2023-06-01 09:01:46
When diabetes damages the nerves, it often causes little discomfort at first. It is therefore important to be very vigilant and pay particular attention to early symptoms. How this can be achieved in everyday practice and which additional risk factors favor neuropathy is described by Prof. Ralf Baron, neurologist and pain researcher, in an interview. The Kiel expert also gives tips on how nerve regeneration can be stimulated and what to look out for in effective therapy for neuropathic pain.
LILLY: Why are people with diabetes at high risk for neuropathy?
Prof. Baron: Diabetes can damage nerves, mainly peripheral ones, through many different mechanisms. The blood sugar increase triggers the whole thing, but we also see patients who have excellent blood sugar control and still develop neuropathy. So there are additional causes, such as inflammatory reactions in the nerves and immunological processes.
LILLY: What about other risk factors besides diabetes?
Prof. Baron: Up to 30 percent of people with diabetes have polyneuropathy – but not all of them. In principle, diabetes alone can lead to polyneuropathy. If other risk factors are added, the risk increases. Alcohol, for example, damages nerves and puts you at greater risk. Smoking is also a risk factor, as is a poor diet, obesity and low levels of physical activity. If people with diabetes avoid all of these, they can reduce their risk.
| Prof. Dr. medical Ralf Baron is Head of the Neurological Pain Research and Therapy Section at the University Medical Center Schleswig-Holstein – Campus Kiel. His research work is dedicated to the pathophysiology and therapy of neuropathic pain conditions. Prof. Baron was a councilor of the International Association for the Study of Pain (IASP) and a board member of the German Society for the Study of Pain (DGSS). |
LILLY: What is the effect of nerve damage?
Prof. Baron: If the nerve cells are damaged, it is usually the longest nerve fibers that are noticed first. And the longest peripheral nerve in humans runs from the spinal cord to the big toe. Sensory problems in the feet are often the first impact. In the course, however, disorders in the autonomic nervous system can occur. This supplies the internal organs, among other things. In the stomach, for example, a manifestation of diabetes-related nerve damage can be gastroparesis, also known as gastric paralysis. This means that the stomach no longer transports the food as well. If the nerves to the intestine are restricted in their function, constipation can occur. If the autonomic fibers in the heart are damaged, the regulation of the heart no longer works properly. There are also autonomic nerves to the extremities that regulate blood flow to the skin. If these are disturbed, functional and structural tissue changes in the extremities can be exacerbated, i.e. something like leg ulcers and ulcers on the feet.
LILLY: How can neuropathy be detected as early as possible?
Prof. Baron: Before any symptoms appear, some nerve fibers must have died. But measuring this is very complex and therefore unsuitable for screening in clinical routine. Therefore, everyone should pay particular attention to the first symptoms: Classic early symptoms are often found in the sensory area on the feet: Something like tingling – some sufferers speak of pins and needles – a burning sensation, especially at night, these are typical warning signals. After that it should be asked. In addition, regular tests for polyneuropathy are important: This includes a clinical examination with the reflex hammer to check whether reflexes are weakened in the lower extremities. A significantly reduced vibration sensation measured with the tuning fork also serves as a symptom of polyneuropathy. It is also advisable to ask how the subjects feel cold and heat.
| VDBD training course “Neuropathy & Diabetes” Do you want to learn more about the current topic? Our training course “Neuropathy & Diabetes” with Prof. Dr. Ralf Baron is complete here for you to call up online. The event is VDBD certified. |
LILLY: What else would be important in supporting people with diabetes?
Prof. Baron: Although the foot can also hurt as a symptom of polyneuropathy, pain stimuli are perceived less there at the same time – a paradox. This implies that those affected are more likely to injure their feet because they no longer feel the pain warning signal. Even if the shoes don’t fit well or if something pinches there, patients with neuropathy don’t feel it like healthy people do. You can therefore develop blisters much more quickly, which can then lead to long-lasting and non-healing ulcers due to the trophic problems. You have to be careful!
LILLY: What is the best way to prevent neuropathy?
Prof. Baron: Controlling blood sugar very well should always be our goal. In addition, people with diabetes should be strongly advised to consistently avoid alcohol because it is a severe neurotoxin. There are probably also immunological processes in diabetes that can attack the nerves directly, even with good glycemic control. Unfortunately, you cannot influence them so far.
LILLY: How do you manage to sensitize those affected to the problem and motivate them to cooperate?
Prof. Baron: It really needs a thorough explanation. Patients must always be made aware of what they need to pay attention to in personal discussions, with information brochures and also at training events. Because the most successful way is for those affected to pay attention to the symptoms and signs mentioned early on and then go to the doctor’s office. Pain and sensory disturbances are subjective, the diabetes team does not see them – even if they are asked about them regularly or examinations are carried out. Keeping the topic flowing into the conversation is a good approach. I could imagine that, for example, during a diet consultation people would regularly ask how they feel in their feet.
LILLY: What measures are useful if someone suffers from neuropathy? Can the neuropathy improve?
Prof. Baron: In principle, any peripheral nerve that is damaged can grow again. For this, however, the damaging factor, the so-called noxa, must be eliminated or at least significantly reduced. This is difficult with diabetes, which is a progressive disease. However, if diabetes is controlled very well, the nerve fibers can also grow back. That’s what I tell my patients, too: you can stimulate regeneration of the nerve fibers with good blood sugar control. Don’t drink alcohol, don’t smoke, don’t be overweight, exercise a lot – all of this has a positive effect on the growth of nerve fibers. There is a whole range of drugs for the symptomatic therapy of neuropathic pain. However, these are not the classic analgesics such as ibuprofen or non-steroidal anti-inflammatory drugs in general. They do not work at all or only very poorly for nerve pain. Rather, other classes are effective, such as anticonvulsants or antidepressants, which attack elsewhere in the pain system. This is information that diabetes teams should include in the consultation.
LILLY: Prof. Baron, thank you for this interesting interview!
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