Questions and Answers

Apr 1, 2001

I am 72 years old and have been a type 2 for 21 years. I keep my blood sugar under control and get lab work done every three months. My A1c remains at 6%. Despite these measures, every year I get neuropathy on a different part of my body that lasts from winter until spring. Currently, I have it in my right buttocks and the back of my thigh. It is very painful. My doctor doesn't know what to do other than to prescribe painkillers that irritate my stomach.

I would be forever grateful for advice about what to do or who to see to improve my condition.

Adena Barry
Topeka, Kansas

First of all, you need to establish whether or not you have neuropathy. The pain in your rear and going down the leg is a common symptom of arthritis. Arthritis is notorious for worsening in the rain and cold and can affect joints throughout the body.

People with 21 years of diabetes can get a condition known as a fasciitis. This is an inflammation of the fibrous bands that are found in the sole of the foot, joining the iliac bone to the tibia, in the palm of the hand and around the shoulder. The pain can be similar to neuropathic pain and quite debilitating.

Also, patchy presentations of neuropathy in a person with diabetes can appear for two reasons: entrapment or mononeuritis multiplex.

Entrapment, a response to rest, splints, diuretics or steroid injections, can be diagnosed by a neurologist. If weakness results, surgical unentrapment may be required.

Mononeuritis multiplex, which can occur suddenly, is often painful, but resolves spontaneously. It may affect almost any nerve in the body and usually requires conservative treatment. If, however, it persists or recurs-as yours has-then it is worth further investigation. Clearly, you need to see your doctor to decide whether further treatment is necessary. Lastly, you might want to consider moving someplace warm to avoid the effects of cold winters on your body.

Aaron Vinik
The Strelitz Diabetes Institutes
Norfolk, Virginia

If I am having low blood sugar levels while sleeping, I tend to dream about eating or drinking. Possibly my subconscious state is trying to wake me. I haven't had any low blood sugars accompanied by unconsciousness. I realize this is not a good warning system, but I am curious to find out if you have ever heard of this before.

Darci Watson
Coal Valley, Illinois

Your question brings up an excellent area for discussion. It has long been known that there is a direct communication between mind and body.

Our minds often influence physical feelings, and we can learn to control certain functions such as body temperature through concentration and bio-feedback. Your description of your dreams clearly reflects the fact that your mind is registering what is happening in your body. This is certainly a form of internal communication.

We may wake up when our bodies are in pain, when we are too hot or cold or when our blood glucose levels go too low or high. Do not hesitate to accept these clues as valid and respond when you get these feelings, which may be translated into dreams. Also, dreams carry many messages. They may reflect things left undone or anxieties or messages from our bodies or our environment. Your warning system is actually quite sophisticated and quite reliable.

Keep a log of the times your body imposes its needs on your dreams and you will be able to measure the competence of your warning system. Just as we might dream of eating a steak when we are hungry, we also can dream of sweets when our blood glucose dives.

Be certain to follow your doctor's orders and check your blood glucose regularly and often. Attend to all clues you receive about yourself whether awake or asleep because education is our key to good control and enhancement of our lives.

Leonard Diamond, PhD
Camarillo, California

Is it safe for Type 2 diabetics to use St. John's Wort?

Antony B. Johnson
Bellevue, Washington

Up to 40 percent of patients with diabetes have moderate to severe depression. One study showed that less than 10 percent are treated. The best treatment is to see a physician and get a prescription for Prozac, Paxil, Zoloft, Wellbutrin or Celexa. These are all anti-depressants and work well. St. John's Wort has a mild but similar effect to these drugs. It is my strong belief that it is best to get properly diagnosed, take a prescription med and have the dose adjusted to meet your needs. Taking St. John's Wort may affect you but dose adjustment by yourself is dangerous. If you do use the product, be sure to tell your physician and pharmacist. Several people using it who had surgery actually died because no one knew they were taking it. In the long run, it is better and cheaper to get a thorough exam, a prescription anti-depressant that is monitored and have the dose adjusted to assure you get the correct result.

Keith Campbell, RPh, CDE
Washington State University
Pullman, Washington

I was wondering if chewing tobacco is more harmful for people with diabetes than it is for other people. I know that it isn't good for anyone and that smoking isn't good either. I like to have an occasional chew and I wondered if it would have any serious consequences on my health and if it could cause complications later in life for a diabetic.

Mike Hanson

There are several concerns regarding the use of smokeless tobacco by patients with diabetes. Some forms of smokeless tobacco (particularly chewing tobacco, but not snuff) contain sugar, which could affect blood sugar levels and increase insulin requirements.

The nicotine in smokeless tobaccos increases heart rate and blood pressure. This can have deleterious effects on the diabetic patient who is more susceptible to high blood pressure and other types of cardiovascular diseases. In addition, the placement of snuff in the mouth results in an extremely rapid absorption of the nicotine into the blood stream.

Finally, placement of smokeless tobacco in the mouth causes irritation and recession of the gums, which can lead to periodontal disease.

Although an "occasional chew" (two to three per week) is less likely to cause complications, the use of all forms of smokeless tobacco can become habituating and lead to dependence, addiction and increased use.

James Guggenheimer, D.D.S.
University of Pittsburgh School of Dental Medicine
Pittsburgh, Pennsylvania

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Apr 1, 2001

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