experience other symptoms such as a hot burning sensation, shooting pains, electric shocks, increased sensitivity to touch and pain, inability to detect temperature changes.
Many people suffering from diabetic neuropathy notice that the pain is worse at night, needing to sleep with their feet hanging off the bed and avoid contact with duvet covers, as this can cause them pain. Others may struggle to put on socks and shoes due to the pain, or they may even cut their feet and not realise due to reduced or altered sensation.
How is this related to diabetes?
People with type 1 or 2 diabetes can be susceptible to developing diabetic neuropathy. Over time, uncontrolled high blood sugar levels damages nerves in the peripheries and stops them from being able to send signals properly. This is because high blood sugar levels damages the walls of the blood vessels supplying the nerves, so they cannot receive sufficient oxygen and nutrients, which eventually leads to irreversible damage and diabetic neuropathy. Studies have shown that that the longer you have had diabetes, the greater the risk of developing neuropathy, especially if your blood sugar is not well controlled.
What other kinds of neuropathies are there?
In contrast to the peripheral neuropathy described above, some people with diabetes may also suffer with a condition called autonomic neuropathy, which affect nerves involved in controlling the heart, bladder, stomach, gut, sex organs and eyes.
You can also develop large fibre neuropathy, which affects nerves associated with vibration, balance, numbness and tingling without pain.
Another kind of neuropathy is known as proximal neuropathy, which often affects nerves in the thighs, hips, buttocks or leg. This causes severe pain, difficulty standing from a seated position, severe stomach pain, and possibly shrinking of your thigh muscles.
The final type of neuropathy associated with diabetes is mononeuropathy, which refers to damage to a single nerve and often results in one specific area of the body being affected.
What are my treatment options?
Once neuropathy develops there is some evidence to support that better sugar control or lifestyle changes are effective in treating neuropathy in people with diabetes and pre-diabetes, but often, drug therapy is prescribed. Amongst the ‘first-line’ medicines are compounds originally developed for other conditions, but which have been shown to help with neuropathic pain. For example, antidepressants (e.g., duloxetine, amitriptyline) and anti-convulsants (e.g., pregabalin, gabapentin) are commonly used to treat diabetic neuropathy, but they are not always effective and can lead to some unwanted side effects.
If these treatments are not effective or well-tolerated, your doctor may potentially prescribe you with opioids (e.g., tramadol, tapentadol) which may also have unwanted side effects such as drowsiness and constipation.
There is no “magic bullet” with this condition and different people respond to different treatments, so it may take time to find what works best for you. However, there may be something else you can do…
What research options are out there?
New medicines for neuropathic pain are being developed specifically for this type of pain. We at St Pancras Clinical Research are currently working on two clinical trials with investigational treatments for diabetic neuropathy, both of which last for six months. For one of our studies, your neuropathy does not necessarily have to be associated with diabetes.
The second study would require a diagnosis of diabetes and you must be taking one of the treatments listed above. In this study, we are investigating a medicine that acts by blocking two proteins found in the body (TNF – Tumour Necrosis Factor, and NGF – Nerve Growth Factor), which are believed to be involved in sensitising nerves, leading to chronic pain. Before being given either the drug or placebo by IV infusions, you will be screened to see if you are suitable. We want to see if this new treatment, in tandem with your current treatment, provides additional pain relief and improvement in your condition.
If you think that you may be suitable or would simply like some more information, please complete our online form to register your interest. The Patient Engagement Team will be in touch with you for a confidential phone call. You may then be invited to our clinic at the Barbican in Central London for a screening visit.
