Peripheral Neuropathy/Diabetes

Peripheral neuropathy (PN) refers to any affliction of the peripheral nerves. Peripheral nerves are those outside the central nervous system that provide signals to skin, joints, muscles and internal organs. The most common symptoms of PN are subtle at first, with tingling and numbness of the toes/skin, decreased sensation, burning, stinging, shoot pain, etc.

Causes of PN can be diabetes, metabolic autoimmune issues, hereditary conditions, infections, toxins, drugs and tumors. Diabetes is one of the most recognizable causes of PN, and PN can begin before diabetes is even diagnosed. Diabetes affects multiple organs because it affects the blood vessels and the peripheral nerves.

These deleterious effects are mediated by decreasing blood flow and oxygen, necessary for nerve function/signals. In other words, high blood sugar levels damage the blood vessels that supply oxygen and nutrients to the organs and peripheral nerves. The organs that do not get oxygen and innervation begin to malfunction and do not repair themselves.

Diabetes increases the risk of many serious medical problems: eye complications (blindness), foot problems (ulcers of the skin), heart (heart attack, high blood pressure), hearing loss, gastroparesis (slow bowel function), kidney, brain (stroke) and sexual function (erectile dysfunction in men and decreased vaginal lubrication, uncomfortable/painful intercourse and decreased sexual drive) — all due to damage to nerves and blood vessels.

In summary, several factors are responsible in the development of PN: (1) damage to vessels supplying nutrients and oxygen to organs and peripheral nerves; (2) autoimmune factors causing inflammation such as nerves, etc.; and (3) lifestyle, such as smoking or alcoholism.

Current treatments and recommended lifestyle changes are able to delay the onset of these complications. First and foremost is control of blood sugar levels in diabetes, detoxification and boosting the immune system. There are multiple medications that can help with symptoms, interventional pain therapies and therapies to potentially slow and reverse the secondary damage. These therapies are available at the Pain Specialist Center and Tennessee Hyperbaric Center.

The most visible sign of PN is when a patient develops an ulcer in the foot (diabetic ulcer) that does not heal due to lack of oxygen and blood supply. Medicare approves hyperbaric oxygen therapy for certain diabetic ulcers. As mentioned earlier, however, diabetes is nonselective and affects every organ. We cannot see the deleterious effects until we have an ulcer, a myocardial infarct, stroke, blindness, sexual dysfunction, autoimmune dysfunction, kidney problems, etc.

HBOT is only approved in the U.S. for severe diabetic ulcers but in other countries it is used for peripheral vascular disease caused by diabetes and vascular disease. A diabetic ulcer is easy to measure (depth, width, etc.) and see the progress after HBOT but what is not visible to the eye is that HBOT treats every organ. It re-oxygenates hypoxic tissue by promoting growth of blood vessels that will deliver oxygen and nutrients to organs, nerves, etc. This reduces the risk of complications from diseases like diabetes.

There are numerous medical studies that show the beneficial effect of HBOT with diabetic ulcers. Of course, it is difficult to study the effects on other organs like the brain and heart because they are not easily examined and measured like an ulcer. There is published literature, however, that shows the potential benefits for HBOT. For example, Cihan Top, et al (Internet Journal or Neurology 2002 Vo. 1 #2) showed the beneficial and significant improvements on the automatic system and neuropathy after HBOT. Ning Gu et al (Diabetes Technology & Therapeutics Feb. 2010, 12 (2): 125-133) concluded that HBOT reduces high blood glucose levels, improves oxidative capacities in the skeletal muscles and that these effects are maintained, even after expose to HBOT. Drs. Polydefis and Ebenezer at the Johns Hopkins Research suggest that blood vessels and support cells may be real targets of treatment for diabetic nerve damage (June 2011).

Hyperbaric oxygen therapy is the only non-hormonal treatment approved by the FDA for biologically repairing and regenerating human tissue. HBOT can be used as an adjuvant to good blood sugar control and lifestyle changes to delay and even possibly reverse the damaging effects of diabetes. HBOT, as well as other advanced therapies for peripheral neuropathy, are available at the Tennessee Hyperbaric Center and Pain Specialist Center.