Stopping prediabetes and diabetes nerve damage takes more than watching blood sugar levels
The diabetes nerve damage that causes pain and numbness in the feet and legs, known as diabetic peripheral neuropathy, is an important topic at Nutrientology. If we can understand this often devastating complication of diabetes, we will go a long way toward not only alleviating the often devastating consequences of this condition, but I believe we will also develop a much better understanding of the nature of diabetes and prediabetes. It is this increased understanding that will help stop the epidemics of diabetes and prediabetes that are afflicting our country, and impacting the lives of so many people.
Doctors typically advise their type 2 diabetic and prediabetic patients to control their blood sugar as a means to try to reduce nerve damage symptoms. Often this is because we don’t have much else to offer these patients. I see patients all day that are on medication to try to alleviate the symptoms of diabetic nerve damage. Despite the fact that they apparently have good blood sugar levels, they are unable to get relief – There are pieces of this puzzle that we do not yet have.
It has been believed that the cause of this nerve damage is the same in type 1 diabetes (T1DM) and in type 2 diabetes (T2DM), but recent thinking on this subject – as a result of studies showing that good blood sugar control doesn’t have the impact in T2DM that it has in T1DM – is starting to promote different ideas as to what may be going on in the damaged nerves of patients with T2DM, as well as in prediabetics for that matter.
T1DM Neuropathy and T2DM Neuropathy are Different.
It appears that the degree of blood sugar control on nerve damage in people with type 2 diabetes is not a major factor in preventing nerve damage in this group. On the other hand, research is showing that in T1DM, glucose control can have a positive effect on neuropathy. In T2DM good blood sugar control seems to have only a small effect on the onset and symptoms of diabetic neuropathy.
T2DM is a disease of metabolism, and as opposed to T1DM, there is often high insulin production. The problem is that your muscle, fat and liver cells do not react to the insulin signal like they should, and your blood sugar level stays high. High levels of sugar in the blood act like a poison – I have posted about the formation of advanced glycation end products and the damage that they can do.
People often look at type 1 and type 2 diabetes in a very similar way, but they are not different versions of the same disease – I can’t help but wonder whether the paradigm used to treat type 2 diabetes is actually contributing to the diabetes epidemic…but I digress.
Recent trials suggest there are things other than good blood sugar control that are strongly influencing the development of diabetic neuropathy. As the readers of Nutrientology know all too well, T2DM is usually found alongside other medical conditions – obesity, high blood pressure and irregular levels of blood fats and cholesterol particles. It is this group of medical problems that make up the metabolic syndrome that is the primary focus of the Nutrientology blog.
There are several studies suggesting that there are factors other than blood sugar control involved in the development of neuropathy in patients with T2DM. The latest thinking is that it may very well be the other factors of metabolic syndrome that are also wreaking havoc on the nerves of people with diabetes, and pre-diabetes for that matter.
This may help explain why I see pre-diabetic patients presenting with early sign of nerve damage in their feet and legs even though they have not had blood sugar levels high enough to be officially diagnosed with diabetes and put on a diabetes medicine.
Nerves need insulin for proper health and development, but unlike your muscles, fat and liver, nerves do not depend on insulin to take sugar out of the blood for energy. A thesis has been put forth that nerves may be developing insulin resistance and, although this does not affect your nerves’ ability to take up sugar and make energy, the insulin resistance does negatively affect the ability of insulin to give its proper signal for proper nerve health. In other words, the nerve becomes resistant to the health effects of insulin, and therefore, becomes sick or damaged.
What Are The Nerves Telling Us?
Some podiatrist foot specialists will biopsy the nerves in the foot and ankle of diabetics with suspected nerve damage to determine if their patient has neuropathy. Researchers have also looked at sural nerve biopsies and found that people with neuropathy have nerves that work harder to manage blood fats and inflammation. The analysis to determine this is complex, and only for research purposes. But if we had a practical test to evaluate the nerves we take for biopsy, and then make treatment recommendations as a result, sural nerve biopsy in the clinical setting would become much more useful.
Some pioneering thinkers are starting to put forth different ideas to get the scientific and medical communities to think differently about T2DM and its complications, specifically diabetic neuropathy. They believe how your body handles blood fats and inflammation are major factors in the development of type 2 diabetes nerve damage.
These researchers have put together a paper presenting evidence,
That obesity, hypertension, dyslipidemia, inflammation and insulin resistance are contributory to T2DM diabetic polyneuropathy to an equal if not greater degree than hyperglycemia.
So, in patients with T1DM it appears that doctors can recommend good blood sugar control as a means to lessen the complication of diabetic neuropathy, but a good blood sugar level by itself is not enough in the case of T2DM nerve damage. Healthy levels of blood fats and reducing inflammation in your body are two important areas that also need to be corrected. If you have excess weight in your midsection, you need to reduce it. The fat in this area is not a benign storage depot of excess calories from food. It is actually very active in creating inflammation throughout your body. Inflammation – like elevated blood sugar and elevated blood pressure – is a silent killer.
Talk to your health care providers about lifestyle changes including proper food and movement to help improve your health and stop prediabetes before it develops into full-blown diabetes with its often devastating consequences.
Much of this post, including the quote above, was adapted from an article written by pioneering thinkers in this field. It is entitled: “Diabetic Neuropathy: One Disease or Two.” It was published in Current Opinion in Neurology 2012;25(5):536-541. The abstract can be found here.