Metformin Has Link to Neuropathy, B12 Deficiency

Called me puzzled! I have never understood why the American Diabetes Association had never called for testing of vitamin B12 deficiency for people taking metformin for any length of time. Even this article shows a lack of this testing and only calls for more research. This is why I am reversing the situation and listing what Diabetes-in-Control lists as practice pearls first.

Practice Pearls:

1. Metformin has been linked with vitamin B12 deficiency.
2. A randomized placebo-controlled trial showed that metformin use is associated with an increase in neuropathy scores for patients.
3. Current guidelines do not offer specific instructions on metformin and B12 deficiency, but future research is warranted.

Yes, one of the most common and beneficial T2DM drugs may contribute to neuropathy and vitamin deficiency – metformin.

The link between metformin and vitamin B12 lowering is well-known and mentioned in American Diabetes Association guidelines as a disadvantage of the drug. However, the ADA gives no recommendations for monitoring and prevention of vitamin B12 deficiency for patients taking metformin. Vitamin B12 deficiency is associated with adverse effects such as anemia, fatigue, mental status changes, and neuropathy. Given the prevalence of neuropathy in diabetic patients, metformin-induced vitamin B12 deficiency is clinically relevant.

The relationship between vitamin B12 deficiency and metformin was studied in a recent randomized placebo-controlled trial. The trial lasted 52 months and included 390 type 2 diabetes patients. They were treated with 850 mg metformin at doses up to three times a day or a placebo. Patients with baseline vitamin B12 deficiency or patients taking vitamin B12 supplements were excluded from the trial.

Metformin is prescribed around the world, so this relationship warrants more investigation according to the study authors. Future studies may clarify the relationship and will help the authors of guidelines decide whether to recommend testing or supplementation.

Our May Support Group Meeting

Our second meeting for the month of May was better than the first and we came away feeling much better. My nurse cousin, Beverly did the presentation about neuropathy and the various causes.

She started off with a few questions. She asked how many had neuropathy. When there were only a few hands, she asked everyone to please be honest as she would move on to another topic if so few of us had neuropathy. At that, Tim asked everyone to consider being honest. This topic was important and he said there was some new information that might be worth considering. Slowly people started raising a hand until at least those that we knew had neuropathy had their hand up.

Tim turned to Beverly and said that everyone that we knew had neuropathy did have his or her hand up. Finally, one more hand was raised. At that point, Allen asked if there was anyone else. He then said that some things were good to keep secret, but when it came to diabetes, Allen said this is not good and we saw what happened with foot problems. We had too many people just begging for amputations. Neuropathy can prevent people from feeling some injuries that can lead to amputations.

Beverly said she would stay on this topic, and she agreed Allen had the right idea and understanding neuropathy was important. She then started by saying we are learning more almost every day about this, but there is still a lot we don't know. She then said both of us have read the same articles and she was happy that I had blogged about it on May 16 and 17, and while it is needed, more testing should be done to determine how accurate the numbers were, the three drugs may only be the tip if the iceberg.

Beverly said I know what Allen went through as Bob has told me and a deficiency of vitamin B12 and Vitamin D were both severe and caused Allen to have two shots of each and to take supplements. Bob has told me he has always tested in range for both, but he is taking supplements. Beverly continued that even her husband Tom takes supplements and is tested two times a year to see what the results are. That is why this new study is important.

Next, Beverly asked how many had gastroesophageal reflux disease (GERD). The numbers were less and this was expected. So Beverly explained what GERD is and that an esophageal scope inserted down the throat into the stomach is used to make that determination. The scope has a light and viewing screen that allows the operator to view the tissue in the esophagus and stomach and take samples if needed. The surgeon is looking for inflammation and potential cancerous cells. Tim did put up the slides of the scope and its operation that she had provided and this drew a lot of discussion.

Then she ask Tim to start the slides on the medications that cause neuropathy by creating vitamin B12 deficiency. This brought up a lot of questions and discussion. She had Tim bring up the other slides from other blogs she had prepared. Because of the time, Tim said we would continue for a little time longer and then we would need to call a halt.

Barry asked what the other topic she would have covered. She said that would have been about colon cancer. This brought questions of the age to start checking. Beverly said this varies by family history and other factors. She said that often she sees the need for many women to start at age 45 and every one else at age 50. Some men also need to start at the age of 45. Siblings of people with colon cancer should possibly start earlier.

Beverly asked how many have had a colonoscopy. All but three hands went up. Her next question asked how many had diverticulitis or more properly pockets or small out pockets in their colon. Six hands were raised and as Tim presented the slide, three more were raised.

Beverly said in talking with Tim, she understood we normally do not have meetings in June through the end of August. Tim asked how many would like this meeting earlier. Every hand was raised. Tim asked how many would be able to attend if a meeting was held on June 6. All but two of the members were in favor. Next, he asked about May 30 and six did not raise their hand. When he asked about June 13, all hands were raised. Beverly said that would work for her and Tim said we will have a meeting on June 13. With that, Tim ended the meeting. It took another 30 minutes for everyone to leave, as there were a lot of questions.

Have Diabetes – Be Cautious of Electric Blankets

Yes, please be cautious! Why? If you have had diabetes for a few years or developed neuropathy before your diabetes diagnosis, you may have problems detecting if the blanket gets too hot. Burns can happen according to M. Regina Castro, MD at the Mayo Clinic.

Dr. Castro says, “Over time, excess blood sugar can injure the walls of the tiny blood vessels (capillaries) that nourish the nerves. This can cause tingling or numbness that usually begins at the tips of the toes or fingers and over a period of months or years gradually spreads upward. Left untreated, it's possible to lose all sense of feeling in the affected limbs.”

The above means you may not be able to sense if an electric blanket or heating pad is too hot. Burns can happen from these and can be very painful. Neuropathy can also make it difficult to tell if bath water is too hot.

If you do not have neuropathy, it is still good to be careful if you have diabetes as about 66 percent do have it. I like the suggestion Dr. Castro gives. She says use the electric blanket to warm up the bed before bedtime. Then turn the blanket off or remove it from the bed before you climb in.

Is Diabetes Progressive?

When I started thinking about blog topics, I had a few ideas that I have blogged about that I wanted to include. As I searched for the different blogs, more ideas flooded my memory. I will start and see where each topic takes me.

The topic for this blog: Is diabetes progressive?

I have received several emails on this topic, asking me how I know this, and to provide proof. The American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists generally ignore this and lay out what they think as being a progressive disease. See the blog by Tom Ross here and my blog here about their thoughts.

They do have some information under Diabetes Care section for preventing diabetes once you have prediabetes, and even some about preventing prediabetes. Read my blog here about one of them. One article can be found here and is on target for this.

Tom Ross is an honest to goodness example of someone that has prevented the progression of type 2 diabetes. By using his meal plans and his exercise program, he was able to avoid medications after diagnosis with the knowledge of his doctor. Yes, he still has type 2 diabetes and he will be the first to tell you this. He has been able to prevent the progression to the complications and like the title of his site, he is not medicated yet. Notice I said his plans and not someone else's plans. He tests to monitor his blood glucose and confirm what he is doing works for him.

Take time to explore and read his website. Take time to read his journey here. Then read this page. For an example of his analytical side read his first blog linked above. For an example of his wry humor read this blog. His blogs range from the hilarious on occasion and to the serious side. In his occupation as a technical writer, his blogs show a wide range which keeps me reading.

My younger brother had diabetes for approximately 35 years and managed it with a meal plan and exercise without medications. Finally, cancer and its treatments forced him on insulin until his death about three years later. Therefore, I know that it is possible to delay the progression of diabetes for decades.

Next, David Mendosa has struggled to lose weight and had peripheral neuropathy that he was not aware of until a doctor and his tuning fork told him he had it. He has been working to improve that condition. He was successful using Byetta to reduce his weight and uses his meal plan and exercise to manage his diabetes. He has succeeded in halting the progression of diabetes and he also blogs about his successes and occasionally a mistake he catches himself making. He writes about diabetes at Health Central and on his own site, especially about his exercise when he does photography.

I especially like his blog here when he quotes Dr. William Polonsky when Dr. Polonsky says, “What’s true is that poor management causes those problems (in talking about the diabetes complications). Well managed diabetes is the leading cause of NOTHING.” You may also enjoy reading David's blog here about the progression of diabetes and what the doctors think of it.

Now me, I have not been as fortunate. I was diagnosed late (probably about three or more years late) and was not even able to manage it with oral medications. Therefore, after about three months, my doctor and I had a good discussion, and I started on insulin. Since then I have been able to manage my diabetes, with the help of insulin. My neuropathy has gotten better although there is still a lot of improvement to obtain. My hearing loss may have some loss from diabetes, but most is attributable to my time in the military and the loud noises I was exposed to. Moving up in age is not helping either.

Basically, the onset of most complications is caused by the lack of diabetes management or poor diabetes management. I have seen this in a few other type 2 patients, but yet I am a member of a group of type 2 people with diabetes and they are managing diabetes extremely well.

What Is Diabetic Neuropathy? - Part 3

This is a quote from this article. “Although the metabolic causes of diabetic neuropathy are perfectly well understood and documented, treatments for this disorder are still limited.” This statement shows that researchers and scientists think they know it all, but studies are still surfacing that can prove them wrong. Some medical researchers are becoming too smug and making statements they should not be making.

Then we have this article that says, “Nearly half of all diabetics suffer from neuropathic pain, an intractable, agonizing and still mysterious companion of the disease. Now Yale researchers have identified an unexpected source of the pain and a potential target to alleviate it.” This is very contrasting. Maybe metabolic causes are understood and it is the neuropathic pain that is the mysterious companion. Regardless, statements like these stand out like the sores they are and create doubts as to whether scientists really understand.

Another quote from the same article even tends to make decisions even more difficult to understand, “How diabetes leads to neuropathic pain is still a mystery,” said Andrew Tan, an associate research scientist in neurology at the Yale School of Medicine and lead author of the study. "An interesting line of study is based on the idea that neuropathic pain is due to faulty 'rewiring' of pain circuitry. With a growing number of diabetics, the condition represents a huge unmet medical need. Once neuropathic pain is established, it is a lifelong condition.”

As much as I detest these statements, we need to realize that authors of studies are attempting to have their research noticed and stand out among all the reports issued on a daily basis. I do not agree that this should be totally necessary and some statements are not that believable as it is, because too many readers of medical science reports have a jaded view caused by statements that are not quite believable.

The study reported by Gretchen Becker in her blog on Health Central covers a potential target for reduction or prevention of the pain caused by diabetic neuropathy and the report can be read here. Yes, this is the second mention, but well worth reading.

Neuropathic pain, whether caused by diabetes or other causes, is still painful and sometimes debilitating, reducing the quality of life for those suffering from it. Since I am one of those people who was diagnosed with neuropathy approximately 10 years prior to the diagnosis of diabetes, it has been a long 19 years with the pain in my feet.

I am glad to see that research is finally beginning to make some progress into the cause and potential treatment for those suffering from neuropathy. I have a tendency to read past the sensationalism promoted the study reports, but at times, I want to scream at what I know to be irresponsible statements.

Final of three parts.

Neuropathy Causes

Just because you have diabetes, does not mean that you will develop neuropathy. And, if you have peripheral neuropathy does not mean you have diabetes. Yet time and time again, these are touted as being facts and even medical guidelines want us to believe this. Experts want us to believe this and my blog here shows where this is headed by the types of tests they want done if they think someone has neuropathy.

To this I say B.S.. I have been searching the web for more explanations and I have now found two articles that I believe give more meaning to neuropathy, causes, and treatments. I will refer you to my blog here, where I discuss the types of neuropathy. I also have four more blogs on different parts of neuropathy in the days following the first blog. I will have three more blogs on diabetic neuropathy following this one.

Now to discuss the causes of neuropathy. Although not mentioned specifically, smoking is a risk factor for peripheral neuropathy. Why so few sources do not mention this is unknown; however, most do advise stopping smoking as a treatment because of the damage it can do to the nerves. About 30 percent of neuropathy is idiopathic, meaning they are of unknown causes and about 30 percent of neuropathy is due to diabetes. The remaining cases of neuropathy are called acquired neuropathies and have the following possible causes:

Trauma or pressure on nerves, often from a cast or crutch or repetitive motion such as typing on a keyboard.

Nutritional problems and vitamin deficiencies, often from a lack of B vitamins. 

Alcoholism, often through poor dietary habits and vitamin deficiencies,

Autoimmune diseases, such as lupus, rheumatoid arthritis, and Guillain-Barre syndrome,

Tumors, which often press up against nerves,

Other diseases and infections, such as kidney disease, liver disease, Lyme disease, HIV/AIDS, or an underactive thyroid (hypothyroidism),

Inherited disorders (hereditary neuropathies), such as Charcot-Marie-Tooth disease and amyloid polyneuropathy,

Poison exposure, from toxins such as heavy metals, and certain medications and cancer treatments,

And metabolic disorders.

While this list may not be totally inclusive, it does account for about 40 percent of neuropathy cases. So if you have neuropathy, there are many possibilities to choose from and diabetes may not be the culprit. If you have diabetes and do not have neuropathy, keep it this way with tight management of your diabetes.

I would also point out that often people with diabetes can have the second item of vitamin deficiencies mentioned earlier and this can lead to neuropathy, especially deficiencies of Vitamin B1 and B12. I have urged people before to have these tests done to have a baseline for reference as soon as a diagnosis of type 2 diabetes is made. This in turn will aid your doctors in proper diagnosis of neuropathy if it develops later. If your vitamin B's are okay then the neuropathy may be caused by your diabetes. Conversely, if you are deficient in Vitamin B1 or B12, maybe you neuropathy is not diabetes caused. Many physicians will not do the tests, but will declare diabetes as the cause of the neuropathy.

I feel that this article and this one are good reading for education about neuropathy. At least then you will have a good understanding of the types and causes of neuropathy. You will know when someone says they have diabetic neuropathy, they may or may not be correct in their assumptions unless they have had the tests and know that it is diabetes caused. I had my neuropathy about 10 years before my diagnosis of diabetes and at the time my neurologist said it was caused by smoking. Right? Probably, but there may have been other reasons behind it.

Mayo Clinic Study – Prediabetes Does Not Mean Neuropathy

Every once in a while we all need to rethink what we have learned or come to expect. So it is with prediabetes and neuropathy. A recent study conducted by Mayo Clinic researchers states that people with prediabetes are no more likely to have nerve damage termed small fiber polyneuropathy than people in good health. The point being made is that this goes against two decades of medical reports. This is interesting!

According to the lead author, "It is highly unlikely that impaired glucose or associated metabolic derangements cause polyneuropathy, at least not to the high frequency previously reported."

Diabetic Neuropathy – Part 5

In the last blog, alternative treatments for diabetic neuropathy were mentioned. Now it is time to discuss the alternative treatments as some are quite effective, but again it is worth pointing out that not everything will work for everyone.

Capsaicin is the chemical that gives hot peppers their bite. When applied to the skin, capsaicin creams can reduce pain sensations in some people. Side effects may include a burning feeling and skin irritation. Alpha-lipoic acid (ALA) is one of the most interesting developments in pain research is the discovery that alpha-lipoic acid, a powerful antioxidant found in food, may be effective at relieving the symptoms of peripheral neuropathy.

Your doctor may prescribe transcutaneous electrical nerve stimulation (TENS) therapy, which can help prevent pain signals from reaching your brain. TENS delivers tiny electrical impulses to specific nerve pathways through small electrodes placed on your skin. Although safe and painless, TENS does not work for everyone or for all types of pain. TENS may be prescribed in addition to other treatments.

Acupuncture may help relieve the pain of neuropathy, and generally does not have any side effects. Keep in mind that you may not get immediate relief with acupuncture and will likely require more than one session. Biofeedback therapy uses a special machine to teach you how to control certain body responses that reduce pain. You then learn how to control these same responses yourself. Biofeedback techniques are often taught in medical centers and hospitals.

The above are all worth investigating and may be of value for you. You may need to use a combination or use in combination with prescription medications. If one treatment does not work in a reasonable time, try another treatment.

The best way to control diabetic neuropathy, and what it does, is to keep your blood glucose tightly managed, taking good care of your feet, and maintaining a healthy lifestyle. Yes, maintaining tight management of your diabetes requires a big commitment on your part, but the rewards are worth it. Whether you are on oral medications or insulin, by watching the foods you eat and monitoring your blood glucose levels is the only way to help avoid or prevent neuropathy and other complications of diabetes.

I would like to remind everyone to reread part one of this series about the four main types of neuropathy. This is because peripheral neuropathy is the most common form, but also because it is the most talked about. Foot care of foot problems is so important I want everyone to know how important this is. I do not wish to seen people needing an amputation because they did not take care of their feet.

First, have a comprehensive foot examination at least a minimum of once a year and more often if possible. Check your feet daily. No, do not just take a glance at them, but really look and examine them. If you are unable the bottoms of your feet, use a mirror or ask a family member or even a friend to examine your feet for blisters, cuts, bruises, cracked and peeling skin, redness and swelling.

Please wash your feet everyday with lukewarm water and mild soap. If you cannot tell the temperature of the water with your feet, use a dampened washcloth and touch it to an area of your body that is still sensitive to temperature. Wash thoroughly and rinse before drying. Be careful when drying as rubbing too vigorously can damage your skin. Dry between your toes and if necessary moisturize your skin liberally, but it is not good to put the lotion between your toes. This applies especially to men to avoid fungal growth.

Trim your toenails regularly and carefully to avoid cutting into the skin. Use a toenail clipper and with an emery board round off the corners not filing into the skin. If you are unable to reach your feet, ask a family member to assist or schedule a regular appointment with your podiatrist to get this done.

Wear clean and dry sock and preferably ones that have a cushion on the bottom to assist in keeping the moisture away from your feet. Avoid socks that are too tight or have a tight elastic at the top or thick seams. You will only harm your feet with this type of sock.

The last, and I want to emphasize this, is to wear shoes that fit your feet properly, are cushioned and comfortable. A podiatrist can be very helpful in teaching you how to buy properly fitting shoes that will help in preventing problems such as corns and calluses. Never buy new shoes in the morning. Wait until later in the afternoon when your feet are more swollen to ensure the shoes are not too tight. Shoes that fit well can be costly. If you are on Medicare, your plan may cover one pair of shoes per year. Your doctor and possibly your diabetes educator may be able to help you. Never buy shoes that pinch your toes or that do not support your feet. Just because it may be the latest fashion, does not mean they are for you.

Please read these articles for additional information, article 1 and article 2.  Part 5 of 5.

Diabetic Neuropathy – Part 4

In case you are not aware of this, diabetic neuropathy has no known cure. Treatment focuses on slowing the progression of the disease, relieving the pain, and managing the complications.

As you should know, management of your blood glucose readings is important. Maintaining these in a narrow range is the best solution for slowing the progression of neuropathy. I will give you the American Diabetes Association's (ADA's) recommendations, which I think are too lax.

They claim this is intense management.

Time                                                           ADA                       Rest of the World

Blood glucose level before meals               70 to 130 mg/dl          3.9 to 7.2 mmol/L

Blood glucose level two hours after meals  less than 180 mg/dl    10 mmol/L

after meals

Hemoglobin A1c less than                          7 percent

People that do not have diabetes generally maintain an A1c between 4 and 6 percent. To help slow nerve damage be sure to follow the recommendations of your doctor for good foot care and keep your blood pressure where it should be. Also, follow a healthy food plan, get plenty of exercise, if needed, get to a healthy weight, and avoid smoking and alcohol.

How do you effectively get pain relief from diabetic neuropathy? There are several medications that are used to relieve nerve pain, but they do not work for everyone. They also have to be weighed against the side effects and balanced to the benefits offered. This is the most difficult part of finding what works for you most efficiently and may require some trial and error.

Some of the prescription medications that may be prescribed include the following: anti-seizure medications, antidepressants, lidocaine patch, and opioids. You may read about them here. There are a few alternative therapies, such as capsaicin cream and acupuncture that may help with pain relief. Doctors do use them with prescribed medications, but some can be effective on their own.

Other neuropathy complications can have specific treatments for restoring functions. Urinary tract problems for both men and women have specific treatments and can have a combination of therapies that can be the most effective. Digestive problems can be treated and gastroparesis, diarrhea, constipation, and nausea may be helped with dietary changes and medications.

Low blood pressure on standing can often be helped with lifestyle measures. Medications can also be used alone in combination to treat orthostatic hypertension. There are many alternative medications and devices to help men with erectile dysfunction and women may get help with vaginal lubricants.

There are also lifestyle and home remedies that may help reduce the risk of diabetic neuropathy. First, people with diabetes generally have high blood pressure and with diabetes can greatly increase your risk of complications. It is important to maintain your blood pressure in the range that your doctor recommends. Read the advice of the Mayo Clinic here.

Second, regardless of whether you think your current food choices are healthy, many people find out once they have diabetes that the foods are not as healthy as thought. Make sure that you attempt to eat a balanced diet. Third, if possible, achieve a healthy weight and stay as active as your condition permits. Select an activity that you enjoy and can continue. If possible, try to do at least 30 minutes per day five days per week or 15 minutes seven days per week. Fourth, if you smoke, realize that with diabetes you are more likely to suffer a heart attack or stroke. Find ways to stop smoking as this increases your chances of neuropathy.

Finally, do all you are able to tightly manage your diabetes. This will help prevent or delay complications for many years.  Part 4 of 5.

Diabetic Neuropathy – Part 3

Seeing a doctor is very difficult for many people. They do not like to admit something is wrong that they cannot handle. Others just will not see a doctor until they have to. Neuropathy is not something to take lightly and does need to be seen by a doctor. It is better to see a doctor sooner than later with neuropathy. I hate to say this, but if you can manage your diabetes, neuropathy may be managed as well. Neuropathy is still possible whether we like it or not.

If you have a cut or sore on your foot or lower legs that does not seem to be healing, is infected or is getting worse, seek medical care. If you have a burning sensation, a tingling, weakness, or pain in your hands or feet that bothers you doing your daily tasks, be sure to see a doctor. If you have dizziness, or changes in your digestion, urination, or sexual function, seek medical care quickly.

These symptoms do not always mean nerve damage, as they may indicate other problems needing medical care. Regardless of the symptoms, record them and get an appointment with your doctor, as this is your best opportunity to prevent more serious complications. If fact, any problems with your feet should be seen by a doctor. This is the best method to prevent any problems from becoming severe enough to cause amputation.

Anyone can develop neuropathy, but people with diabetes are more susceptible if they have these risk factors. Number one is poor blood glucose management as this is the greatest risk factor for every complication of diabetes. Keeping your blood glucose levels consistently within goals is the best way to protect the health of your nerves and blood vessels.

Another factor is just the length of time you have had diabetes. This is especially true if your blood glucose levels are poorly managed. Peripheral neuropathy is most common in people who have had diabetes for 25 years. Others who are successful in their management of their diabetes may never develop peripheral neuropathy.

Kidney disease is another factor that can be caused by poor management of diabetes and can increase the toxin in your blood and contribute to nerve damage. Finally, smoking causes your arteries to narrow and harden, reducing the blood flow to your legs and feet. This makes it more difficult for cuts and wounds to heal.

People with type 2 diabetes should prepare for their appointments by being prepared. Your preparation will depend on the doctor you are seeing. Unless your doctor is very knowledgeable about diabetes, expect to be referred to an endocrinologist as they specialize in treating metabolic disorders, such as diabetes. You may also be referred to a doctor who specializes in treating the nervous system (neurologist). Here are some tips to help make the best use of the time you have to spend with the doctor.

When you make the appointment, be sure to ask about special preparations necessary, such as fasting or diet restrictions. Next write down any symptoms you are experiencing. Be sure to include any symptoms even if they seem unrelated to the reason for seeing this doctor. Make a list of all (this is important) medications you are taking and include all vitamins and supplements you are taking. While this may seem unimportant, record any major stresses or recent life changes that have happen, such as illnesses, family deaths, major accidents, etc.. Depending on what you can find out, it may be wise to take your blood glucose meter with you as well as your daily log of blood glucose readings.

If possible, ask a family member or a friend to come with you. Instruct them to record potential important information to assist you in remembering everything all the information you will receive during the appointment. Also write down the questions for your doctor. List the most important one first in case time expires before all are asked. Some doctors will accept a list of questions and send a follow-up letter with answers, but this is not to be expected.

If you cannot get a referral to a neurologist, check with your medical insurance company to see what they will allow or suggest. Some will offer a list of two or three that are in proximity to you. A neurologist will give you an examination to check your muscle strength and tone, tendon reflexes, and sensitivity to touch, temperature and vibration.

Other tests may include a filament test using a monofilament and electromyography (EMG) which measures the electrical discharges produced in your muscles. Other tests may be a quantitative sensory testing to assess how your nerves respond to vibration and temperature changes and a nerve conduction studies that measures how quickly the nerves in your arms and legs conduct electrical signals. Finally autonomic testing may be done if you have symptoms of autonomic neuropathy to determine your blood pressure in different positions and assess your ability to sweat.

The American Diabetes Association recommends all people with diabetes have a comprehensive foot exam, either by a doctor or by a foot specialist (podiatrist), at least once a year. In addition, your feet should be checked for sores, cracked skin, calluses, blisters, and bone and joint abnormalities at every office visit. If you already have diabetic neuropathy, you will likely be referred to a podiatrist or other specialist for monitoring and treatment.

The next blog will be on treatment. Part 3 of 5.

Diabetic Neuropathy – Part 2

Knowing how to manage your diabetes helps prevent many of the complications of neuropathy. In other words, know how to tightly manage your blood glucose levels. It is also important to know when to see your doctor when there are signs and symptoms of neuropathy as discussed in my previous blog.

The signs and symptoms may not always indicate neuropathy damage; however, they may be an indication of other problems that require medical care. This is where many people make a mistake of thinking – oh this is really nothing and do not seek the medical advice they should have sought. Then it can be too late and damage can be done that can cause more serious problems.

Read the article here for more detail and follow the advice to prevent more severe problems. The damage to nerves and blood vessels can be caused by several variables, and chief among them for those of us with diabetes is prolonged exposure to high blood glucose levels. High blood glucose can damage delicate nerve fibers, causing diabetic neuropathy.

While the exact reasons are not fully understood, a combination of variables are likely involved. High blood glucose interferes with the nerve communications and it weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients. Other variables that may contribute as well include inflammation in the nerves, genetic factors, and smoking and alcohol abuse.

If you have diabetes, you can develop neuropathy and there are variables that make you more likely to have nerve damage. Topping the list is poor blood glucose management followed by the length of time a person has had diabetes, but do not forget that people with type 2 diabetes sometimes develop peripheral neuropathy before diagnosis. Kidney disease and smoking are also risk factors for neuropathy.

The complications of diabetic neuropathy include loss of a limb, charcot joint, urinary tract infections and urinary incontinence. Low blood pressure can be caused by neuropathy, as can digestive problems. When you feel faint or dizzy when coming to a standing position can be the result of low blood pressure and should be looked after by a doctor. Digestive problems can cause what seems a myriad of problems, from constipation to diarrhea and nausea, vomiting, bloating, and loss of appetite.

Autonomic neuropathy often damages the nerves that affect the sex organs in men and women. This leads to erectile dysfunction in men and problems with lubrication and arousal in women. Neuropathy can also cause the sweat glands to not function properly so your body is not able to regulate body temperature properly. This can be life threatening. Even worse, for the elderly, neuropathy caused pain, disability, and embarrassment – robbing them of their independence, leaving them increasingly isolated and depressed.

More serious is hypoglycemia unawareness. Normally when your blood glucose level drops below 70 milligrams per deciliter (mg/dl) or 3.9 millimoles per liter (mmol/L) you develop symptoms like shakiness, sweating, and an increase in heart rate. These alert you to the problem so that you can take steps to raise your blood glucose quickly. Autonomic neuropathy may interfere with your ability to have these symptoms. This is extremely dangerous as hypoglycemia can be fatal.

Next blog is about seeing your doctor. Part 2 of 5.