What causes diabetic neuropathy?

Q: My 65 years old diabetic mother had a bypass heart surgery. After surgery she had severe pain in her right leg. On diagnosis, it was found that there is mild sensory neuropathy in both median nerves and sensory neuropathy in both lower limbs. What is the treatment for this problem? Please advise.

A:Diabetic neuropathy is a very common complication related with diabetes. It is caused by damage to the nerves supplying hands and legs. It starts distally i.e. in the fingers and toes (first toes then fingers), and ascends upwards. It is usually symmetrical, meaning both the sides have nearly the same symptoms. Very rarely, some nerves may be more affected than others, causing pain / burning / tingling or numbness only on one side.

It is common for neuropathic pain to worsen during stress, physical (as in surgery) or mental. However, many a times during major surgeries, patient's nerves may be stretched or compressed, and as the patient is sleeping / unconscious, it is not noticed until after surgery. Such "mononeuropathies" may become more painful in diabetics. Most of these are transient, and improve over few months.

There are some good medicines to relieve neuropathic pain, like carbamazepine or pregabalin. Please consult a qualified neurologist, as this is a very well known condition, and treatable to a great extent.

Diabetic neuropathy may significantly reduce pain or touch sensation perception, hence diabetics are advised to take extreme care not to sustain wounds especially over hands and feet. They should NOT use HOT / COLD fomentation for pain. Extra care should be taken to keep feet clean, and while cutting nails. They should use soft footwear always, except when in bed.