Diabetic Nerve Pain and What You Can Do About It

One of the saddest statistics about diabetes is that, at the time of their diagnosis, fully 48% of those newly diagnosed with diabetes already have signs of diabetic nerve damage.

You can see this documented in this table where "impaired foot sensitivity" is a diagnostic sign of neuropathy:

Prevalence of microvascular complications at the time of diagnosis in diabetic patients identified by screening and in general practice

which is taken from this study:

Microvascular Complications at Time of Diagnosis of Type 2 Diabetes Are Similar Among Diabetic Patients Detected by Targeted Screening and Patients Newly Diagnosed in General Practice: The Hoorn Screening Study

It is known from studies of people with Type 1 diabetes that it takes a decade of exposure to elevated blood sugars to produce neuropathy. But high blood sugars creep up on people with Type 2 diabetes, and it turns out that even blood sugars in the "prediabetic" range can cause it.

You can read more about the research that documents the relationship of high post-meal blood sugars to neuropathy HERE.

Doctors miss the early diagnosis of Type 2 diabetes in these people because they rely on the fasting glucose test, or perhaps the A1c test, to screen for diabetes.

Unfortunately, neurologists who have researched the topic have found that the incidence of neuropathy correlates entirely to rising post-meal blood sugars, not fasting glucose or A1c. As soon as post-meal blood sugars (or GTT blood sugars) go over 140 mg/dl (7.7 mmol/L) the incidence of neuropathy starts to rise. It starts with small nerve fibers and with extended exposure to high blood sugars, extends to the thicker fibers.

But even after they diagnose people with Type 2 diabetes, the treatment that doctors give their patients ensures that even those who did not have neuropathy at diagnosis will develop it over time, because most doctors who are not specialists follow the treatment guidelines provided by the American Diabetes Association (ADA). These guidelines focus entirely mainly on lowering A1c using oral drugs and when they mention post-meal blood sugars at all--which is not often, they recommend post meal blood sugar levels that are way over the blood sugar level where science has found neuropathy begins.

Symptoms of Neuropathy

Neuropathy starts out with pain and tingling in your feet. It usually is present in both feet, which can help you distinguish it from similar foot pain that can be caused by compressed nerves due to bad vertebral discs or piriformis syndrome which is likely to be present on only one side of your body.

The damage to your nerves is being caused by glucose blocking up the tiny capillaries that feed your nerves so that they do not receive the nourishment they need and start to die. Though you feel the pain in your sensory nerves, neuropathy also affects your autonomic nervous system--the nerves that control involuntary functions like heart beat and sexual response. It also turns out that the autonomic nervous system, through the vagus nerve, controls your immune system. So when your nerves are dying your immune system may not get the message that invaders have attacked your feet, which is part of what leads to the devastating infections that lead to diabetic amputations.

Treatment for Neuropathy

If you go to your doctor complaining about tingling or numbness in your feet, you are likely to be given a prescription for an expensive drug like Lyrica or Topomax. These drugs do not have any effect on the progress of your neuropathy. Instead, what they do is disrupt the pain signals being sent to your brain so that you don't feel them. They have also been linked to suicidal thinking and actions and the FDA just today published new guidelines warning of this devastating side effect in people taking these drugs.

But while you take these drugs, even though you might feel better, the nerve damage continues. Eventually your nerve pain goes away to be replaced by numbness, which is easier to live with but much worse for your health. Once your feet are numb, infection can easily take root and since your immune system is weakened, it can lead to tissue death requiring amputation.

This is very scary especially for those of you who have seen relatives lose their limbs. But the good news is that you can reverse neuropathy by lowering your post meal blood sugars.

Doctors may not tell you this because after years of urging their patients to shoot for the dangerously high ADA blood sugar targets, they have observed most of their patients develop neuropathy. This convinces them that "tight control" (as defined by the ADA) cannot prevent neuropathy. Since they assume that all people with diabetes will eventually develop it, they give you your pain pills and shoo you out of the office.

Effective Treatment for Neuropathy

Everything changes when you define "tight control" to mean "Maintaining post-meal blood sugars below the level where neuropathy begins." That level turns out to be 140 mg/dl (7.7 mmol/L). Lower your blood sugar to this level, meal after meal, and your nerves sill start to heal.

This is a good 40 mg/dl lower than the dangerously high 180 mg/dl two hours after eating which the ADA officially defines as "tight control." And when you bring your blood sugars down below 140 mg/dl and keep them there for a few months, your feet will get better.

In fact, people who have done this have reported on web discussion groups that once they get into truly good control, they can tell when their blood sugar has gone over 140 mg/dl because their feet begin to hurt. If they bring it back down, the pain stops.

If you have been living with much higher blood sugars for a while and have neuropathy that has progressed to numbness, there is one bump in the road you should be aware of. If your nerves are so damaged that they have become numb, when you start to heal them, they may hurt.

Regenerating nerves always hurt, itch or tingle. This is true whether they are regenerating from glucose poisoning or mechanical damage. If your feet start to hurt after you have lowered your blood sugar, remind yourself that this is good not bad.

It is a sign that your nerves are healing and that, even more importantly, your immune system is learning that you have feet again and will get back on the job of fighting off invaders.

If you think it is impossible to get your post-meal blood sugar down below 140 mg/dl after eating, be assured it is not. Thousands of people with diabetes--both Type 2 and Type 1--who are active on online discussion groups are doing it.

The secret is to follow a strategy like the one described here:

How to Get Your Blood Sugar Under Control

If you are taking insulin or a sulfonylurea drug like Amaryl that can cause hypos, you will have to work slowly and carefully cut back on your doses of medication as your blood sugars come down to avoid hypos. Talk to your doctor or diabetic educator about how to do this if you don't already know how.

No matter how bad your blood sugars might be now, there is some combination of dietary change, oral medication, or insulin, properly prescribed, that will bring your post-meal blood sugars down to the safe zone.

If your doctor or educator is not supportive of your desire to achieve truly safe blood sugars targets, and does not respond with enthusiasm to your desire to lower your post meal blood sugars to the safe range, find a new one who is better trained and more up-to-date, who will.

The take-away lesson here is this: It is post meal blood sugars that cause neuropathy. People can get identical A1cs with very different post meal blood sugars which is probably why the research finds there is no clear correlation between A1c and the presence of neuropathy, especially when A1c is below 8%.

Your fasting blood sugar, which is the only blood sugar many out-of-date doctors monitor, is also worthless in evaluating your neuropathy risk, because it is possible to have extremely high post meal blood sugars and completely normal fasting blood sugars. I did that myself years ago when I had fasting blood sugars of 98 mg/dl and post meal blood sugars at every meal over 250 mg/dl.

This 140 mg/dl post meal blood sugar target is very mainstream--the American Association of Clinical Endocrinologists has been recommending it for five years now and I have heard rumors that some of that organization's members would like to see it lowered even further.

I personally try to keep my blood sugar under 120 mg/dl at all times, though that is not always possible. But even with eating quite a few meals that missed that target, I have been able to maintain my A1cs in a range between 5.5% and 5.8% over the past decade, and has been enough to keep me from developing any signs of diabetic neuropathy.

I do periodically experience neuropathy caused by compressed nerves in my spine, thanks to some ruptured vertebral discs. But as long as I keep my blood sugar in the safe range, I have found that over time those nerve injuries are able to heal up, too.

Do Supplements Help?

People often write to me asking about whether there are supplements that can help with neuropathy. As is the case with any painful, chronic condition, diabetes attracts flocks of vultures eager to prey on the desperation of sufferers. These vultures will gladly sell you herbs and potions at inflated prices with the promise they will heal you.

Save your money. There are very few supplements that appear to have any affect on neuropathic pain and the evidence for them is underwhelming. You can read what researchers have found about these supplements here:

Useful Supplements for People with Diabetes

But after years of reading the discussion boards, my impression is that very few people find these supplements worth the expense, while everyone who follows the advice about modifying their diet experiences improvement. So your best bet is to put the money you would have wasted on expensive herbs and supplements into buying the foods that lower your blood sugar. It's a much better investment.