AboutCatherine Burns. RN. BS. Expertise I will endevour to answer questions re daily "Self Management of Diabetes Care" for people who are currently under the care of a physician.
My focus would be Diabetes health care education and not diagnosis.
Experience I have 15 years experience as a Diabetes Nurse Educator.
Education/Credentials I am an RN for many years.
I have a BS in Healthcare Management.
I was a Certified Diabetes Educator for many years.
Question I have neuropathy in my feet and a little in my hands. My blood glucose test
scores are nearly always between 105 and 124. In 4 months I have had 5 that
were over 126 with the highest 127. My A1c is 6. Mostly my overnight blood
glucose is higher than ideal but still rarely in a diabetic range. My neurologist
can find no other cause so far, but says the pattern is consistent with Diabetic
neuropathy. My family doctor has said that some people are exquisitely
sensitive to elevated blood glucose levels and so the neuropathy may be from
this. The diabetic specialist, I saw says you can't have diabetic neuropathy
unless you have diabetic eye damage, & many years of diabetes. Can you
shed any light on this or suggest where I can get better information. Thank
you.
Answer Dear Sue,
The following input is provided for informational purposes only, and it is not intended to be substituted for the advice of personal expert physicians.
I recommend discussing medical concerns with the most appropriate resources - the personal expert physicians attending to your unique health needs.
Peripheral neuropathy causes pain and numbness in your hands and feet. The pain typically is described as tingling or burning and decreased or loss of sensation. I am sorry to hear you have this problem.
A number of factors can cause neuropathies as follows: Excerpts from the Mayo Clinic .com web site.
Trauma or pressure on the nerve. Nerve pressure can result from using a cast or crutches, spending a long time in an unnatural position, repeating a motion many times such as typing at a computer keyboard or having a tumor or abnormal bone growth. When peripheral neuropathy affects a single nerve, trauma or nerve pressure is the most likely cause.
Diabetes. When damage occurs to several nerves, the cause frequently is diabetes. At least half of all people with diabetes develop some type of neuropathy.
Vitamin deficiencies. B vitamins are particularly important to nerve health.
Alcoholism. Many alcoholics develop peripheral neuropathy because they have poor dietary habits, leading to vitamin deficiencies.
Autoimmune diseases. These include lupus, rheumatoid arthritis and Guillain-Barre syndrome.
Other diseases. Kidney disease, liver disease and an underactive thyroid (hypothyroidism) also can cause peripheral neuropathy. Patients with HIV/AIDS also are prone to develop peripheral neuropathy.
Inherited disorders. Examples include Charcot-Marie-Tooth disease and amyloid polyneuropathy.
Exposure to poisons. These may include some toxic substances, such as heavy metals, and certain medications especially those used to treat cancer.
Unfortunately, it's not always easy to pinpoint the cause of peripheral neuropathy. In fact, if your neuropathy isn't associated with diabetes, it's possible the cause may never be found.
Peripheral neuropathy isn't a single disease, but rather a symptom with many potential causes. A neurologist is the expert resource to screen and make a diagnosis.
If your feet are numb, you may be less likely to feel when they've become injured. Make sure to check your feet regularly so that you can treat minor injuries before they become infected.
Go to this web site above for additional detailed information on peripheral neuropathies.
There are numerous medications available for treating neuropathy and the neurologist is the expert here.
You are attending a diabetes specialist (endocrinologist) who is advising you on target blood glucose levels and target A1C levels for your health, prevent other potential complications, and provide some relieve of current neuropathy symptoms.
Using the chart below, you can see how your A1C result correlates to average blood sugar. For example, if you have an A1C of 6, then your average blood glucose is 135 mg/dl.
AIC result = Average Plasma Blood Glucose
5 = 100 mg/dl
6 = 135 mg/dl
7 = 170 mg/dl
8 = 205 mg/dl.
9 = 240 mg/dl
10 = 275 mg/dl
11 = 310 mg/dl
12 = 345 mg/dl
. For people with diabetes, the American Diabetes Association (ADA) recommends an A1C of less than 7,1 while the American College of Endocrinology (ACE) and International Diabetes Federation (IDF) suggest 6.5 or lower.
Congratulations on achieving an AIC at 6.
Management of peripheral neuropathy involves establishing that the neuropathy is caused by diabetes instead of other causes and aiming for optimal stable blood glucose control.
Stability may well be the key feature, because blood glucose flux is associated with pain
The blood sugar should ideally be about 100 before meals, and 140 or 150 at the highest blood sugar that is ever seen. This is extremely tight control, difficult to achieve and not safe for some diabetics due to hypoglycemia episodes, other medical conditions, age and so and so forth..
The personal endocrinologist is the expert to set the safe target blood glucose levels with the patient
Additionally, however, most patients will require medication for neuropathic pain and the endocrinologist / neurologist are the experts in this area.
My recommendations are to be advised by your personal endocrinologist and neurologist who are the experts in their field of medicine and are the best personal information and treatment resource for you. You cannot find better personalized information on the Internet However, there are some reliable Internet resources that provide GENERAL HEALTH INFORMATION and The American Diabetes Association at diabetes.org is one I recommend for people with diabetes.
Every patient with neuropathy resulting in numbness (anesthesia ) should be under the care of a podiatrist for routine foot care, such as trimming nails and calluses. The podiatrist will provide you with preventive education Daily self inspection of feet and recommended daily foot care is vital for healthy feet. The potential complications of not attending to this can be devastating. Diabetes.org has a section on foot care that I recommend reading in the meantime.
I trust you have an annual eye examination by an ophthalmologist?
Please share this general information with your physicians for review, and again, be advised by their expertise.
Good health to you,
