Neuropathy - An Early and Dangerous Complication

Neuropathy, a word which means "sick nerves", is an early complication of diabetes which starts to occur in people who have blood sugars most doctors dismiss as "normal" or "mildly pre-diabetic."

Because nerves are damaged by "mildly" elevated blood sugars most doctors ignore, almost one half of people with Type 2 diabetes already have detectable neuropathy by the time they have been diagnosed with diabetes. Many other people who are never officially diagnosed with diabetes but have higher than normal blood sugars also get "diabetic" neuropathy. It may be a major cause of the impotence so common among men in their 40s and older.

The pain of neuropathy usually starts out in your feet. It can feel like tingling or burning, though some people describe it as feeling like there is something in their shoe between their toes when there really isn't anything in the shoe.

One characteristic of diabetic neuropathy which differs from similar nerve pain that can be caused by disc problems in the back, is that it usually is symmetrical--i.e. it occurs in both feet.

Less commonly, diabetic neuropathy can cause problems in the hands and arms.

Nerves affected by neuropathy eventually become numb. When you are examined after your diabetes diagnosis, your doctor should test your feet with a tuning fork or a thin filament that looks like fishing line to see if you have dead nerves in your feet you may not have noticed. Many people with diabetes do and it is an important finding which tells the doctor that you are at risk for serious infections. If the doctor does test you for neuropathy when you are diagnosed with diabetes consider finding a doctor more aware of modern diabetes treatment who will do this test.

Neuropathy Affects More Than Just Your Feet

While the nerves of your feet are the ones you are most likely to notice, the presence of neuropathy in your feet suggests that other nerves in your body are also under attack, most notably those that control sexual response and those of the autonomic system which control functions like blood pressure, heart beat and the movement of food through your digestive system.

The more years you spend with high blood sugars, the more likely you are to develop impotence (both male and female), and gastroparesis, which refers to the condition where your food no longer moves through your body in a normal way but can get stuck in your stomach due to non-responding valves.

Another nerve that gets damaged by high blood sugars is the vagus nerve, a vital nerve that connects your brain to almost all of the rest of your body and which has been found to regulate the immune system. This may be another reason why people with diabetes have trouble fighting infections since a weakened vagus nerve may not signal the immune system that your body is under attack.

The vagus nerve also regulates heart beat. It is possible that damaged vagus nerves may have something to do with the high incidence of fatal heart attack in people with diabetes, who may have abnormal heart beats which cause sudden cardiac death.

Neuropathy Leads to Amputation

The pain of neuropathy in your feet is unpleasant, but suppressing the pain with drugs, or waiting until the nerve becomes numb only gets rid of the pain and doesn't cure the underlying process causing that pain.

Since the drug companies are promoting some very expensive new drugs as treatments for neuropathy, if you complain of pain in your feet, your doctor may prescribe one of these drugs for you, rather than explaining to you how you can actually reverse this neuropathy and stressing that it is important that you do so as soon as you can.

That could be a huge mistake. First of all, the drugs being sold for neuropathic pain don't work very well, despite their high cost, and they have disturbing side effects, some of them affecting your mood and state of mind.

But more importantly, the underlying process causing your nerve pain is what leads to the unrelenting infections that result in amputation. If you have neuropathy, your nerves are failing because the tiny blood vessels that supply those nerves are being clogged and dying, which means that soon they won't be able to bring infection fighting white blood cells to infected tissue. Once that happens it is almost impossible to keep an infection from leading to gangrene, which is why people with diabetes end up with amputated feet and legs

Neuropathy CAN be Stopped and Even Reversed

Don't settle for drugs that only numb nerve pain. Eliminate its cause and allow your nerves to regenerate while they still can!

The way you do this is by doing what you can to bring your blood sugars at all times below the level at which damage occurs. Research suggests that this level is somewhere around 140 mg/dl (7.8 mmol/L).

Quite a few people with neuropathy have reported on the alt.support.diabetes newsgroup that if they keep their blood sugars under this level, their nerve pain either goes away or is much less painful.

A study conducted in Kumamoto Japan found that people who concentrated on lowering their blood sugar after every meal to even a higher blood sugar target--180 mg/dl (10 mmol/L) saw their neuropathy reverse slightly, too. Much more than people who had the same A1c levels, but did not focus on bringing down post-meal blood sugars.

The key here is that you have to focus on lowering Post Meal Blood sugars. Lowering fasting blood sugars won't help if your body is spending hours with very high blood sugars after every meal.

How to Lower the Post-Meal Blood Sugars that Cause Neuropathy

To bring your blood sugars to the level that will reverse neuropathy it is essential that you measure your blood sugars one and/or two hours after each meal and eliminate anything from your diet that causes your blood sugars to spend more than an hour over 140 mg/dl (7.8 mmol/L).

Cutting way back on carbohydrates, even supposedly "healthy" carbohydrates like oatmeal and fruit is the first step to achieving this. How can a food be "healthy" if it is pushing your blood sugar up to levels where your small blood vessels are dying?

If cutting way back on the foods that raise your blood sugars doesn't achieve this healthy blood sugar level, demand that your doctor help you find a drug regimen that will. The American Association of Clinical Endocrinologists now recommends that all people with diabetes keep their blood sugars below 140 mg/dl (7.8 mmol/L) by two hours after every meal. So in demanding that your doctor give you this level of care, you are asking for mainstream treatment.

Doctors who dismiss this level of care as unnecessary are behind in their education about diabetes and should be avoided. They aren't the ones who will lose a limb by following outdated advice. You are!

ALA May Help Neuropathic Pain

Alpha Lipoic Acid is a supplement which some people report has helped greatly with their neuropathy. Unlike drugs like Neurontin, which only mask the pain, ALA may work by reducing insulin resistance and improving blood sugar. It is expensive, but it is worth buying a bottle and giving it a try to see if it helps you. Dr. Bernstein recommends taking it with Evening Primrose Oil and Biotin.

The efficacy of ALA was demonstrated in a 2006 study published in Diabetes Care. It appears to be most efficacious at reducing neuropathic pain rather than numbness. The study found that higher doses worked faster but also caused nausea and other gastrointestinal side effects. The authors suggests that 600 mg once a day is the optimum dose.

http://www.diabetesincontrol.com/modules.php?name=News&file=article&sid=4326

Healing your Nerves Can Hurt

As you improve your blood sugar levels, you may be disturbed to notice more pain, rather than less, in your feet. The reason for this is that when numb and dying nerves begin to heal, they begin to transmit again, and these transmissions, unfortunately, are painful. This pain is "good pain" though, and it will get better on its own.

Tylenol is one medication that may help with the nerve pain caused by healing nerves. Just be careful not to overdo the doses, as too much Tylenol is hard on your liver and kidneys and NEVER DRINK when you are taking Tylenol as the combination of Tylenol and alcohol can be fatal.

Healing your Nerves May Reverse Impotence

There are two different mechanisms that cause impotence. One is nerve damage and the other is clogging of the small arteries of the sexual organs. Dr. Richard K. Bernstein reports that he's found that in his patients it is possible to reverse impotence caused by diabetic nerve damage but not by damage to the arteries.

If you experience impotence, whether or not you have been diagnosed with a blood sugar problem you should monitor your post meal blood sugars to see if they are what are causing the problem.

What the glizty TV ads--and your urologist--don't tell you is that Viagra and Cialis only work for a brief time for people whose impotence is caused by nerve damage from high blood sugars because, over time, if the high blood sugars aren't eliminated, they destroy the circulatory system to where it can't be stimulated by these drugs.

Lowering your blood sugar to where your nerves are no longer under attack is the only way you can maintain your sexual function for years to come!

Be Obsessive About Foot Care When You Have Neuropathy

Neuropathy in your feet or legs indicates that any infection you get in your feet could flare up and result in an incurable infection that would require amputation.

This means you need to treat any foot infection, including fungal infections like Athlete's Foot as an emergency requiring a trip to the doctor.

Make sure your shoes fit and check your feet regularly for blisters or any small cuts that could develop into something worse.

Must You Avoid Heating Pads, Electric Blankets, etc.?

The reason for the warnings you see on things like heating pads and electric blankets that say they should not be used by people with diabetes is because if your neuropathy is advanced, your dead nerves will no longer tell you if these appliances are hot enough to burn you. This can lead to dangerous burns that lead to infection and amputation.

Take these warnings seriously until you've had a thorough examination that shows that your nerves in your feet are intact and doing their job.

Corneal Sensitivity another Casualty of Neuropathy

A study reported in Diabetes Care in July 2007 found that decreased corneal sensitivity, which can lead to corneal ulcers, correlated to the degree of neuropathy in people with diabetes. This points out, once again, how many different nerves are affected by exposure to high blood sugars, and how neuropathy is probably the most all encompassing of all the diabetic complications.

http://care.diabetesjournals.org/cgi/content/full/30/7/189

What about the New Pain Drugs?

New and expensive drugs like Lyrica (Pregabalin) and Neurontin (Gabepentin) are being prescribed by doctors thanks to aggressive marketing campaigns being run by their manufacturers.

Unfortunately, both these drugs have serious side effects and are not very effective for diabetic nerve pain. There are certainly NOT anywhere as effective as lowering post-meal blood sugars which will work for most neuropathic pain without any side effects.

The side effects of Lyrica flagged by the FDA include allergic reactions which can be severe, water-related swelling of the hands and feet, blistering and severe dizziness. The FDA recently added the following warning to the prescribing information for Lyrica: "Treatment should be immediately discontinued in patients who develop skin redness, blisters, hives, rash, dyspnea [shortness of breath], or wheezing."

MEDSCAPE: FDA Safety Changes 11/9/07

Neurontin can cause suicidal thoughts. It also strongly affect the central nervous system and is basically addictive in that if you stop taking it suddenly you can experience seizures. On top of this, is it not terribly effective for neuropathic pain and there for with the risk of severe side effects It is not seem to be an appropriate drug for neuropathic pain control.

Zoloft/Neurontin Concealed Evidence: Suicide Risk/Lack of Efficacy