Diabetic Neuropathy

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Neuropathy: An Early and Devastating Diabetic Complication

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

Because nerves are damaged by the "mildly" elevated blood sugar levels that 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.

You can read the research that connects "prediabetic" blood sugars with the rising incidence of neuropathy here: Research Connecting Blood Sugar Levels with Organ Damage

The pain of neuropathy usually starts out in your feet. It can feel like tingling or burning, though some people experience it as feeling like there is something stuck between their toes when nothing is actually there.

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

Nerves affected by neuropathy eventually become numb. This may feel better than having the painful nerves of early neuropathy, it is more dangerous, because when your nerves are numb, your immune system loses the ability to fight infection, making you vulnerable to the unchecked infections that lead to amputation.

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 not 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. Also, if you are diagnosed with diabetic neuropathy and your doctor's only response is to prescribe a drug like Neurontin, which mutes the pain of neuropathy while doing nothing to reverse the actual neuropathy, it is essential that you find a better doctor--one who will help you achieve the normal or near normal blood sugars that can restore life to your damaged nerves.

There Are Several Other Common Causes for Neuropathy

Though diabetes is a major cause of neuropathy, it is far from the only cause, so unless you have had abnormal blood sugars for several years you should not assume that nerve problems are due to abnormal blood sugars. Another, equally common cause for nerve pain or numbness in the feet or in the arms is degenerative disc disease. However, the nerve damage associated with degenerated discs usually affects one side at a time. Diabetic nerve damage tends to be symmetrical--it occurs in both feet at the same time. Repetitive stress can also cause the symptoms of neuropathy by causing tendons and muscles to swell up and pinch nerves.

Lowering your blood sugar will, over time, reverse diabetic neuropathy. However, it will not heal nerves that are damaged by ruptured discs or swollen tendons.

Diabetic 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, heartbeat 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.

The discovery that the vagus nerve controls the inflammatory response was reported here:

The inflammatory reflex Kevin J. Tracey. Nature 420, 853-859, 19 December 2002, doi:10.1038/nature01321

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 heartbeat. 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. If you have diabetic 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.

Diabetic Neuropathy CAN be Stopped and Even Reversed

Don't settle for drugs that only numb nerve pain. Eliminate the high post-meal blood sugars that cause neuropathy and your nerves will regenerate!

The way you eliminate the high post-meal blood sugars that are damaging your nerves is surprisingly simple but very effective. Read about it here:

How To Lower Your Blood Sugar

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 than the one recommended by the American College of Clinical Endocrinology, saw their neuropathy reverse slightly. People who had the identical A1cs but had not lowered their post-meal blood sugars had much higher rates of neuropathy.

Long-Term Results of the Kumamoto Study on Optimal diabetes Control in Type 2 Diabetic Patients. Motoaki Shichiri, Hideki Kishikawa, Yasuo Ohkubo, Nakayasu Wake. Diabetes Care. Volume 23 Supplement 2, 2000.

The blood sugar target used in this study (180 mg/dl or 10 mmol/L) was much higher than the post-meal blood sugar target currently recommended by specialists. Anecdotal reports posted online over the past decades suggest that keeping blood sugars under 140 mg/dl after most meals for six months will reverse diabetic neuropathy for people with Type 2 Diabetes, especially if the neuropathy has only developed in the past few years.

To Reverse Your Neuropathy You Must Lower Post Meal Blood Sugars

Lowering fasting blood sugars won't help if your body is experiencing hours of high blood sugars after every meal.If changing what you have been eating in the way described HERE does not get you to a truly 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 tell you this level of control is unnecessary are telling you that they have fallen way behind in their education about diabetes. Such doctors are very dangerous to your health. They aren't the ones who will lose a limb by following outdated advice. You are!

B-12 Deficiency Caused by Long-Term Use of Metformin Causes a Different Kind of Neuropathy

Though it has many benefits, there is one problem with metformin that can occur when people take it for a decade or longer. Metformin can make changes in the gut that keep it from absorbing Vitamin B-12 properly. Some degree of B-12 vitamin deficiency is found in 30% of people who take metformin. Longer use makes it more likely that the deficiency will develop, but it can be found in people who have taken it for shorter periods of time. B-12 deficiency also become more common as people age and their gut tissues no longer work as well as they used to, independent of metformin use.. A final group of people who are at risk of B-12 deficiency are vegans as meats are a major source of dietary B-12

The reason this is important is that B-12 deficiency eventually causes a form of neuropathy that doctors often confuse with diabetic neuropathy. Unfortunately, unlike diabetic neuropathy. the neuropathy caused by B-12 deficiency may be irreversible. So you must demand that your doctor check your B-12 levels checked every few years since you don't want to wait until nerve pain symptoms develop as that kind of nerve pain may be permanent.

If you are diagnosed with neuropathy, insist that your doctor test your B-12 levels before assuming it is diabetic neuropathy. If your levels are low insist that your doctor prescribe B-12 injections. Many family doctors are not aware of the Metformin/B-12 Neuropathy Connection, so you must take charge here.

B-12 Supplementation Isn't Enough to Prevent Deficiency

If your B-12 levels are low because your gut tissues aren't absorbing B-12 correctly you will not be able to metabolize the B-12 in supplement pills. Though supplements do help people without diabetes, a large, well-designed study of NHANES data found that people with diabetes who took metformin did not appear to be able to benefit from oral B-12 supplements.
Association of Biochemical B12 Deficiency With Metformin Therapy and Vitamin B12 Supplements.
Lael Reinstatler, et al., Diabetes Care 2012 Feb; 35(2): 327-333.

ALA May Help Diabetic 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. You can learn more about the evidence suggesting ALA may help your nerves and how to use it here:

Helpful Supplements for People with Diabetes

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 first transmissions, unfortunately, are painful. This pain is "good pain" though, and it will get better on its own. Itching and tingling in nerves that have previously been numb can also be signs that dead nerves are regenerating.

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. The combination of Tylenol and alcohol can destroy your liver.

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 in his book, Dr. Bernstein's Diabetes Solution: The Complete Guide to Achieving Normal Blood Sugars
that he's found it is possible to reverse impotence caused by diabetic nerve damage in his patients, but not the 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. Over time, if the high blood sugars aren't eliminated, these high blood sugars will destroy the circulatory system in your sex organs to where they 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 and Electric Blankets?

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 found 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.

Corneal Sensitivity Is Reduced and Relates to the Severity of Neuropathy in Patients With Diabetes Mitra Tavakoli et al. Diabetes Diabetes Care 30:1895-1897, 2007

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 dangerous 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 addictive in that if you stop taking it suddenly you can experience seizures. I have personally heard from someone who experienced hallucinations when trying to stop taking Neurontin, whose doctor told him that it would take a year for him to wean himself off the drug safely. On top of this, is it not terribly effective for neuropathic pain.

These drugs also can cause dramatic, unrelenting weight gain--something people with Type 2 Diabetes can do without. With its side effect profile, these are not appropriate drugs for neuropathic pain control.

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

Certain Commonly Prescribed Antibiotics Can Also Cause Neuropathy So Avoid Them

The fluoroquinolone family of antibiotics, which includes ciprofloxacin (Cipro), gemifloxacin (Factive), levofloxacin (Levaquin), moxifloxacin (Avelox), norfloxacin (Noroxin), and ofloxacin (Floxin) have been found to cause a form of neuropathy which can be irreversible. These drugs can also cause hypoglycemia in people with diabetes. They are commonly prescribed for urinary tract infections, but there are other drugs that are a better choice for people with diabetes. If you are battling with neuropathy, ask your doctor to prescribe one of the other, safer, drugs.

Diabetes Self-Management:Nerve Damage and Fluoroquinolone Antibiotics.

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