Here are the warning signs: Prickling, tingling, some pain or numbness in your feet and legs. And the symptoms get worse at night. You may be suffering from early symptoms of diabetic neuropathy or nerve damage. This is a common complication among diabetic patients.

Alarmingly, this often goes undetected due to misdiagnosis or underdiagnosis, according to Dr. Rayaz Malik, a professor of medicine at Weill Cornell Medicine Qatar and the University of Manchester, who was recently in the Philippines to advocate awareness on diabetic peripheral neuropathy.

Failure to detect early signs of PN leads to even more serious complications — one of the worst of which is the patient ending up getting his legs amputated.

Lower-limb amputations innocently start with a foot ulcer — a slow-healing wound or sore at the bottom of the feet that a person with uncontrolled diabetes does not feel at all. Why? Because of diabetic PN, which causes loss of sensation.

PN is a silent disease, quietly damaging your nerves as you go along with life — until it is too late. Your chronic high blood sugar, without your knowledge, has begun to gradually demolish your nerves, so that ordinary activities in your daily life like climbing the stairs or walking become a horrific struggle.

This is why P&G Health, the health care division of Procter and Gamble known for popular brands such as Vicks, Oral-B, Downey, Head and Shoulders (their products practically occupy a large percent of grocery shelves), is shedding light on PN — because early detection is crucial.

On World Diabetes Day last 14 November, P&G Health kicked off their month-long PN awareness called 'Winning the Fight Against Neuropathy in Diabetic Patients." They brought together globally renowned medical experts, media, and health care professionals from across Asia-Pacific and the Middle East for a series of scientific forums that will spread information about PN and save numerous lives.

One of the main objectives of the program is to train doctors to catch the early symptoms of PN and prevent what could be a terrifying existence filled with pain and crippling disability.

One of the experts they brought into the Philippines was Dr. Malik, also known for having established in his career an Early Neuropathy Assessment Group.

"(Neuropathy) is a forgotten complication of diabetes," said Dr. Malik at a recent roundtable discussion with select media members. "As soon as you think about diabetes, you think of heart attacks, strokes, people getting retinopathy or going blind, or people getting kidney failure and getting dialysis. But actually, neuropathy is more common than any of those complications. At least 50 percent of people get it, and when it affects you, it's terrible."

Distorted signals
PN means there is damage to a person's peripheral nervous system — a destruction in the communication channels between the brain/spinal cord and the rest of the body.

Think of a choppy or a static phone call. Or poor WiFi or television signal. The messages are unclear, distorted or erroneous. When your peripheral nerves are damaged, your body does not get the message that your feet hurt, or if it's cold. And this results in a major problem.

"In diabetic neuropathy, the nerves aren't working," said Dr Malik. "So you don't feel there's a problem. So you never go to the doctor."

Dr. Malik further explained the loss of sensation. A pair of brand-new or ill-fitting shoes, for example, may cause discomfort. To people without diabetic neuropathy, they would wince in pain and naturally remove their shoes to prevent further discomfort and damage. But to those with PN, they don't feel a thing. Hence; foot ulcers develop.

Primary care
Dr. Malik emphasized the importance of primary care. Doctor-patient consultations alone would be able to detect PN.

"Primary care is important," he said. "Secondary care, as specialists, we deal with foot ulcers and amputations. It should be starting in primary care. The message (about PN) should go out to the people with diabetes."

This is why P&G is doing a massive push this November to get the message across about the early signs of PN, especially to persons with diabetes.

"What we do is we support access to knowledge for primary care physicians — and it's free" said Dr. Inna Eiberger, Director and Head of Medical and Technical Affairs for Global Nerve Care Franchise, P&G Health.

Dr. Eiberger added that P&G brings in experts to educate primary care physicians, including in the Philippines, to ask "active questions" to patients during consultations, and that the doctors do not need fancy and expensive devices to detect early signs of PN. A smart interview alone would catch the disease early on.

PN in pre-diabetic patients
When I asked Dr. Malik how soon PN develops in people with diabetes, his answer was disturbing.

"That's an interesting question," he said. "We have actually shown that even in (people with) pre-diabetes, the (neuropathy) process may be starting."

Again, pins-and-needles and numbness in your feet and legs, especially at night? Time to book an appointment with your doctor, with a result of your FBS (fasting blood sugar test), and prevent a life of disability.