Diabetic Neuropathy May Be Caused By Low Vitamin D

Diabetic peripheral neuropathy (DPN) is a type of diabetic neuropathy that occurs in the arms and legs, and can result in symptoms such as numbness, tingling, burning, sensitivity to touch, and loss of balance. Now, in a new meta-analysis, researchers out of China have found that vitamin D deficiency may contribute to diabetic peripheral neuropathy.

Researchers have yet to determine the cause of DPN. However, it is thought that oxidative stress from hyperglycemia and inflammation plays a role. Studies looking specifically at vitamin D and DPN are scarce. Because vitamin D has been shown to help maintain beta cell function and reduce inflammation, some researchers speculate that low levels of vitamin D may be a risk factor for DPN.

In late 2014, a research team from China analyzed all available research on vitamin D and DPN to determine if vitamin D is related to risk of DPN in patients with diabetes.

They searched the available literature for studies that looked at vitamin D levels and DPN in type 2 diabetes or compared vitamin D levels in DPN patients to those without DPN. Six observational studies equaling a total of 1,484 patients with type 2 diabetes were included in the analysis.

Did a combined analysis of these studies reveal a relationship between vitamin D and DPN? The researchers found:

• Compared to those without DPN, patients with DPN had a significantly lower average vitamin D level of 7.69 ng/ml.
• After looking at the studies that adjusted for confounding variables, patients with a vitamin D level lower than 20 ng/ml had a 2.68 times increased risk for DPN compared to those with a higher level.

The researchers stated,

“In conclusion, this meta-analysis suggests that vitamin D is involved in the development of DPN in type 2 diabetic patients, and vitamin D deficiency is very likely to be associated with increased risk of DPN.”

They went on to add,

“The identification of the associations of DPN with modifiable risk factors can provide us some implications for the development of new therapies for DPN. Since vitamin D deficiency is a modifiable risk factor for DPN, vitamin D supplements may be an effective treatment for type 2 diabetics with DPN and vitamin D deficiency.”

The researchers note that the small number of studies and study population may limit their results. They also acknowledge that the inclusion of cross-sectional and case-control studies limits their analysis, whereas the inclusion of prospective studies could improve understanding of vitamin D’s role in DPN. Presently there are no published trials looking at vitamin D supplementation and DPN.

While systematic reviews and meta-analyses come with a few notable flaws, such as study differences, this research provides a comprehensive first-look at vitamin D’s role in DPN. At least, the release says prospective studies should be conducted next, and followed by clinical trials, before firm conclusions can be made.

I would appreciate you reading my blog from May 16 for other information on causes of neuropathy. With the many causes of neuropathy, those of us with neuropathy should be aware of the tests and medications that may help us or harm us.

What Is Diabetic Neuropathy? - Part 2

Today, there is no cure for diabetic neuropathy. Optimistically I feel that medicine is closer than before. There is a host of treatments available and some may assist you in reducing the effects of diabetic neuropathy, while others may not help at all. The most effective treatment is maintaining blood glucose levels at or near normal. This seems to be impossible for about 50 percent of people with diabetes, as they will develop diabetic neuropathy.

With the studies still finding other causes, I am a little cautious about the statement that the metabolic causes of diabetic neuropathy are perfectly understood and documented. Treatments are yet still in the infancy state, but several are on the way. First, I will discuss some of the aids to help in reducing the pain and controlling some of the symptoms. Unless people start realizing that they need to manage blood glucose levels, diabetic neuropathy will, like diabetes, continue to get progressively worse.

The blog here by Gretchen Becker also explains part of the reason I am cautious about people understanding everything about diabetic neuropathy. We may be closer, but there is more that we may learn.

There are a few drug-related options as well as physical therapy for controlling pain caused by diabetic neuropathy.

Drug Options:

• Antiepileptic Drugs: these are becoming a common drug for painful diabetic neuropathy. It has important side effects like sedation and weight gain.
• Classic Analgesics: for those with a debilitating chronic pain condition, these drugs can offer immediate relief.
• Trycilic Antidepressants: Very effective in decreasing pain but since the doses must be high for them to be effective the individual can become addicted t the dosage. Cardiac arrests are common when ingesting these drugs.
• Serotonin-Norepinephrine Inhibitors: these are commonly used to target painful symptoms of diabetic neuropathy. They may also help depressive patients.

Physical therapy is the next area for investigation. With medications, physical therapy can help relieve pain and should be used to avoid drug dependency. Certain physical therapies can help alleviate pain, burning, and tingling sensations in legs, feet. Physical therapy may also help patients with muscle cramps, muscle weakness, and even sexual dysfunction.

Then there is electrical nerve stimulation, which is painless (although I can't attest to this), may help those suffering from stiffness. Electrical nerve stimulation may also help foot ulcers heal.

Regular massages or manual therapy involving stretching of the muscles performed by qualified chiropractors or massage therapists will inhibit muscle contractions, spasms, and atrophy due to poor blood supply. Muscle strengthening with specific exercises, such as swimming or even some aerobic exercises will help maintain muscle strength and reduce muscle mass reduction.

A good physical therapist will make sure that exercises for patients with diabetic neuropathy do not hurt their feet, which are usually sensitive. Therapeutic ultrasound is a method of stimulating the tissue beneath the skin's surface using very high frequency sound waves, can help some patients regain sensitivity in their feet. The latter did not work for me, but did for another patient and he had few problems for several years.

Events are unfolding in the world of neuropathy and neuropathic pain. I have two articles of which this is one and holds promise for those of us suffering from neuropathic pain. This medication, which will not be on the US market for several years, will help with neuropathic pain and epileptic seizures. It has been developed in Israel so it will be necessary to have it on the market there before FDA gets it hands on it. This should hold out hope for anyone suffering neuropathic pain.

The second article is about a food product available now by prescription. It is to relieve the numbness caused by neuropathy and restore much of the sensations deadened by neuropathy. This product is not a cure, but a needed bandage for neuropathy and the lack of feeling in your feet and hands. There are some questions that still need answering, as this could be the closest we have come to having a product that will reverse the effects of neuropathy. Read an article about it in the above link, or go directly to their website and read about it. Use the site for contact with representatives if you find a doctor that will prescribe the medication.

The complications of diabetic neuropathy can sneak up very quietly and sometimes be very devastating. So be very careful if you have or are treating diabetic neuropathy. If you lose sensation in your feet, the risk of infections can grow very rapidly if you do not check you feet daily. If you are not able to see the bottoms of your feet, have another family member check them for you, or if this is not possible, get yourself a mirror on a pole that can be used for this task. Get to a doctor if you have a cut that is not healing or a bruise that is not getting better.

Bladder and kidney infections need immediate attention and should be seen by a doctor as soon as possible. Frequent nausea and vomiting can result in poor blood glucose management thereby make the neuropathy worse and you should also see a doctor. The last item is muscle damage or decrease that needs attention by a doctor. Do not let these complications of diabetic neuropathy get the advantage of you, but see a doctor and let the doctor make the decision about what needs to be done.

Next blog is the final of three parts.

What Is Diabetic Neuropathy? - Part 1

Apparently there is more added to diabetic neuropathy recently, and there has been some new classifications added or revised. This article dated May 11, 2012 has some terms I have not encountered recently. Therefore, I think this could be very enlightening for others and especially members of our informal group.

Diabetic neuropathy refers only to people with any type of diabetes. Reading the first sentence only can be misleading. Therefore, I am quoting the conditions and definitions for clarity and accuracy.

“Different nerves are affected in varying ways. Relatively familiar conditions, which may be associated with diabetic neuropathy, include:

• Third Nerve Palsy: When the individual cannot move his eye normally due to damage of a cranial nerve.
• Mononeuropathy: When only a single nerve is affected - the nerve is physically compressed, resulting in a lack of blood supply.
• Amythrophy: Muscle pain due to progressive waste and weakening of muscle tissues.
• Mononeuropathy multiplex: Profound aching soreness regularly felt in the lower back, hips or legs, resulting in sharp loss of sensory function of the nerves. This can slowly develop over a number of years.
• Polyneuropathy: Most commonly, this disorder results in weaker hands and feet, as well as some loss of sensation in the affected areas. Some patients complain of a burning needles-like pain. This disorder occurs when many nerves throughout the body simultaneously malfunction. The patient might step on something that should hurt, but feel nothing. It can appear either without warning or steadily over a long period.
• Autonomic neuropathy: The visceral nerve is affected, which may impact on the heart rate, digestion, respiration, salivation, perspiration, blood vessels, and sexual arousal. This occurs when there is a failure from the heart arteries to adjust heart rate and vascular tone to keep blood flowing continually to the brain. Dizziness or fainting when standing up rapidly is common.
• Sensory motor neuropathy: When sensory nerve loss affects the face; in some cases it may spread to the upper arms.”

Read my blog here for comparison of terms and notice the increase in terms used in this article. I am not sure if some of these were extracted from some of the prior used terms or are new definitions that needed to be explained. Terminology has increased from four to seven.

Recent studies have found that approximately 50 percent of people with diabetes develop diabetic neuropathy. The disturbing part of this is the signs (diagnosed by a doctor) and symptoms (felt by the patient and needs to be told to a doctor) tend not to be experienced for 10 to 20 years after diabetes diagnosis. Even more frustrating is that the majority of individuals with neuropathy symptoms do not realize what is happening until the complications are severe or possibly permanent.

Because of their importance, again I will quote from the article, “Some of the signs and symptoms associated with diabetic neuropathy:

• Numbness, electric pain, tingling and (or) burning sensations starting in the extremities and continuing up the legs or arms
• Heartburn and bloating
• Nausea, constipation or diarrhea
• Problems swallowing
• Feeling full when eating small amounts of food
• Throwing up after a few hours of having eaten
• Orthostatic Hypotension (feeling light-headed and dizzy when standing up)
• Faster heart rate than normal
• Chest pains, which sometimes can be a warning of an impending heart attack
• Sweating excessively even when temperature is cool or the individual is at rest
• Bladder problems - difficulty in emptying the bladder completely when going to the toilet, leading to incontinence
• Sexual dysfunction in men
• Sexual problems in women with vaginal dryness and lack of orgasms
• Dysesthesia - the patient's sense of touch is distorted
• Significant facial and eyelid drooping
• Eyesight may be affected
• Muscle weakness
• Speech impairment
• Muscle contractions"

How is diabetic neuropathy diagnosed? This is where a patient needs to communicate with the doctor when some of the symptoms (more than one) of the above are noticed. The doctor should do or recommend some diagnostic tests before making a definitive diagnosis. The doctor should also ask some very specific questions and the patient needs to answer them honestly.

If your doctor orders an MRI, you should question the validity for doing this as it is not the tool for definitive diagnosis as discussed in my blog here. The doctor may order an electromyogram (EMG). This records the electrical activity in the muscles. The doctor may also request a Nerve Conduction Velocity test (NCV). This test records the speed at which induced signals pass through the nerves. Both are excellent definitive tests and less expensive than an MRI.

During the physical examination, the doctor will check your ankle reflexes, for loss of sensation in your feet, changes in skin texture and color, and for a sudden drop in blood pressure when you stand up from the prone position. The doctor may also use the filament test and the vibration test to check for loss of sensation.

Next blog will cover treatments and complications.