This is the continuation of last week’s article on Leg Cramps.

 Leg Cramps and Diabetes

What is the relationship between diabetes and cramps in the lower limbs? Plenty! Diabetes is a condition caused by an increase in blood sugar. This results in increased urine output for the diabetic patient. A substantial amount of electrolytes like sodium, potassium and magnesium are excreted in this increased urine loss. This causes an imbalance in the diabetic patient’s electrolyte levels in the blood. Reduced potassium levels triggers increased irritability of the skeletal muscle fibers, with resultant muscle spasms and leg cramps.

Another cause of leg cramps in diabetic patients is diabetic neuropathy. Long term diabetes causes substantial damage to the peripheral nerves, making the nerve fibers susceptible to being increasingly irritable, leading to leg cramps. It is also believed that arteriopathy, which is damage to the arteries of the lower limbs, also contributes to the process of leg cramps.  It is not one factor alone, but a combination of all these pathologies that contributes to increased incidence of painful muscle spasms in diabetics. Low calcium levels are also believed to play a role in such patients.

 

What are the main complaints of diabetic patients related to leg cramps?

 

Usually the diabetic complains of getting painful cramps that awaken them during sleep. These are called nocturnal cramps, and can cause severe sleep loss for the patient. In advanced and long term diabetes, the pain element might be absent, due to destruction of the pain fibers of the neurons or nerve cells.

How does one prevent leg cramps in diabetes?                                                                                 

Much thought and research have gone into this field. Experts say that the best way is to increase consumption of food rich in potassium such as oranges, cantaloupes, sweet potatoes, and fruits. In fact, the most common and cheapest source of potassium may be bananas, although bananas should be used in moderation.  In addition, regular checking of the blood electrolyte levels may serve as advance warning to the patient of leg cramps. Regular use of potassium supplements may be required as well as changes in diet.

Leg Cramps in Children

Like adults, children too tend to have leg cramps, and diabetes may increase this tendency as well  along with what is known as ‘growing pains’. The main and most common cause, however, is because children are usually very active.  They often do not know the limits and risks, of prolonged and strenuous physical exercise or activity. There is then, excessive build up of certain chemicals like lactic acid in the skeletal muscles of the thigh and the calf. This causes what is called in medical terminology, ERMC (exercise related muscle cramps). These can last from a few seconds to a few minutes. Recent studies suggest that rather than the build up of chemicals in the muscle, cramps are the result of central nervous system fatigue. We all know that the brain via the spinal cord and the nerves extending from here, control the skeletal muscles (muscles of the limbs).

Normally, there is always a mechanism of feedback, whereby the skeletal muscles are inhibited from becoming overactive during muscle contraction. Prolonged exercise is believed to alter this inhibitory system, resulting in hyperactive muscles and consequent muscle cramps. Perhaps it is both of these mechanisms (accumulation of harmful substances and loss of inhibition) that cause painful spasms of muscles. In addition, children (and indeed adults also) often sit or stand in awkward postures for extended periods of time precipitating muscle cramps. Other factors include improper footwear and obesity. Obesity is now becoming an increasingly common factor in both adults and in children. This has a lot to do with current lifestyles with emphasis on fast food and long hours of television viewing. Other causes of cramps in children include electrolyte imbalances, specifically potassium and magnesium deficiency. Exercise can also cause dehydration with loss of electrolytes and fluids in sweat, resulting in the cramps. More ominously, serious illnesses like leukemia can also cause painful cramps. A pinched nerve due to awkward positions while sleeping can be a contributor as well.

Treatment of Cramps in Children                                                                                                                                                

Since cramps are caused by painful contractions of the affected muscles, the remedy lies in stretching the muscle. Thus, the first thing to be done if a child suffers from spasms of the calf muscles is to gently hold the toes and bend the foot from the ankle, upwards and towards the shin of the leg, thus stretching the calf muscles. Hold this position for some time till the cramps subside. Alternatively, gently massage the affected calf muscles preferably with warm water or oils. One might also use one of the many medicated pain relieving creams or ointments, available over the counter at a pharmacy. Other things that can help include taking preventive measures like increasing the dietary consumption of green vegetables and fruits to supply sufficient electrolytes and vitamins. Finally, it is important to rest after exercise; gradually increase the capacity for exercise; and ensure proper hydration.

Your feet mirror your general health . . . cherish them!