Diabetic Nerve Pain: A Guide for Patients and Families - American Academy of Neurology

you Jerry Mathers has been in the spotlight all his life the former child star has also spent many years managing diabetes and sometimes the pain that goes with it I would even describe it this way if someone took a pin and stuck it in your foot that's kind of what it feels like it's called diabetic nerve pain or diabetic peripheral neuropathy the longer you have diabetes the greater your risk of developing this condition diabetic nerve pain is a pain that arises from damage to the nerves when a person has diabetes controlling blood sugar is an excellent way to change the course of this problem but even if you have good control over your blood glucose levels you can certainly have severe nerve pain associate with diabetes this program is about managing diabetic nerve pain with the help of medical experts and real patients you'll learn what causes this pain and what you can do about it Jerry Mathers is an American icon his parents didn't seek to make him a child star he was discovered in a department store then after a few parts and commercials and movies he went to an audition that would transform his life I said well you know I really don't want to be here because I have a Cub Scout meeting and they said okay you can leave and so I went to the meeting they called that night they said I had a job as the beaver and a new television series because they would rather have a little boy that wanted to go to the Cub Scout meeting than be an actor so that's how I got the job for Leave It to Beaver the show ran from 1957 to 1963 but has had a long life in reruns around the world jerry is used to being recognized everywhere I think it's because I grew up in people's living room and so when they see me they'll either say hi beaver which doesn't offend me in the least or hi Jerry after going to high school and college Jerry returned to the role as a grown-up in the 1980s with the new Leave It to Beaver when that ended he became a businessman one of his ventures was a successful catering company so suddenly I started putting on a lot of weight I knew that I was laying around a lot I didn't have the energy but I thought it was the good life Jerry started having pains and his feet and legs but he didn't realize they were connected to diabetes because he didn't know he had it they were kind of shooting pains but honestly I thought that was from just being overweight and it did hurt but I was the kind of person that just kind of went I it'll go away but a family friend a physician insisted Jerry get a checkup that's when he learned he had type 2 diabetes and the doctor said his blood sugar levels were way out of control she said if you don't do something about your diabetes you will be dead in three to five years that was more than ten years ago Jerry learned how to manage his blood sugar levels with medication and a change in lifestyle right now he's not experiencing diabetic nerve pain for many people with diabetes however it's a daily part of coping with the disease but as you'll see help is available it starts with commune ocation sharing how you feel with your healthcare team it's important to communicate all the symptoms you're experiencing so that when it does become unpleasant and a disruption your ability to enjoy activities or to do your work or to sleep something can be done ted has had diabetes for 20 years he knows about the importance of keeping his blood sugar levels under control well when I started out I didn't manage my diabetes real well and then I started to get real sick and decided I needed to take a little better care of it by the time the person says to themselves oh I have damage I better change my lifestyles too late look right up at the arm strip on the wall their diabetes can cause a number of problems that creep up slowly diabetic nerve pain is one of the most common and it is due to an attack on the nerves so the nerves are actually dying nerves carry pain signals throughout your body they're very sensitive to high levels of blood sugar the sugar is actually eating at the proteins that are part of the nerve nerve damage can lead to many different symptoms ranging from numbness or lack of muscle control to tingling burning prickling sharp pain cramps and extreme sensitivity to touch mister problem which may not be really an issue for a very long time it might be a simple tingling or numbness but not a painful experience and then suddenly become one that is distressing and painful a diabetic nerve pain came on about five or six years ago it felt like the pain felt like needles and that in my in my feet and it started in my toes and went to my feet it's now going up my legs Ted's experience is typical pain is often felt first in the feet and hands because they're farthest from the brain and spinal cord long nerve fibers are usually the first to be damaged by high blood sugar levels and like many people with diabetic nerve pain Ted suffers most at night I noticed the pain at night more than I do during the day when I'm laying down and trying to sleep that's it most your risk for diabetic nerve pain is higher if you have poor blood sugar control have had diabetes a long time have high blood pressure smoke or are tall some of these factors you can do something about talk to your healthcare professional about managing blood sugar and high blood pressure and getting help to quit smoking if you already have pain from nerve damage there are medicines techniques and some devices that can help provide relief so with awareness and action you can develop a plan to manage diabetic nerve pain as we've heard when Jerry Mathers first experienced nerve pain he didn't even know he had diabetes when his foot hurt he tried to ignore it especially at night when I was laying down at night to go to sleep I get these shooting pains and I think well I must have just turned it wrong during the day it's not uncommon that a patient will not realize that they have diabetes and experienced a burning or tingling pain in their feet and this may be in some cases the first clue that a patient actually has diabetes and you may check a few other things to make sure that something else is not also in the mix then you can be fairly confident that the diabetes is causing the nerve pain for Donna there was never a doubt about the connection she has had diabetes since childhood and the pain has been with her for a long time I've started feeling it around 20 years ago I had a lot of numbness and tingling and achiness a little bit of heaviness in my legs and I had some trouble walking like any kind of pain diabetic nerve pain cannot be measured directly with any test or machine but you can describe your pain using a pain scale for example from 1 to 10 my pain can range up to a 10 and it can affect my daily activities where I might not be able to do anything that day I'm laid up on the couch I think the best way to approach the physician is to not only talk about the intensity of pain but also the quality but what it feels like and what they're experiencing what are you doing for exercise and I think the opportunity to discuss how this is impacting in your daily activities or your recreational activities is a crucial part of helping physician understand what you're going through in addition to checking your blood sugar level a healthcare professional can diagnose your pain by considering whether there might be other causes and by testing your reflexes and sensitivity to touch you might also be referred to a neurologist for electronic tests of nerve function I think what a patient has nerve pain associated with diabetes the first thing we try to explain to them is that oftentimes our goal is to reduce their pain intensity not simply to take it all away it's perfectly normal to want your pain to be reduced as much as possible but thinking about what you want to be able to do can help you set realistic goals my goals are to just be able to get up in the morning and live pretty much a normal lifestyle for Donna that means finding a way to dampen a painful array of distracting sensations I feel out of burning and tingling and it feels like bugs are actually crawling on your your feet when I go in for a doctor visit I tried to explain what I would like to do and what I would like to get out of my visit and maybe things that he can help me with to achieve that defining goals can start the process of finding the best treatment for example patients might need help getting sleep or handling their mental health maybe they're no longer sleeping well you may be able to manage pain pretty well if you've got a good night's sleep Ted identifies his objective very simply the goals in my treatment are to stop it from progressing any farther I know I can't get the nerve damage that I've done back get it and get that stuff back but I'm trying to through medication and exercise and my diet I'm trying to stop it from going further the first step in managing diabetic nerve pain is to get your blood sugar levels under control this can prevent further damage and possibly even reduce the pain talk with your healthcare professional about how eating a healthy diet exercising checking your blood sugar and taking your medication can help I was very careful with my meds because suddenly I realized how much I had to lose and so I immediately started on the meds and we also started me on a diet and exercise regime even if you test your blood sugar often at home you also need to get a regular checkup with an a1c test that's the test that tells you how the sugar levels have been over time if the a1c is running high that tells you although the sugar today may look fine the sugar over the last couple of months has been very high for Jerry Mathers a key part of getting his blood sugar under control was learning how his attitude toward food had put him at risk I said I looked around me there were a lot of people that were my weight I had no idea about diabetes I had heard about it I thought it was from eating too much candy and sugar and that's how you got it and that is how naive I was at that time I didn't even realize that weight was a factor for it so in addition to controlling his blood sugar with medication Jerry also started taking control of what and how much he eats portion control is one of the things that I really have to watch especially at restaurants because you know restaurants they typically give you because you're paying for it a lot more that you can eat and a lot of times people think well if it's there I'm going to eat it well I've now found out it's much better to take it home a half sometimes two and even three meals in the course of a week and that is much more of a proper sized portion to eat for many years now Jerry has made healthy food choices and regular exercise key to his everyday life he's it and his blood sugar is under control but he still checks it regularly and he gets an a1c test at the doctor's office regularly to make sure he stays on course my doctor now we communicate very well sometimes my blood Sugar's have gone up and we say well what are you doing differently and it's usually that I've been working someplace I've been out of town I've been cheating a little bit because you know you do that you think I did this and nothing happened but it always shows up in the end and we talked about it and I make changes again and and become remote evaded so that's why it's good to see him every six months and it's a barometer of where I am and how I'm doing for Donna controlling blood sugar levels is more of a struggle despite checking them regularly and taking medication I am considered what they call a brittle diabetic so sometimes no matter what I do I could be high one day low the next day so it's been pretty difficult through the years diabetic nerve pain has developed in her feet legs and hands for Donna an ongoing pain management plan is the key to moving forward with her life getting help for the pain there are very many different things you can do for that I just think you have to be very open with your doctor many types of medicines may help relieve diabetic nerve pain they come in different forms pills patches injections and creams it might take time to find the treatment that works best for you there are multiple different types of medications for diabetic nerve pain they work by different mechanisms and much of the work of a physician and a patient together is to sort out what the best combination might be or whether one medication will suffice as Ted discovered it can be a step-by-step process other medical conditions and treatments must be taken into consideration Ted also keeps his doctor informed about changes in the pain and how the medication is working and I let him know what level of pain I'm having and whether I think that I should get a little more pain medicine or whether I should have it on a different schedule work with my doctor and he's real good about working with me on that the goal is to find medicines that work for you without causing side effects that you cannot tolerate sometimes a side effect such as drowsiness can be timed to your advantage for example if a medication makes you sleepy you might want to take it at night oftentimes the relationship with the physician is one of trying to find the right combination to minimize side effects and maximize relief it's important to understand that 100% pain relief is usually not possible no matter what treatment has tried yet studies show that people report real improvements and mood activity work sleep and enjoyment from life even when pain just comes down a few notches on a ten-point scale and the medications we use we expect them to get down three points so if they're in aids they can get down to a 5 maybe a 4 I have to tolerate a certain amount of pain most of the time while working with their healthcare team to manage pain patients also need to keep the ultimate goal in mind to improve the diabetes to improve their lifestyle to do other things for themselves and that will in the long term do more for the pain than the medications that I'm using you might also talk with your health care professional about non medicine pain treatments devices and techniques that you might consider include electric nerve stimulators cold water treatments or a bed cradle to keep sheets and blankets from touching sensitive feet and legs physical therapy can be very useful especially if it helps you get up and around physical therapy as part of the beginning of a fitness program I of course explain to the patients that this is not a 6-week program this is a 60 year program but they're just starting with the six weeks in physical therapy being active can not only help you feel better it can also help you control your blood sugar levels I get up every day I run it's about five miles I walk a lot of it and I'm honored to my heart rate and I find that that helps control my blood sugar just as exercise is very important for diabetes itself exercise is also very important for pain management you don't need to invest in a health club membership or expensive equipment but you do need to invest in your health by doing what you can to be active before starting any exercise program though talk to your healthcare professional my exercise isn't as much as I'd like to because I'm having problems walking my stability isn't real good but I do take my dog out for a walk I do walk a quarter of a mile down this street to my mailbox and get my mail in that I try to walk quite frequently the term alternative and complementary is used to describe other treatments that many people have tried for relieving chronic conditions such as pain they don't require a prescription and they might not have been scientifically studied your healthcare team needs to know if you plan to try them approaches which may be historically were considered complementary are now part of the mainstream of care for many patients and that might be the role of acupuncture or the role of other techniques which are not necessarily pills but are a central part of the ways that we combine therapies to help folks get relief again always tell your health care professional about any alternative or complementary therapies you may be using nowadays Jerry Mathers loves to be on his feet but when his diabetes was first diagnosed he was in pain and his blood sugar was alarmingly high now in the very beginning when I was running the 7 to 850 and my blood Sugar's my feet were hurting quite a bit and I just and they told me that it wasn't going to go away but as his weight and his blood sugar came down Jerry was able to get back on his feet literally so that took me about six months before the the the really severe foot pain went away and it got gradually less Jerry continues to take extra care with his feet he knows that people with diabetes might have nerve damage that would make them unaware of dangerous infections at worst foot problems related to diabetes can require amputation that's why it's important to check your feet at home and at the doctor's office that's one of the things my doctor does he looks at my feet one of the other things that people may not know about diabetes is it also affects your healing process so if you get like a scratch or anything like that it takes longer to heal in diabetes the immune system the system that fights off infections it doesn't work as well as in people who do not have diabetes so not only may you not feel they also develop you may in addition wind up not be able to fight off the infection that occurs because you got that ulcer I checked my feet all the time I'm I'm very cognizant about my feet I have some problems with my toenails Annette and I I'm real careful about cutting my toenails and if I get a cut on my toes or anything I'm you know real aggressive about taking care of that so that I don't lose my feet here are the basics of the foot care you need to do on a regular basis clean your feet daily using warm not hot water and mild soap don't soak your feet just wash them and use a soft towel to dry them off check your feet and toes every day for cuts blisters redness or other problems you look at need to look at the nails to see if they're developing unusual ridges or growing funny and then lastly you want to check to make sure you can feel things in your feet if you can't you may want to see a doctor to explain to help explain and diagnose why the feeling your feet is not working my mom through the years has helped me a lot with checking my feet my daughter helps me once in a while but growing up it's always been my mother Donna's lucky to have help at home some of the places you need to check are difficult to see on your own you need to have someone else look under your feet because it's very hard or look in a mirror to look under your feet keep toenails trimmed and file smooth wear shoes or slippers indoors to protect your feet from injury and wear shoes that fit well and let your toes move break in new shoes slowly and carefully it's important to make sure that a patient with diabetes has correctly fitting shoes because they're a risk for not only having ulcers which could be related to undue pressure but also other infections either of the nail or from a cut that they might not otherwise feel when it happens because they're sensation is reduced in their feet oftentimes patients with chronic pain feel a sense of isolation because it may not be apparent to the people in their life what they're going through the family needs to understand what the person can and cannot do they should not help when the person is able to do something so they don't enable the person lying flat or sitting around instead of going to walk I was gonna count on the support of friends and family has kept Donna going for decades my family gives me a great amount of support I do also have a close-knit group of friends that give me support also I think that's what has helped me get through it I think sometimes when you get really down and they look at things a different way that really helps you Ted and his wife are a team she's there for him in many ways including helping to choose the right food Alfa wasn't for my wife I probably make a lot of healthy food choices in addition to asking family and friends for help or if you're on your own talk to your health care professional about what support services might be available in your area connecting to others can make a big difference be sure to find a support group with a strong positive and uplifting tone it's important I think to make sure that patients who have chronic pain have an outlet to discuss what they're going through either with family or with friends or with patients who are experiencing a similar set of symptoms Jerry Mathers still has a lot in common with the beaver he has a positive approach to life he and his wife can look toward the future knowing his blood sugar is under control but when somebody tells you and you believe them that you have three years to live or you can make changes I think most people would do what I did and make changes for Donna the challenges are more difficult as we've heard her diabetes has been very difficult to control she monitors her blood sugar closely it's become second nature because it's just it's part of my life now and I wake up in the morning and it's it's my daily routine okay we take your blood pressure okay regular check-ups are also part of the routine not only with the doctor who helps manage her diabetes but also with an eye doctor a foot doctor and a pain management specialist I think it's also important to make patients aware that there's going to be an ongoing assessment and an ongoing dialogue so I try to have them keep the overall picture in mind and to just set limited reasonable goals and take it one day at a time Ted is a veteran he served during the Vietnam era when he started to experience diabetic nerve pain he thought he could just tough his way through at first I didn't worry so much about the pain as the as the disease as the pain came on I lived with my toes being a little numb and feeling funny and trying to take care of my diabetes but now I work pretty hard at the pain if you are diabetic and you're experiencing shooting burning type pain especially in your feet and hands you need to find out what might be causing it ask questions and insist on getting answers you understand if you are not finding help through your regular medical care then a neurologist may be able to help you improve your condition finding the best treatment for you may take some trial and error but as you've seen in this program you can find relief for diabetic nerve pain you

Channel: AANChannel

Views: 48,445

Keywords: diabetes, neuropathy, nerve pain, pain, neurology, American Academy of Neurology, Jerry Mathers

Id: xmR8Q3OENRI

Length: 28min 30sec (1710 seconds)

Published: Tue May 03 2011