To tell you a real case, it was ten years ago, when I was engaged in the pain profession myself for five years, a close friend introduced a patient, 60 years old, male, diabetic for eight years, who had not been able to control his blood sugar well.
Six months ago he started to have some hand numbness and foot numbness with pain, and didn’t pay much attention to it, until a month ago, suddenly both eyes lost their vision dramatically, and within a month he was almost completely blind, with only a simple sense of light. To add insult to injury, gangrene began to appear in one foot a week ago, and when he came to the clinic, he was found to have wet gangrene of the right bunion, low skin temperature at and below the right ankle, and a bruised complexion with severe pain. A consultation with a vascular surgeon and an orthopedic surgeon was requested, and amputation below the right knee was recommended.
Later, after comprehensive consideration by the pain department, anti-infection was given first
After the surgery, the blood circulation in the right lower limb was restored and the infection was controlled, and finally the right thumb was amputated and the right foot was saved. This was also a blessing among misfortunes.
From this incident, two questions arise, diabetic patients with numbness and pain in the feet and hands, in the end is not a big problem? And what is the connection with eye blindness?
We know that diabetes is a lifelong metabolic disease characterized by chronic hyperglycemia. Long-term increase in blood sugar, large blood vessels, microvascular damage and endanger the heart, brain, kidneys, peripheral nerves, eyes, feet and other complications. Numbness and pain in the hands and feet are often the first symptoms to appear, but are often overlooked.
First, let’s understand the characteristics of hand and foot neuralgia caused by diabetes.
Initially, it may only be a numbness if any, a slight intermittent tingling, if not taken seriously and controlled, with the extension of time, the original slight pain and numbness, gradually aggravate into persistent symptoms, pain and numbness characteristics begin to diversify.
May present with spontaneous burning-like pain, flashing pain or electric shock pain in the hands and feet bilaterally; with pins and needles sensation or stabbing pain.
It can also manifest as walking pain, often described as “walking barefoot on hot sand”, with indescribable discomfort even in the widest and most comfortable shoes.
Further progression can cause severe pain with minor irritation, often starting in the toes and then extending bilaterally and symmetrically, with a sock-like distribution and gradually affecting the foot and lower extremities.
Symptoms of painful diabetic peripheral neuropathy often worsen at night, causing the patient to be unable to sleep. Painful symptoms may occasionally involve both hands, with the fingertips often being the first to be involved.
When numbness and pain in the hands and feet are accompanied by the above characteristics, it is time to pay enough attention to it. This is because the presence of such symptoms indicates that multiple mechanisms of diabetes induce increased production of reactive oxidative products in the mitochondria, which have unknowingly begun to cause microangiitis, macrovascular and neuropathy, and may have developed a considerable degree of damage.
The more serious complications of diabetes develop gradually over a considerable period of time and will come to the fore at some point, as in the case of the patient mentioned at the beginning of this article, who was asymptomatic for up to eight years, first developing numbness and pain in the limbs, followed quickly by diabetic retinopathy leading to blindness and foot ulcers six months later.
In addition, serious complications of diabetes include diabetic nephropathy, diabetic coronary artery disease, and diabetic cerebrovascular disease, among others. These complications progress slowly, but may break out suddenly at some stage of the disease, causing major organ dysfunction or even life-threatening. As the top doctor treats the disease before it occurs, diabetic patients must pay attention to early complications such as numbness and pain in the hands and feet, and take effective comprehensive treatment under the guidance of a doctor to prevent them before they occur.
