Among the manifestations of bi syndrome in Donguibogam, symptoms involving tingling and muscle cramps share many similarities with modern medicine's peripheral neuropathy. Among these, paresthesia and pain starting from the toes can be the classic presentation of diabetic peripheral neuropathy.
Peripheral neuropathy is a condition that occurs when the nerves at the ends of the limbs—meaning all nerves outside the brain and spinal cord, including sensory, motor, and autonomic nerves—become damaged. It is particularly common in diabetic patients because chronic hyperglycemia exerts a severe impact on the nerves. Excess glucose in the blood damages blood vessels much like sticky syrup, harming the tiny neurovascular vessels that supply nutrients to nerves and obstructing the delivery of oxygen and nutrients to nerve cells. Consequently, the nerves gradually starve and lose their proper function.
Beyond nutritional deficiency, hyperglycemia causes harmful substances called advanced glycation end products to accumulate within nerve cells and activates the sorbitol pathway, causing internal cellular damage. In this process, the myelin sheath, the protective covering of the nerves, is also destroyed, disrupting nerve signal transmission. Initially, symptoms like numbness, hypoesthesia, tingling pain, burning sensations, sharp stabbing pain, or muscle cramps appear starting at the tips of the toes or soles of the feet. As the condition progresses, symptoms travel upward and can affect the hands or arms as well. A hallmark feature is stocking-glove sensory impairment, where sensation becomes abnormal in areas covered by gloves or socks.
The greater problem is that due to this sensory loss, patients do not feel pain even when wounds or blisters develop on their feet, delaying detection. Minor injuries can progress to ulcers or infections, potentially leading to amputation in severe cases. Furthermore, muscle weakness or reduced balance in the feet makes falls more likely, and damage to the autonomic nervous system can trigger complications such as dyspepsia, urination disorders, and orthostatic hypotension. Therefore, for those with diabetes, strictly managing blood glucose as well as receiving early diagnosis and care through regular foot exams and nerve function evaluations is essential. Modern medicine focuses on slowing disease progression and improving quality of life through strict blood glucose control, pain-relieving medications such as gabapentin and pregabalin, physical therapy, and education on foot care.
