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I attended a party this weekend at a friend's house. The hostess said, "Scott, I want you to meet my brother-in-law, Alan. He has diabetes, and you two should talk."
This happens to me often and I always relish the opportunity to connect with another person with diabetes. This guy had a very good question for me: "I am losing all feeling in my foot, yet I get shooting pains from neuropathy. What should I do?"
I provided the name of my endocrinologist and told him to try to get an appointment as soon as he could. "Getting appointments is tough, so be sure and use my name," I told him.
"Tell him you want to get your diabetes under really good control," I suggested, adding that before the appointment, he should make a list of all his symptoms.
While at my office the next day, I looked through our extensive database of diabetes articles. I selected the ones about neuropathy, edited them down for an overview of all the treatment options, and emailed it to Alan. I told him I know people whose neuropathy pain went away with aggressive blood sugar management and the use of supplements. I also sent Alan the article about why people with diabetes need to take vitamins.
"Ask the doctor which of these supplements or new drugs might help you," I wrote.
Here is a summary of what I sent to Alan, taken from previously published DIABETES HEALTH articles.
High Blood Sugars are the Main Culprit
Excess blood glucose bonds to proteins in the body, leading to nerve damage and narrowing of the arteries. Blood and oxygen flow are then diminished, causing poor circulation, pain and tissue death. Elevated blood glucose levels are also known to decrease levels of magnesium in the body, contributing to vascular constriction, impaired blood flow and insulin resistance.
If you have neuropathy, don't stop pestering your doctor until you get a treatment plan that keeps your BGs below 150 most of the time or an HbA1c lower than 8 percent.
Alan Marcus, MD, says that two of the most effective treatments are normalizing cholesterol and magnesium levels in the body. Given the connection between magnesium deficiency, diabetes, atherosclerosis and hypertension, magnesium supplements are often recommended for the treatment and prevention of neuropathy. (See pages 21 and 39 of this issue.) A blood test is recommended to determine if you have a magnesium deficiency. It should be noted, however, that magnesium is not recommended for patients with kidney failure.
Myo-inositol (a B vitamin) deficiency has been connected to diabetes in animal studies (Clinical Diabetes, July-August 1991). Renowned neuropathy expert, Aaron Vinik, MD, recommends brewer's yeast as a rich source of myo-inositol that can be safely taken in doses up to 3,000 mg. daily.
People with Diabetes Need More Antioxidants
Many studies in recent years have proven that antioxidants help prevent diabetic complications, especially neuropathy and retinopathy. Both vitamin E and gamma-linoleic acid are antioxidants. Antioxidants work by neutralizing harmful free radicals which have been found to damage cells and impair the immune system.
Vitamin E improves circulation and oxygen utilization, and may help to repair nerve damage. Dr. M.G. Traber discovered that patients with neuropathy had significantly lower vitamin E amounts in their tissues than people with other types of neurological disorders (The New England Journal of Medicine, 1987).
In addition, a study of the effect of gamma-linoleic acid on diabetic neuropathy suggests that supplements are beneficial to nerve function (Lancet, December 1991). A number of readers have reported benefits from gamma-linoleic acid, preferably in the form of borage oil capsules, found in many health food stores.
Jeffrey Blumberg, PhD, a professor of nutrition at Tufts University, is an antioxidant expert who has been studying nutrition for 20 years. He calls diabetes a "free radical disease." People with diabetes use up their antioxidant stores more quickly, so their requirements are actually higher.
"It's not so much that your levels are depleted and you're going to get scurvy; it's that your requirements are higher than other people in order to maintain usual health. Because your disease is creating more free radicals, and free radicals use up the vitamins, therefore you need more."
Alpha-Lipoic Acid Supplement Beneficial for Painful Neuropathy
Lester Packer, a professor of molecular biology at the University of California, Berkeley, has seen neuropathy improvement with daily intravenous alpha-lipoic acid (ALA) treatment, concluding that, even in pill form, ALA "holds great promise."
A 1995 study published in Diabetologia says that 600 mg. of ALA for three weeks was "associated with a significant reduction of various symptoms of peripheral neuropathy including pain, paraesthesiae [burning, prickling, tingling] and numbness."
Phillip Low, MD, a neurologist at the Mayo Clinic, says that ALA promotes blood flow to nerves, helping to repair neuropathy damage. Currently, ALA is used in Europe to treat and prevent complications associated with diabetic neuropathy, as well as cataracts.
Electric Sock: New Neuropathy Treatment
The Silver-Thera electrotherapy sock worn while sleeping reduced neuropathy pain and improved blood flow in 70 percent of a study group at the University of Texas. The Silver-Thera sock must be prescribed by a doctor and is covered by Medicare and other insurance policies. Call Prizm Medical at (800) 447-4422 for more information.
Electrotherapy Provides Relief to Type 2 Patients with Neuropathy
Electrotherapy provided pain relief to approximately 85 percent of patients with peripheral neuropathy.
According to the Spring 1999 issue of Diabetes Technologies and Therapeutics, 83 percent of the patients receiving electrotherapy reported improvements.
In another study, 85 percent of the patients receiving electrotherapy and the drug amitriptyline reported improvement. According to the August 1998 issue of Diabetes Care, electrotherapy improves oxygen in the nerves.
Drug Treatments for Neuropathy
Dr. Vinik tells us that there are two types of neuropathy pain: C-fiber type pain and A-delta type pain. People with long-standing type 1 and type 2 diabetes are susceptible to both types of pain, but people with newly diagnosed diabetes may have an acute form of C-fiber type pain. Different therapies exist to treat each type of pain.
C-Fiber Type Pain
C-fiber type pain is described as burning pain that worsens at night, causing insomnia, weight loss, anxiety and depression. With C-fiber type pain, the patient often complains that the slightest touch is considered painful. For this reason, people with C-fiber type pain do not like bedclothes to come in contact with the skin, nor do they like the hairs of the skin to be disturbed.
Capsaicin, extracted from the chili pepper, is used in the form of a topical cream (such as Zostrix-HP). It is thought to work either by depleting a neurotransmitter that is fundamental to the body's pain mechanism or by acting as a counter-irritant, causing an initial increase and then decrease of pain by overstimulating certain nerves. To avoid the high cost of capsaicin, Vinik recommends making your own capsaicin-like cream by mixing three teaspoons of cayenne pepper in a jar of cold cream. Special care must be taken when applying it to prevent irritation to other parts of the body. Users should wear gloves and apply only a thin layer of the cream three to four times a day.
The drugs clonidine, Neurontin, carbamazepine, Dilantin, and the antidepressants: amitriptyline, nortriptyline and imipramine, have all been shown to benefit sufferers of C-fiber neuropathy pain. Some people experience unpleasant side effects with these drugs, which may outweigh the benefits.
A-Delta Type Pain
A-Delta type pain is a more deep-seated, gnawing, toothache-type pain which often does not respond to the treatment measures used for C-fiber type pain. A-delta type pain feels like wearing a pair of shoes one size too small.
Vinik reports that short-term insulin infusion has been found to ease A-Delta type pain. The infusion is administered by intravenous drip for 48 to 72 hours, using .8 to 1 unit of insulin per hour. Standard diabetes treatments, including insulin and oral hypoglycemic agents, are not changed and a regular meal plan is followed. If a relapse in pain occurs, the infusion can be repeated.
If these measures fail, however, there are several treatments available that may abolish the pain. These include lidocaine (when given by slow infusion), tramadol, dextromethorphan, transcutaneous nerve stimulation, analgesics, and calcitonin. (See DIABETES HEALTH, March 99 for the complete article.)
Awareness Is Key
Along with any treatment, check your feet and shoes daily. Foot care kits for health care providers and educational materials for patients can be ordered from the National Institutes of Diabetes and Digestive and Kidney Diseases at (800) 438-5383.
Neuropathy can be controlled and prevented, but it must be respected. Be aware of the prevalence and destructive power of neuropathy and take all the preventative measures you can.
Recommendations about taking any of the drugs or supplements mentioned here should always be made on a case-by-case basis by a qualified medical professional. Take this list to your physician. Not all remedies are recommended for all people.
Remember, the best protection against diabetes complications is to achieve near-normal blood sugar levels. The information in this issue, and all of our issues, is dedicated to help you achieve them.
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.