No More Painful Nights.

Are you one of the millions of people kept awake by pain at night? Here's hope for you whether you're sleepless in Seattle or anywhere else.

City to city, state to state, millions of Americans are unable to get to sleep at night because of the pain in their legs from diabetic neuropathy. Diabetic neuropathy is on the increase because diabetes is on the increase (expected to double by the year 2010). It is estimated that there are about 15 million diabetics in the United States alone, and 60 percent of these have some form of nerve damage, with 30 to 40 percent of these with neuropathy, according to the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK). The NIDDK is a part of the National Institutes of Health (NIH).

Diabetic neuropathy is a nerve disorder that is caused by diabetes. Symptoms include a number of sensations from numbness, tingling, pins and needles feelings, and sharp jolting pains to cramps and extreme sensitivity to even light touch. It is this pain that keeps so many awake at night. Once it starts there is usually no regression or remission from the pain. As the pain becomes more and more severe it becomes more difficult to walk normally. The foot often becomes wider and shorter; the gait changes; and foot ulcers begin to appear as pressure is now being put on parts of the foot that are less protected. Ulcers also lead to other problems that can keep you awake at night.

Hyperglycemia (elevated blood sugar levels)is associated with damage to nerve tissue, impairing the nerves' ability to transmit signals. It is also associated with damage to the blood vessels that bring oxygen and food to these same nerves, complicating the damage being done. Researchers believe that high blood glucose levels damage the nerves through these two pathways. A third process that has been implicated is that elevated blood sugar increases the imbalance between free radicals and antioxidants, and this damages blood vessels and nerve cells.

Infected ulcers that can result in amputations occur because of three factors: (1) lack of sensation in the foot that allows sores to go unnoticed until gangrene sets in; (2) elevated blood sugar levels that depress the immune response, preventing normal protection from simple infections; and (3) poor circulation in the legs and feet due to atherosclerosis, preventing normal blood flow to the lower legs and feet.

Nerve damage from diabetes is not limited to the nerves of the legs and feet. Elevated blood sugar levels impact all nerves of the body--some more significantly than others. Nerve damage can affect the heart and other organs as well as the bladder and sexual organs, which leads to impotence in both men and women.

New drug research on diabetic neuropathy is being done around the world. Most of it is focused on handling the pain. But diabetic intervention programs have shown exciting results using lifestyle changes alone. They have seen a significant reduction in medications and pain associated with neuropathy. Their patients not only are experiencing less pain, but getting greater mobility in their limbs.

For those who do not have symptoms of neuropathy and who want to prevent getting them, the answer is to keep your blood sugars in normal limits all the time! The Diabetes and Control and Complications Trial by the NIH has shown that those who are able to keep their blood sugar levels as close to normal can reduce by 60 percent the nerve damage that could occur. Experience has shown that a plant-based diet, regular exercise program, and stress management can significantly reduce the pain and other symptoms associated with diabetic neuropathy.

Going sleepless is an option, but not one of the best choices we could make. Today there is something that can be done to change the course of diabetic neuropathy or even prevent it. Get help to change your lifestyle to one that will significantly reduce your risks. This same lifestyle can greatly reduce the risk of diabetes for our children, another group that is showing a substantial rise in the number of cases of diabetes.

This new lifestyle is simply moving our diets to a predominantly plant-based one, low in polyunsaturated and saturated fat and cholesterol. Get into a daily exercise program, keep the weight within normal limits, and learn to prevent or manage stress. This approach will also reduce the risk for secondary complications often associated with diabetes--heart disease, end-stage renal disease, hypertension, blindness, and circulation problems. Lifestyles should be such that they enhance your health and longevity, not destroy them.

Dennis C. Blum, Dr.P.H., M.P.H., is former president and CEO of the Lifestyle Center of America and writes from Killeen, Texas.