What is DPNP?

Diabetic peripheral neuropathic pain is a term used to describe a clinical complication associated with patients of type 1 and type 2 Diabetes Mellitus. It is manifested as nerve damage caused by persistent high blood glucose levels [1]. It develops slowly over a period of many years. If you are diabetic, keep an eye on your symptoms. If you notice any numbness, tingling sensation, and weakness in your hands or feet, visit your doctor as soon as possible. These are the earliest symptoms of DPNP. Your skin being numb, you do not feel any pain when an ulcer develops on your hands or feet unless you see it. DPNP leads to poor wound healing culminating in limb amputation.

 

What are the Types of Diabetic Neuropathy?

Diabetes can cause different types of nerve damage including:

• Peripheral neuropathy
• Autonomic neuropathy
• Focal neuropathy
• Proximal neuropathy

 

Who Suffers from it?

People with uncontrolled diabetes mellitus suffer from DPNP. Persistent uncontrolled blood glucose levels cause nerve damage in different areas of your body [2]. Almost 25% of diabetics develop diabetic peripheral neuropathic pain and up to 50% of all diabetics develop DPNP after 25 years of being diabetic. Keeping your blood glucose levels normal is necessary to avoid this painful and challenging condition.

 

What are the Symptoms of DPNP?

Symptoms of DPNP develop gradually starting from the nerves of the feet. ‘Pins and needle’ sensation in the damaged nerve area is the foremost manifestation of DPNP. Following are the common signs and symptoms associated with it [3]:

• Tingling sensation
• Numbness of limb
• Sudden sharp shooting pain
• Sores and blisters on your feet
• Increased sensitivity to touch
• Pain in your hands and feet
• Difficulty in walking due to uncoordinated movements
• Muscle wasting
• Nausea, vomiting, and diarrhea or constipation
• Indigestion
• Bladder problems
• Dizziness on standing up
• Burning sensation in feet
• Bloating
• Increased or decreased sweating
• Erectile dysfunction
• Vaginal dryness
• Double vision
• Increased heart rate
• Inability to sense hypoglycemia
• Swollen feet
• Deep stabs
• Pinching sensation
• Loss of balance

 

What Causes DPNP?

The exact mechanism of the development of DPNP is not known. However, chronically high blood glucose levels result in it [4]. High blood glucose and triglycerides levels damage small blood vessels responsible for providing nutrition to your nerves, leading to peripheral neuropathy. Damaged nerves are unable to do their work properly leading to lapses in nerve transmission. DPNP first develops in the legs and feet followed by arms and hands. Numbness leads to loss of ability to feel pain leading to the development of ulcers that do not heal. Limb amputation is the ultimate result of these non-healing ulcers.

 

 

What Treatment Options are Available for DPNP?

It is difficult to treat to long developed DPNP. However, the following options are available for DPNP [5]:

• Medical Treatment: following are the commonly prescribed drugs for DPNP:

1. Opioid pain killers
2. Gabapentin
3. Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)
4. Selective Serotonin Reuptake Inhibitors (SSRIs)
5. Tricyclic Antidepressants (TCA)

• Surgical Treatment: surgical decompression of the nerves relieve DPNP.

 

 

 

 

 

References:

1. https://pubmed.ncbi.nlm.nih.gov/17714113/
2.  https://academic.oup.com/jcem/article/90/8/4936/2838549
3.  https://www.niddk.nih.gov/not-found?404url=diabetes.niddk.nih.gov/dm/pubs/neuropathies/#peripheralneuropathy
4.  https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/peripheral-neuropathy
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431761/

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