On 05 Jul, 2025, Seniors Today hosted their weekly Health Live Webinar with a Senior Neurologist, Dr Megha Dhamne, who spoke on and answered questions about Diabetic Neuropathy: Prevention and Care for Seniors
Dr Megha Dhamne is Consultant, Neurology at the P. Hinduja Hospital and Medical Research Centre, Khar, Mumbai. After completing MBBS and MD Medicine from BJ Medical College, Pune (2006), Dr Megha Dhamne went to the US to pursue residency in Neurology from the Baylor College of Medicine, Houston,Texas (2012). Later, she pursued a Fellowship in Neuromuscular Medicine, from Cleveland Clinic, Cleveland, Ohio (2017)
She has also worked in Singapore at the National Neurological Institute for three years before moving back to India in 2018. Currently, she is with the Hinduja Hospital in Mumbai after practising as a Neuromuscular specialist at Dr L H Hiranandani Hospital, Mumbai
Diabetic Neuropathy is a very common problem where the patient feels a burning sensation in his feet or cotton like feel of the foot or feeling of always wearing a sock on your foot, which is a symptom of neuropathy. Presentation of these symptoms is a sign that your nerves could be affected and this is called neuropathy.
Neuropathy is a condition which affects your nerves and can cause burning, numbness or an abnormal sensation in your feet.
Diabetic neuropathy can have both type I and type II diabetes mellitus.
In type I diabetes mellitus, the risk of developing diabetic neuropathy is high because the patient has a history of diabetes for many years.
Not only that, diabetic neuropathy is also seen in 50 % of the patients with Type II Diabetes Mellitus.
Neuropathy usually starts as a sensory neuropathy starting from the feet.
It is usually not associated with any weakness/ difficulty in walking/ movement.
Diabetic neuropathy classically presents as:
- Burning of feet
- Numbness in feet
- Tingling sensation in your feet
It starts in the feet and goes up/ progresses upwards and then involves the hands.
Diabetes causes neuropathy due to several factors and mechanisms, some of which are:
- Hyperglycemia
- Dyslipidemia- abnormal cholesterol metabolism
- Hypoxia
- Ischemia
- Vascular insufficiency
- Metabolic syndrome
- High blood pressure > 130/ 86 mmHg
- High fasting blood glucose level
- Excess abdominal fat
- Dyslipidemia
- Impaired insulin signalling
- Inflammation
Problems associated with diabetic neuropathy:
- Dry skin because the circulation is also affected in that area
- Cracked feet
- Non healing cuts, ulcers, burns
- Corns, calluses
- Recurrent fungal infection
If not intervened on time, diabetic neuropathy can lead to non healing foot ulcers that might require amputation of the foot.
Having a good glucose control has a good benefit against diabetic neuropathy in type I diabetes mellitus, however in type II diabetes, the benefit is only marginal.
Pre diabetes is defined as:
- HbA1c between 5.7 to 6.4%
- Fasting blood glucose levels between 00-125 mg/dL
- Post prandial blood glucose between 140- 199 mg/dL
Even patient with pre diabetes are predisposed to developing diabetic neuropathy.
Causes of metabolic syndrome:
- Obesity
- Sedentary lifestyle
- Unhealthy diet
- Smoking
- Inadequate sleep
Pre diabetes an metabolic syndrome increase the risk for developing:
- Diabetes from pre diabetes
- Cardiovascular diseases such as stroke, heart attacks
- Neuropathy
- Fatty liver
- Cancer
Rare neuropathies also associated with Diabetes Mellitus:
- Carpal tunnel syndrome
- Ulnar neuropathy
- Lumbosacral plexopathy
- Autonomic neuropathy
- Cardiac autonomic neuropathy
These need to be differentiated from auto immune neuropathies so they can be treated accordingly.
Other common causes for neuropathy include:
- Low Vit B12 levels
- Excess alcohol consumption
- Chemotherapy
- Anti tubercular drugs can also cause neuropathy
- Auto immune diseases such as Lupus and Sjogren’s syndrome
- Certain cancers such as Multiple Myeloma, lymphomas can also cause neuropathy
- Infections- leporsy, HIV, hepatitis
- Hereditary
- Gullian Barre Syndrome
Diagnosis is based on the symptoms, clinical examination followed by a nerve conduction study and a skin biopsy (currently unavailable in India).
The treatment of Diabetic Neuropathy includes taking a multidisciplinary approach which broadly includes:
- Medications: for controlling the blood sugar levels, blood pressure, cholesterol levels. Medication to manage the neuropathic pain
- Alternative therapies which include supplements for vitamins and minerals
- Lifestyle modifications
- Nerve stimulation treatments such as
- Spinal cord stimulation
- TENS
- TMS
- Acupuncture
Diabetic neuropathy is very difficult to treat. You too have to work on your diet and lifestyle.
Here are a few things you can do to reduce your neuropathy:
- Lifestyle changes
- Diet- should include a healthy amount of fruits and vegetables
- Vitamins
- Exercise regularly
- Sleep on time
- Stress relaxation
- Quit smoking
You also need to take care of your feet if you have diabetes or diabetic neuropathy. This can be done in the following ways:
- Examine your feet regularly for injuries
- Wear a good footwear to avoid injuries
- Even if you have a small wound, show it to a physician
- Treat fungal infection of your toenail, if you have any
- Walk/ exercise for at least 30 minutes a day
- Eat right
- Take your medications
- Try to control the risk factors