#HEALTH: When it's more than a tingle

BURNING, tingling or numb feet can be easy to dismiss, but for people with diabetes, they may signal changes in the nerves.

A burning sensation that appears as you settle into bed. A prickling feeling that comes and goes.

Numbness that's difficult to put into words… For someone living with diabetes, such changes can be easy to dismiss, especially when there's no actual pain.

But sometimes, what the feet are telling you deserves closer attention.

These sensations can be among the signs of diabetic peripheral neuropathy, a form of nerve damage associated with diabetes that commonly affects the feet and legs.

And because nerve damage can also reduce sensation, the absence of pain doesn't necessarily mean everything's fine.

A recently published Malaysian study on neuropathic pain (https://onlinelibrary.wiley.com) offers a glimpse of how relevant the issue may be locally.

Among 13,592 adults screened across nine tertiary hospitals, 40.1 per cent of those who reported having diabetes screened positive for probable neuropathic pain.

The result was a screening finding, not a diagnosis, and didn't establish that diabetes was the cause.

But it does underline why unusual or persistent sensations are worth discussing with a healthcare professional.

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RECOGNISE THE UNFAMILIAR

The difficulty, says Dr Tan Kenny, consultant neurologist at Loh Guan Lye Specialists Centre (LSC), is that people don't necessarily describe nerve-related symptoms as pain.

"They don't always use the word 'pain' when describing what they feel. They may say their feet feel hot, prickly or strangely numb."

That distinction matters.

One person may experience a burning or shooting sensation, sometimes more noticeable at night.

Another may notice pins and needles or a gradual loss of feeling. Someone else may have little or no obvious symptoms at all.

And while diabetes can be associated with nerve damage, it shouldn't automatically be assumed to be the explanation for every episode of tingling or numbness.

"Having diabetes doesn't automatically explain every episode of tingling, so we need to understand the symptoms, examine the patient and consider other possible causes," advises Dr Tan Kenny.

That's why noticing a change – rather than trying to work out its cause yourself – is often the more useful first step.

There's another reason not to ignore a gradual loss of sensation. When feeling in the feet is reduced, a blister, cut or other injury may be harder to notice. Something that would normally hurt enough to demand attention may go unnoticed instead.

In other words, not hurting doesn't necessarily mean nothing is wrong.

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WHAT YOUR FEET ARE TELLING YOU

Before seeing a healthcare professional, it helps to pay attention to what has actually changed.

Does it feel like burning, prickling or an electric shock? Does the numbness affect one foot or both?

When did it begin, and is it becoming more frequent or noticeable?

It's also useful to consider whether it's affecting sleep, walking or other everyday activities, and whether there are visible changes such as a wound, redness or swelling.

These observations are not a diagnostic test; they simply give a healthcare professional a clearer picture of what's happening.

For those unsure how to describe what they're experiencing, a six-question digital neuropathic pain screening tool developed by Viatris Malaysia (https://www.painscreeningtool.com/) offers another starting point.

It's designed to help users describe the type of pain they're experiencing to a healthcare professional.

Even without symptoms, routine foot assessments remain an important part of diabetes care.

"Pain tends to get our attention, but a gradual loss of feeling can be easier to overlook," says Dr Fang Li Chen, consultant physician at LSC.

"Foot health should be part of regular diabetes reviews. Patients should check their feet daily and seek medical advice promptly for a new wound, redness or swelling - even if it doesn't hurt."

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BEYOND THE SYMPTOM

If nerve-related symptoms are raised during a consultation, assessment typically begins with a review of the symptoms and medical history, followed by checks of the feet, sensation and circulation.

Further tests or specialist referral depend on the findings.

For patients, the first step is simply to tell their healthcare professional what feels different. Where further expertise is needed, care may involve different disciplines.

The appropriate combination of care depends on the individual's symptoms and clinical findings.

It's advisable to consult a healthcare professional to ensure you have all the necessary information and guidance before making any healthcare decisions.

WHEN PAIN AFFECTS LIFE

For those experiencing nerve pain, the problem may extend beyond the sensation itself.

Persistent discomfort can interfere with sleep. Changes in how the feet feel may affect walking or other activities.

And when a symptom begins to alter the way someone goes about an ordinary day, that's useful information for a healthcare professional to know.

"A pain score tells us only part of the story. We also want to understand how symptoms affect sleep, movement and everyday life," says Dr Chan Wei Heng, consultant orthopaedic surgeon and Interventional Pain specialist at LSC, adding: "When patients have overlapping pain or mobility concerns, working alongside colleagues involved in diabetes and nerve care allows us to look at the patient more holistically and ensure the appropriate specialist assessment and care are considered."

It's a reminder that managing nerve pain is about more than reducing a number on a pain scale.

It's also about helping someone sleep more comfortably, move with confidence and get on with everyday life.

For someone living with diabetes, the most useful habit is also the simplest: paying attention to what has changed.

It could be a burning foot at bedtime, or persistent pins and needles. An unfamiliar patch of numbness, or a small wound that has gone unnoticed.

None of these symptoms, on its own, tells you exactly what's happening. But they may be worth talking about.

Sometimes, noticing the difference is the first step towards finding out why.

For info regarding clinical services available at Loh Guan Lye Specialists Centre, go to www.lohguanlye.com.