One of the first signs of diabetes (high blood sugar) is peripheral neuropathy, characterized by numbness and tingling in the feet, a feeling so uncomfortable that it can wake you up at night. Because peripheral neuropathy is a leading cause of amputations and disabilities in the United States, anyone with early symptoms—which also include burning; muscle weakness, cramping or atrophy; and undetected sores on the feet—should seek treatment with a podiatrist or internist, says Katonah Podiatry.

Neuropathy is the result of damage to the peripheral nerves, which lie outside the brain and spinal cord, she says. “These are the little fibers that give you sensations. In the case of diabetes, the increased blood sugar affects the tiny nerve endings in the lower extremities. This may occur even before it registers in a blood test. Ironically, the most common drug for diabetes, metformin, is a big culprit in causing neuropathy also.”

Besides diabetes, other causes of neuropathy include chemotherapy, vitamin B12 deficiency, metformin use, poor blood flow, elevated homocysteine and idiopathic (unknown) causes, and elevated levels of the amino acid homocysteine.

When treating patients for neuropathy, Hoffman puts them on a vitamin regimen. “L-methylfolate, B6, benfotiamine (B1) and riboflavin (B2), alpha lipoic acid and vitamin B12—there are good combos of these supplements, so they do not have to be taken separately. The results are incredibly good with this therapy,” she says.

Since patients with neuropathy can’t feel their feet, it’s particularly important that their shoes fit well, she adds. 

“There is the diabetic shoe bill which pays yearly for a pair of shoes that are extra depth and fitted properly,” she says. “The shoe bill has decreased amputations by 60 percent. Please inspect your feet daily to avoid infections.”

Location: Katonah Podiatry, 200 Katonah Ave., Katonah, NY. For more info, call 914.232.8880, email [email protected] or visit KatonahPodiatry.com.