Ask the doctors: Itchy feet from type 2 diabetes could have several sources
Q: I have type 2 diabetes, and in the last year I have had a problem with excessive itching of my feet. A nerve study showed I had good nerves to my feet, but there might be problems with the finer nerves. Is this itching a form of neuropathy? Is there anything that can help?
A: When someone has type 2 diabetes, it means their body is no longer able to use insulin properly. The body's cells become resistant to this hormone needed to move glucose out of the blood and into the cells so the cells can use it as fuel. The pancreas can also gradually lose the ability to produce enough insulin to keep up with demand. Together, these changes make it difficult to keep blood sugar levels within the normal range.
Over time, persistently elevated blood sugar begins to take a toll on the body. This can include damage to the kidneys, heart, eyes, nerves and extremities. One common result of this damage is the onset of unusual sensations, particularly in the feet. Known as peripheral neuropathy, it often causes tingling, stinging or burning. While less common, the persistent itchiness that you have described is also possible. And as you have surmised, it can also be a form of neuropathy.
The nerve conduction study you underwent typically assesses larger nerve fibers. It is the smaller sensory fibers that transmit pain and itch. These may not show up clearly on routine testing. As a result, even when nerve studies appear normal, the finer nerves can play a role in the symptoms.
That said, neuropathy is not the only reason people living with type 2 diabetes may experience itchy feet. High blood sugar can interfere with the skin's self-repair mechanisms, including the ability to hold water. This can lead to chronic dry skin, which can become itchy.
When this is the case, it is important to use gentle cleansers when washing the feet. Use hypoallergenic and fragrance-free lotions to keep the skin on the feet supple and moist. Also, be careful about friction caused by footwear. Choose socks with a soft, close weave that won't irritate the skin. Shoes should be supportive, without any pinch or pressure points.
People living with diabetes can also sustain damage to the nerves that control sweating, which can leave the skin of the feet very dry and prone to itching. The disease can also suppress immune function. This increases the risk of developing a fungal infection, such as athlete's foot, which can cause intense itching.
While vigilant foot care can lead to a reduction in itching, the most important thing you can do is work on improved blood sugar control. That includes using any medications prescribed by your doctor, eating a nutritionally balanced, low-glycemic diet and getting regular exercise.
And if you haven't talked to your doctor yet about this itch, we urge you to do so. They can prescribe topical treatments and, if needed, certain oral medications. These can help manage the itch and improve your quality of life.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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