Life with Type 2: Napoleon Conquers My Heel

Patrick Totty

| May 3, 2014

After the initial shock when we are first told we have type 2 diabetes, most of us set out determined to manage our disease in an exemplary way. I know that for me, at the back of my mind was the thought that I would be the great exception: I would hurl back my diabetes just like the Russians hurled Napoleon's troops back at the gates of Moscow two centuries ago.

Of course that was nonsense. Napoleon, in the form of my type 2, long ago made himself at home in my own private Moscow. As a mayor, he can be a moody creep, swinging from interfering with my life by administering shocking spikes to my blood sugar to benignly leaving me alone for weeks at a time.
One thing he left alone for years was my feet. I had been told many times as part of the standard warnings about diabetes that neuropathy was in my future, and that its first target would be my feet. Fortunately, that wasn't the case for a long time. I figured that as long as I did a lot of walking and tightly controlled my blood sugar, I could stave off any ill effects on my feet indefinitely.

But not lately. Over the past year, a combination of numbness and pain has settled in my feet. Especially distressing is the permanent soreness that seems to have colonized my right heel. It's as though the muscle there has been deeply bruised. The fact that I have no choice but to walk on it means that it never really has chance to heal. It forces me to clomp around very gingerly when I rise in the morning until everything gets warmed up. Then it becomes a minor background irritant. But when I'm at rest, not distracted by other things, it can throb like the pedal version of a migraine.

This is a big bite of reality sandwich. In the journey that we all make with type 2, most of my lingering hopes that I could bypass the disease's classic symptoms are just about gone. I forgot that neuropathy is a creeping condition, helped along by years of higher-than-normal blood sugar. Even with exquisite control, we type 2s still run blood sugar levels higher than normal, and that wears away at our nerves over time. So it was never realistic to think that neuropathy wouldn't drop by my house one day for a prolonged visit.

Still, there are parts of my body that type 2 has not managed to pry its way into. My eyes are still in good condition, with no hint of macular degeneration. If the choice is between limping around or not being able to see, it's pretty easy to guess which option I'll take. My cholesterol levels are good, and all the standard tests reveal nothing else to fret about besides diabetes itself.

There are still little things I can do to not let neuropathy overtake me in terms or morale or mobility. Although I'm years past being a runner, I remember that the natural running gait for humans is on our toes. Although my hobbling around is nowhere near to running, I often walk on the toes of my right foot until the heel gets its blood supply and stops complaining. It's an ad hoc tactic, but it works.

I joke with my wife that most of the TV shows we like seem to carry an awful lot of ads aimed at older people with every sort of condition of aging. Among them are ones for medicines that treat the symptoms of neuropathy. I've never really paid attention to them-until now. I'm not quite ready to take that step, but it could be next.

And that's what much of life with type 2 is about: what's next.

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Categories: type 2 diabetes

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Posted by Steve Parker, M.D. on 4 May 2014

That heel pain sounds like plantar fasciitis to me. It's treatable and often curable. Ask your doctor about it.


Posted by OldTech on 4 May 2014

Hi Pat,

Sorry to here that your neuropathy is progressing. When you say exquisite control what is your range of blood glucose over a day?

Like you when I was recently diagnosed I said to myself that I was going to win this war. So after learning a lot more about diabetes I decided that I would follow Dr Bernstein's strategy.

So far, using his very low carb diet (less than 30 grams per day), I have my blood glucose normalized at 70 - 90 mg/dL with only occasional postprandial spikes going to 110 mg/dL. My last A1C was 4.9. I am on metformin 500 mg twice a day.

At the time of my diagnoses I did have some autonomic neuropathy damage and I am seeing slow improvement. My dry mouth at night is fading. The iterating phantom itch on my feet seems to be gone. And I am finally just starting to sleep through the night without having to get up to go to the bathroom. My lower GI track still seems to be damaged, although it too may be getting better.


Posted by leslieann on 6 May 2014

your heel pain may be plantar fasciitis (sp?) and why are you worried about macular eye disease when you should worry about retinopathy which is when the vessels in the eyes leak and you lose vision.I've had diabetes for over 50 yrs and all is well (so far).Keep exercising,watch the diet and keep all your appts for Drs visits etc

Posted by rosiolady on 6 May 2014

Thank you for frankly sharing your experiences with type 2. Although I turned out to be a type 1 (diagnosed at age 29 so I was thought to be type 2 way back then) there are some similarities in what can happen. I've found most diabetics do't realize that diabetes is a progressive disease, kind of like aging is (well, it's not thought of as a disease, though). So they're horrified and ashamed when a new problem develops. I wish doctors would be more honest about it and not always try to "blame the victim." You can do your very best and yes, it will at least delay onset of some problems, but not always. We're each individual. If you've tried your best, you should be proud of yourself.

Posted by bobscof on 7 May 2014

I second Steve's reply. I have type II and developed the same debilitating heel pain. A VA podiatrist told me it was Plantar Fasciitis. He gave me a stretching exercise to counter the effects: lean against a wall or other support, and stretch the affected leg as far back as you can until you feel the calf muscle stretching. The pain is now gone unless I fail to stretch out my calf muscle regularly. It's not often you can find such a simply way to reduce a severe pain and avoid medication for it.

Posted by Anonymous on 8 May 2014

Patrick Totty responds:

A lucky man learns something new every day, and that sure applies in my case. Steve, leslieann, and bobscof, thank you for pointing out something that just hadn't occurred to me. What I was describing most likely is plantar fasciitis, and I appreciate you making me aware of that.

Also, leslieann, thanks for making a good distinction between macular degeneration and retinopathy. Fortunately, I'm OK on both fronts. I'll certainly be clearer about describing those conditions in the future.

Rosiolady, thank you for a good insight. There's a reason why doctors call our condition "progressive," and it's good for all of us to keep it in mind.

OldTech, more power to you in following Dr. Bernstein's strategy for dealing with diabetes. As the wheels come off the "science" about how people with diabetes can eat a lot of carbohydrates (the ADA says up to 180 grams daily), Dr. Bernstein's approach is getting vindicated. Your numbers show that he knows what works.

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