Diabetic Peripheral Neuropathy: Symptoms, Treatment, and Family Links

Diabetic peripheral neuropathy

Hello Doctor: My father has a history of diabetes for 11 years.
Last year, he experienced numbness and pain in his limbs, sometimes feeling numb all over.
He visited the neurology department at Taichung Veterans General Hospital, where he was diagnosed with moderate to severe neuropathy (as per nerve conduction studies).
The doctor prescribed gabapentin 100 mg, a vasodilator 500 mg, and half a tablet of Xanax.
After taking the medication for 3 to 4 months, he noticed improvement and stopped taking it on his own, but he occasionally resumed medication when the numbness and pain returned.
However, since the end of March this year, his condition has worsened to the severity he experienced last June, and upon returning for a follow-up, the doctor prescribed the same types and dosages of medication as before.
I have the following questions for the doctor:
1.
Can diabetic peripheral neuropathy cause significant pain and widespread numbness? Is my father's situation uncommon? (His numbness and pain have reached a level of mild disability.)
2.
Does diabetic peripheral neuropathy pose a life-threatening risk?
3.
My father often complains that the medications are ineffective; it seems that gabapentin is not working.
Could there be an issue with drug tolerance?
4.
Can my father's pain and numbness be improved with neurosurgery? What are the potential surgical complications?
5.
Three years ago, I underwent a nerve examination at Taichung Veterans General Hospital due to military service, which indicated nerve damage, and I was deemed unfit for service, but I do not have any discomfort (pain or numbness).
I would like to know if my father's neuropathy could be related to familial neuropathy rather than just diabetic peripheral neuropathy.
(Could it be that my father's symptoms have emerged due to aging?)
6.
My father may have Guillain-Barré Syndrome (GBS) or Acute Inflammatory Demyelinating Polyneuropathy (AIDP) (he only underwent nerve conduction studies at the hospital).
7.
Does my father need to go to the neurology department at National Taiwan University for more precise testing to determine the type of neuropathy?
P.S.: My father's blood tests are normal, his blood pressure is 80-120 mmHg, and his HbA1c is normal.
Thank you, doctor, for addressing these detailed questions.

Cheng, 20~29 year old female. Ask Date: 2009/04/11

Dr. Lin Zijing reply Neurology

1.
Does diabetic peripheral neuropathy cause severe pain and numbness throughout the body?
Answer: It mostly causes numbness and pain in the extremities, with a small portion experiencing pain in a single nerve.
2.
Can the numbness and pain from diabetic peripheral neuropathy be life-threatening?
Answer: Peripheral neuropathy can ultimately lead to muscle weakness and atrophy, affecting mobility, but it generally does not pose a life threat (other diabetic complications can).
3.
My father often complains that the medication is ineffective; gabapentin seems not to be working.
Is there a possibility of drug tolerance?
Answer: It is possible that the dosage of gabapentin is insufficient; consider adding other types of medications for a multi-faceted approach.
4.
Can my father's pain and numbness be improved with neurosurgery? What are the potential surgical side effects?
Answer: Some individuals have undergone surgery to disrupt pain-sensing nerves to treat neuropathic pain, but the side effect is permanent loss of sensation.
5.
Three years ago, I underwent a neurological examination at Taichung Veterans General Hospital to check for neuropathy due to military service, and the results indicated neuropathy, which led to my exemption from service.
However, I do not experience any discomfort (pain or numbness).
I would like to ask if my father's neuropathy is related to familial neuropathy rather than just diabetic peripheral neuropathy.
Could it be that my father's symptoms are manifesting due to aging?
Answer: You should consult your physician regarding the specific type of neuropathy that led to your exemption from service.
6.
My father may have Guillain-Barré Syndrome (GBS) or Acute Inflammatory Demyelinating Polyneuropathy (AIDP) (he only underwent muscle nerve conduction studies at the Veterans General Hospital).

Answer: GBS and AIDP refer to acute inflammatory demyelinating polyneuropathy, which typically presents rapidly and does not worsen gradually; Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) would worsen slowly, leading to weakness in the limbs.
7.
Does my father need to go to the neurology department at National Taiwan University for more precise testing to determine the type of neuropathy?
Answer: If diabetes is well-controlled and symptoms continue to worsen despite medication adjustments, further evaluation is necessary.

Reply Date: 2009/04/11

More Info

Diabetic Peripheral Neuropathy (DPN) is a common complication of diabetes that can lead to significant discomfort and impairment in quality of life. Given your father's history of diabetes for 11 years and the recent exacerbation of his symptoms, it's important to address your questions comprehensively.

1. Pain and Numbness in DPN: Yes, diabetic peripheral neuropathy can indeed cause severe pain and numbness, particularly in the extremities. While it is more common for patients to experience symptoms in their feet and hands, some individuals may experience more widespread symptoms, including sensations of pain or numbness throughout the body. Your father's experience of severe symptoms is not necessarily rare, especially in the context of long-standing diabetes, which can lead to more severe nerve damage.

2. Life-Threatening Risks: Generally, diabetic peripheral neuropathy itself is not life-threatening. However, it can lead to complications that may pose risks to life, such as foot ulcers or infections that can result from unnoticed injuries due to loss of sensation. Additionally, if neuropathy leads to muscle weakness, it can affect mobility and increase the risk of falls, which can be dangerous, especially in older adults.

3. Medication Effectiveness and Tolerance: Gabapentin is often prescribed for neuropathic pain, but its effectiveness can vary among individuals. If your father feels that the medication is not working, it could be due to several factors, including insufficient dosage or the development of tolerance. It may be beneficial to discuss with his physician the possibility of adjusting the dosage or exploring alternative medications or therapies, such as duloxetine or pregabalin, which are also used for neuropathic pain.

4. Surgical Options: Surgical intervention for neuropathic pain is generally considered a last resort and is not commonly performed for diabetic peripheral neuropathy. Some procedures may involve decompression of nerves, but these come with risks, including permanent loss of sensation or other complications. A thorough evaluation by a neurologist or pain specialist would be necessary to determine if surgery is appropriate.

5. Family History and Genetic Factors: While diabetic peripheral neuropathy is primarily a complication of diabetes, there can be genetic predispositions to nerve damage. If you have a family history of neuropathy or other neurological conditions, it could be relevant. Aging can also exacerbate symptoms, as the body's ability to repair nerve damage diminishes over time.

6. Possible GBS or AIDP: Guillain-Barré Syndrome (GBS) and Acute Inflammatory Demyelinating Polyneuropathy (AIDP) are acute conditions that typically present with rapid onset of weakness and sensory changes. These conditions are distinct from diabetic neuropathy, which develops more gradually. If your father's symptoms have worsened rapidly, it may warrant further investigation to rule out these conditions.

7. Further Evaluation: If your father's symptoms are not improving with current treatment and are worsening, it may be prudent to seek a second opinion or further evaluation at a specialized center, such as the neurology department at a university hospital. Advanced diagnostic tests, including nerve conduction studies and possibly a skin biopsy, can provide more insight into the nature of his neuropathy.

In summary, managing diabetic peripheral neuropathy involves a multidisciplinary approach, including careful monitoring of blood sugar levels, medication management, and possibly physical therapy. It is essential to maintain open communication with healthcare providers to ensure that your father's treatment plan is effective and adjusted as needed. Regular follow-ups and comprehensive evaluations can help in managing symptoms and improving quality of life.

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