Five Best Practices for Preventing and Controlling Diabetic Neuropathy

The National Institute of Diabetes and Digestive and Kidney Diseases estimates that diabetic neuropathy—a peripheral nerve disorder caused by diabetes or poor blood sugar control—affects 60 to 70 percent of people with diabetes. The most common form of diabetic neuropathy is distal symmetrical peripheral neuropathy (DSPN). DSPN is the leading cause of foot ulcers, which can lead to extreme pain and even amputations.

“It feels like I’m barefooted walking on hot cement, and the sun is beating down on it,” said Kathy Carrell, who participated in the Centers for Medicare & Medicaid Services’ (CMS) Everyone with Diabetes Counts program run by Qsource, the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) serving Alabama, Indiana, Kentucky, Mississippi and Tennessee.

Carrell has pre-diabetes, which she has managed with metformin, diet and activity for 30 years. At first, her foot pain kept her in constant tears, and at one point she didn’t go anywhere for two weeks because it hurt to walk. She went to the emergency room where the doctor gave her a shot, but soon the pain became unbearable again.

To prevent DSPN’s progression and the need for amputation, blood sugar control is recommended for people with pre-diabetes and diabetes. However, in some cases, like Kathy’s, blood sugar control cannot relieve the pain of neuropathy. Pain management may be necessary to allow those affected to continue functioning throughout the day, but it often takes time for a clinician and a patient to find the right treatment.

For Kathy, it took six months to find a medication that helped control the pain resulting from DSPN. As soon as her doctor prescribed Pregabalin, a drug that controls the pain signals sent across the nervous system, Kathy was able to walk and significantly improved her quality of life.

While it wasn’t an easy journey, Kathy is an example of someone who has maintained good blood sugar control and managed pain through a combination of medication and positive lifestyle changes.

Following are five best practices for preventing and controlling diabetic neuropathy:

1. Learn About Diabetes Self-Management: It’s important for beneficiaries to learn how to self-manage diabetes. QIN-QIOs teach foot care and other key health behaviors to minority and rural Medicare beneficiaries through the Everyone with Diabetes Counts program.

2. Check Your Feet Daily: People with diabetes, or who are at-risk for diabetes, should examine their feet daily for cuts, redness or anything unusual, and call their doctor if a sore is not healing.

3. Get The Right Shoes: Proper foot care starts with wearing the right shoes. The Everyone with Diabetes Counts program offers tips in five languages on finding the proper shoes.

4. Preventive Care Is Key: Having a full foot exam at least once a year is critical for detecting a lack of sensation or other changes in one’s feet that could have serious complications down the line. A new video from the QIO Program provides a demonstration of an annual diabetic foot exam.

5. Don’t Give Up on Treatment and Medications: Medications and treatments for DSPN do not work the same for everyone. It’s critical to keep working with clinicians until an effective treatment plan is established.

Click here to learn more about CMS’ Everyone with Diabetes Counts Foot Care Campaign.

This article was originally posted in the August 2017 QIO News.