Diabetes can damage your nerves and cause pain throughout your body. Diabetic nerve pain can reduce your quality of life, making it hard to walk, sleep and even sit as the blood flow to the limbs gets cut off. Diabetes is expected to affect nearly 1 million Singaporeans by 2050, leading to painful complications in a number of cases.

Dr Tan Kian Hian, Senior Consultant from the Department of Anaesthesiology at Singapore General Hospital, gives detailed answers to your questions.

Question by colin.tingfm

Dear doctor, my mother was first diagnosed with Peripheral Neuropathy and have been prescribed with the necessary medication to stablise her blood glucose and to ease the pain on her foot (after going for nerve tests). However she shared that she usually has the cramps on early mornings but after exercises and moving around, it would be better by the afternoon. As such, it disrupts her daily routines especially in the mornings. How can I assist her in one way or another to let her live her life to the fullest especially in the mornings? There is no cure to this?

Answered by Dr Tan Kian Hian, Director and Senior Consultant, Pain Management Centre, Senior Consultant, Department of Anaesthesiology, Singapore General Hospital

Dear colin.tingfm,

I am glad to hear that your mother’s blood sugar level is stabilised, as that is a key management of her neuropathy, and that she has been started on pain medications. If she continues to have cramps, it may be prudent to seek the advice of a doctor. There are many reasons why cramps can occur and the underlying causes need to be excluded before attributing them to the neuropathy. But please encourage her to continue with her exercises, as this is vital to her health.

Question by meerobus

I have diabetes type 2 for about 10 years. I started taking medicine in 2012 when diet control did not really help. But my diabetes has always been within controllable level (hbA1c less than 7). I retired in 2013 when I turned 62 and increased my activities like jogging, walking, hiking, cycling and swimming. In 2015 I started to feel numbness at 3 of my toes on my right leg. Later both my feet will feel "hot" at night. Now these numbness and hotness can develop anytime of the day. NUH doctors told me they are the result of my diabetes. Then I started to get leg fatigue easily. NUH spine doctors advised me to cut down on my exercises and my legs and feet got better. Until today there is no clear explanation what caused my pain and numbness especially after jogging (4 KM only each time). I now cut down on all my exercises.

Answered by Dr Tan Kian Hian, Director and Senior Consultant, Pain Management Centre, Senior Consultant, Department of Anaesthesiology, Singapore General Hospital

Dear meerobus,

The symptom “hot” feet does sound like painful diabetic neuropathy. I am also assuming that you saw spine doctors because you have spine related problems. This may also contribute to your lower limb symptoms. In general, some form of exercise will be good for both your overall health and control of your blood glucose level. It is, of course, important to do the appropriate exercises, taking your overall condition in consideration. It will be great for you to seek advice on this from your doctors and physiotherapists on the appropriate exercises that are suitable for you.

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Dear doctor, my father has been diabetic for close to a decade. He started experiencing foot pain in the last few years. Recently, the pain is getting lesser but he has been complaining about numbness. Should I be worried? Ampanman22

Answered by Dr Tan Kian Hian, Director and Senior Consultant, Pain Management Centre, Senior Consultant, Department of Anaesthesiology, Singapore General Hospital

Dear Ampanman22,

I am glad that your father’s pain is improving. Numbness tends to persist for a longer period. For a start, it is important that his sugar levels remain well-controlled. If the numbness persists, please see a doctor and consider starting him on nerve pain medications, which may help relieve his discomfort.

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I stand long hours at work, sometimes in high-heel. Other than painkiller/medication, anything I can do to prevent the pain from worsening? My blood sugar is high but I don’t need meds now. Thanks – lin_yt

Answered by Dr Tan Kian Hian, Director and Senior Consultant, Pain Management Centre, Senior Consultant, Department of Anaesthesiology, Singapore General Hospital

Dear lin_yt,

The blood sugar level needs to be controlled to prevent diabetes related complications, including nerve pain. This will be the most important. High heels will aggravate your pain and if possible, wearing them should be avoided.

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Dear Doctor Tan. Is there anything I can feed my husband (other than his diabetic medicine) to reduce or reverse his leg pain? He hasn’t been able to sleep well and it’s been hard for him to go for a short walk even. Are there exercises we can do which will lessen the pain? Susi

Answered by Dr Tan Kian Hian, Director and Senior Consultant, Pain Management Centre, Senior Consultant, Department of Anaesthesiology, Singapore General Hospital

Dear Susi,

In addition to good blood glucose control, there are medications which your husband can take to reduce pain associated with diabetes, which we call painful diabetic neuropathy. Exercises will help to improve his overall health, pain as well as glucose level. There are different exercises which he can do to which includes swimming, stationary cycling etc. A referral to a Physiotherapist will be very helpful.

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Doc, I just got diagnose with diabetes at polyclinic. Now is ok but will I get pain for sure later? How long before my condition gets painful? Chew

Answered by Dr Tan Kian Hian, Director and Senior Consultant, Pain Management Centre, Senior Consultant, Department of Anaesthesiology, Singapore General Hospital

Dear Chew,

The chances of getting pain from diabetes can be greatly reduced if you control your blood sugar levels and maintain an active lifestyle. Start early and you may never have pain from diabetes!

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Dr. Tan, I read that diabetics who got their leg amputated sometimes have pain. But the leg is no more… How is it possible? Thanks MikeL

Answered by Dr Tan Kian Hian, Director and Senior Consultant, Pain Management Centre, Senior Consultant, Department of Anaesthesiology, Singapore General Hospital

Dear MikeL,

What you have described is phantom limb pain. This is a phenomenon which can happen to patients who have pain in the amputated part of the limb. This happens due to complex changes and interactions in the nerves, the spine as well as the brain. So these patients are not imagining the pain. It is real and there are medications which can alleviate this symptom.

Ref: P16 ​