My husband was diagnosed with diabetes almost a year ago. At first he was experiencing numbness in his feet. Over the past few months, he began having pain as well, sometimes as far up his leg as his calf. What can we do to help these symptoms? I have read that vitamin E and even flaxseed oil are good for the circulation. Would those be helpful?
Name Withheld

Lee Sanders, DPM, responds: Your husband may have a condition that should be treated with doctor-prescribed medication, and a proper diagnosis is vital to determining how to treat what he is experiencing. The likely cause of his symptoms is either peripheral arterial disease (PAD), which is due to poor circulation, or diabetic peripheral neuropathy (DPN), due to nerve damage. Here are some questions that would help your health care provider with a diagnosis: Does your husband have pain in his legs when he walks? (If so, how far can he walk before he must stop to rest?) Do his feet appear red or blue in color when they are lowered, and does the redness disappear with elevation of his legs? Are his feet and legs cold? Does he hang his leg over the side of the bed at night to relieve pain? Is only one leg affected by pain, and is this leg swollen, warm to the touch, and reddish-brown in color? A "Yes" to any of these questions may indicate PAD, and your husband should see his doctor immediately if that is the case. 

If he is not having the above symptoms, then he may be suffering from neuropathy. DPN is an important quality-of-life issue for half of all people with diabetes. The pain is often described by patients as tingling, burning, sharp, shooting, and lightning-like. Other unpleasant symptoms include numbness, feelings of feet and legs being "asleep," or prickling or crawling sensations. However, not all peripheral neuropathy is caused by diabetes. The diagnosis of DPN can be made only after a careful clinical examination. All people with diabetes should be screened annually for DPN. 

Although there is currently no cure for this complication of diabetes, optimal glucose control helps to prevent DPN. Several studies suggest that avoiding extreme fluctuations in blood glucose helps as well. It's also recommended that people with either condition improve cholesterol and blood pressure, do not smoke, and avoid excessive alcohol consumption. Many people will require a medication to manage their painful symptoms; avoid trying an unproven method or remedy, such as vitamin E or flaxseed oil. (Always check with your doctor before taking any supplement to make sure it doesn’t interfere with your medications.) A proper diagnosis needs to be established before your husband can move forward with the right treatment.