Diabetic Neuropathy, You’d better be checking your blood sugars!

Blood_Glucose_Testing

Diabetes causes high blood sugar levels, either from lack of insulin (type I diabetes) or insulin resistance (type II diabetes).

Many diabetics develop numbness, tingling, neuropathic burning pain, or weakness that starts in the feet and progresses up the legs (“glove and stocking” pattern) from diabetic polyneuropathy.

Neuropathic pain in feet

Neuropathic pain in feet

Loss of protective sensibility from neuropathy can cause painless injuries that result in ulceration, infection and bony deformity “Charcot joints”.

Diabetic ulcer

Diabetic ulcer

Diabetic foot deformity, Charcot joint

Diabetic foot deformity, Charcot joint

There are many medications that can reduce the symptoms of neuropathic pain, such as gabapentin, pregabalin and duloxetine.

However, the only treatment that has been shown to be effective for diabetic neuropathy is improved control of blood sugar.

While many patients and their doctors rely on the glycosylated hemoglobin to measure how well their diabetes is controlled, it is important to recognize that this is an average measure of blood glucose levels, and patients with mild diabetes can have peaks (which are neurotoxic) and troughs (which can also be harmful), which average each other out, leading to a “normal” glycosylated hemoglobin level , and a false sense of security that everything is OK.

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Blood sugars – you can have a normal “average” level, but still get nerve damage from high peaks after you eat

If you have diabetic neuropathy, we suggest that you check your finger stick glucose regularly and write the numbers down in a book or on a computer spreadsheet, so that you can review them with your doctor.

We usually suggest the following schedule to our patients:

Pick the same 2 days each week (no matter what you have eaten those days) to do the test.  On those days, check a “fasting” sugar when you first wake up (should be <130, ideally <110), a second sugar test before dinner (should be <130, ideally <110), and a third test 2 hours after dinner (should be <180, ideally <140).

Remember, although improved blood sugar control will prevent progression of your neuropathy, it won’t make it better, so start today before things get too bad!

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