Background:

Up to 60% of patients living with type 2 diabetes (T2DM) develop peripheral neuropathy.

 

Risk factors: Hyperglycemia, metabolic syndrome, duration of T2DM, hypertension.

 

Chronic hyperglycemia can produce a proinflammatory state.

 

Chronic inflammation is linked chronic pain syndromes, including diabetic neuropathy.

 

There is limited evidence for the effect of dietary interventions on neuropathic pain.

 

This case highlights the connections between diet, inflammation, and diabetic neuropathy.

 

Case Report:

55yo M with poorly controlled insulin dependent T2DM, dysphagia, and chronic pancreatitis with severe peripheral neuropathy

Symptoms: Constant numbness and burning in his feet bilaterally, radiation into calves

Exacerbating factors: Eating, especially cake or bacon, plain vegetables are only food that do not exacerbate pain.

Current medication regimen: gabapentin 600/600/900 mg, duloxetine 30 mg daily without relief

Trialed medications: diclofenac 1% topical gel, ibuprofen, acetaminophen, tramadol 50 mg TID PRN with some efficacy.

Workup: gastric emptying scan, EGD, and colonoscopy

Plan: Endocrinology, limiting processed foods, and integrative medicine referral.

 

Discussion:

Diabetic neuropathy relief is often through improvement of glycemic control through lifestyle modifications

 

Low-fat vegan, vegetarian, and high anti-inflammatory diets have been shown to improve glucose control

 

RCTs have shown efficacy of a low-fat plant-based diet and supplementation with nano-curcumin for significant reductions in neuropathic pain.

 

More research is necessary to elucidate the role of anti-inflammatory diets or diets low in processed foods for the treatment of diabetic neuropathy.

 

Worsening pain after eating foods other than unprocessed fruits and vegetables highlights the role that inflammation may play in the development and persistence of chronic pain syndromes.

 

An integrative approach in addition to traditional medication management is crucial in the management of painful diabetic neuropathy.