# Diabetic Neuropathy Question **URL:** \ **Category:** In My Humble Opinion\ **Created:** [May 23, 2014, 5:24pm UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110 "2014-05-23T17:24:51Z")\ **Posts on this page:** 17\ **Page:** 1
**Author:** ![Indyellen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/indyellen/32/4176_2.png) [@Indyellen](https://boards.straightdope.com/u/Indyellen)\ **Post date:** [May 23, 2014, 5:24pm UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/1 "2014-05-23T17:24:51Z")
This is not a ‘need answers fast’ sort of thing, thank goodness. 🙂 I have had some odd pains/itches/twitches lately, and as my glucose levels haven’t been great for about 6 months, I have decided to be paranoid and start freaking out that this weird stuff is diabetic neuropathy. So, basically, I am just looking to find out from people who may have had it, or may have treated it, what sort of things **would** be signs or symptoms to look for that I would then take to my doctor. _Disclaimer: I am not seeking medical advice, but personal experiences. If I get too paranoid, I will go to my duly designated physician for a professional opinion._ ---
**Author:** ![Hari\_Seldon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hari_seldon/32/5173_2.png) [@Hari\_Seldon](https://boards.straightdope.com/u/Hari_Seldon)\ **Post date:** [May 24, 2014, 1:18am UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/2 "2014-05-24T01:18:54Z")
I had diabetic neuropathy (tingling starting in my toes, now pretty generally in my feet) a number of years before I was actually diagnosed with diabetes. That is my blood sugar, while not great was below the diabetic level (it was around 6 mmol/l = 108 mg/dl). Something like 6 or 7 years later, it finally hit the magic 7 and I started on metformin. Now, 9 years later, my blood glucose level is around 5.5 (A1G around 5.5%, BTW) but the neuropathy is still getting slowly worse. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [May 24, 2014, 1:54am UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/3 "2014-05-24T01:54:01Z")
Diabetic neuropathy is symmetric, and generally starts in the toes. About 15% of diabetics already have it to some extent by the time they’re diagnosed. Numbness, burning, “pins & needles” sensation, loss of vibratory and position and temperature sense are common. If you are a diabetic, your doctor should be checking your feet for signs of neuropathy on a regular basis. Good control of diabetes slows the progression and prevents complications. Medications such as tricyclic antidepressants and GABA analogues can reduce the symptoms. That’s my ‘shoot from the hip’ nutshell summary of the issue. More info will cost ya. 😉 ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [May 24, 2014, 2:03am UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/4 "2014-05-24T02:03:33Z")
In addition to the Doc’s excellent summary, I’ll share the phrasing I hear a lot from patients: “It’s numb, but it hurts at the same time. That doesn’t make any sense, does it?” Well, no, not entirely, but as I hear it over and over again, I just accept that it’s a pretty good description of something that I haven’t experienced myself. Since different nerve fibers send different sensation messages, my guess is that some are damaged while others are still working. Definitely time to get those sugars under better control. It may not reverse, or it may only partially reverse, but you can slow the progression down with better sugar control. ---
**Author:** ![The\_Holdsworth\_Effect](https://avatars.discourse-cdn.com/v4/letter/t/848f3c/32.png) [@The\_Holdsworth\_Effect](https://boards.straightdope.com/u/The_Holdsworth_Effect)\ **Post date:** [May 24, 2014, 2:53am UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/5 "2014-05-24T02:53:41Z")
> [@whynot](#): > > in addition to the doc’s excellent summary, i’ll share the phrasing i hear a lot from patients: “it’s numb, but it hurts at the same time. That doesn’t make any sense, does it?” > > definitely time to get those sugars under better control. It may not reverse, or it may only partially reverse, but you can slow the progression down with better sugar control. eccchhhooo ---
**Author:** ![Hirka\_T\_Bawa](https://avatars.discourse-cdn.com/v4/letter/h/db5fbb/32.png) [@Hirka\_T\_Bawa](https://boards.straightdope.com/u/Hirka_T_Bawa)\ **Post date:** [May 24, 2014, 6:27am UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/6 "2014-05-24T06:27:55Z")
To add to **Qadgop** and **WhyNot** , the one description that I look for a patient complaining about that suggests Neuropathy is “burning”. While other complaints like numbness, pins & needles, itching, twitching, and etc, can be caused by other things, the description of “burning” makes me immediately think of some sort of nerve damage. So, if you have a “burning” feeling, without any known source of fire or heat, make sure to mention it to your doctor. ---
**Author:** ![panache45](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/panache45/32/64_2.png) [@panache45](https://boards.straightdope.com/u/panache45)\ **Post date:** [May 24, 2014, 7:28am UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/7 "2014-05-24T07:28:03Z")
Years before my diagnosis, I started having numbness in my outer thighs. Now, years later, the symptom has actually lessened. A common ongoing symptom is a sudden acute pain, like someone is jamming a large needle into my feet, or sometimes hands. Fortunately it doesn’t last long. And in the past few years I’ve been experiencing a lot of itching in my right hand. Scratching it has no effect. All in all, I’m lucky to be alive and relatively healthy, almost 19 years post-diagnosis. ---
**Author:** ![GythaOgg](https://avatars.discourse-cdn.com/v4/letter/g/49beb7/32.png) [@GythaOgg](https://boards.straightdope.com/u/GythaOgg)\ **Post date:** [May 24, 2014, 5:15pm UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/8 "2014-05-24T17:15:02Z")
As a CDE, the one complaint I hear the most about diabetic neuropathy is that it’s much worse at night when people go to sleep. They don’t have the distractions they do during the day and they feel it more. Anyone presenting with neuropathy should also be evaluated for the presence of retinopathy and nephropathy (damage to the eyes and kidneys) with a dialated retinal exam and a urine micoralbumin test. Both of these should be done at a minimum yearly. If neuropathy has started it’s likely damage is going on in those places, too. ---
**Author:** ![yawuntz](https://avatars.discourse-cdn.com/v4/letter/y/a5b964/32.png) [@yawuntz](https://boards.straightdope.com/u/yawuntz)\ **Post date:** [May 24, 2014, 6:41pm UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/9 "2014-05-24T18:41:33Z")
> [@Indyellen](#): > > This is not a ‘need answers fast’ sort of thing, thank goodness. 🙂 > > …my glucose levels haven’t been great for about 6 months…\* What kind of levels are you getting? Overuse of [alcohol](http://www.nlm.nih.gov/medlineplus/ency/article/000714.htm) can also bring about some of the same symptoms you’ve described. ---
**Author:** ![cochrane](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cochrane/32/10441_2.png) [@cochrane](https://boards.straightdope.com/u/cochrane)\ **Post date:** [May 24, 2014, 7:03pm UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/10 "2014-05-24T19:03:45Z")
I am diabetic and experience neuropathy from time to time. The best way I can describe it as feeling like someone has stuck an electrified fork into my foot. Not so much a burning sensation as one like an electric shock. ---
**Author:** ![Broomstick](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/broomstick/32/246_2.png) [@Broomstick](https://boards.straightdope.com/u/Broomstick)\ **Post date:** [May 24, 2014, 7:21pm UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/11 "2014-05-24T19:21:56Z")
> [@Qadgop\_the\_Mercotan](#): > > If you are a diabetic, your doctor should be checking your feet for signs of neuropathy on a regular basis. Just as an aside - since my spouse has a spinal injury he’s _never_ been able to feel his feet. At all. Ever. This is always worth a chuckle when some new, unsuspecting medical person comes in to check his feet. “Can you feel this, Mr. B?” “No.” _::: cue panic :::_ “Uh… read the chart - spinal damage pre-dates diabetes by decades.” They check other ways for diabetic side effects, though. And for neuropathy in his hands. Of course, the carpal tunnel syndrome can complicate that… And, needless to say, visual checks of his feet are even more important than someone with any remaining sensation. But then, he’s been doing them since he was a kid so he’s pretty good at it. Regardless of any co-morbidities, though, do try to keep your blood sugar under control and get regular check ups. ---
**Author:** ![Merneith](https://avatars.discourse-cdn.com/v4/letter/m/57b2e6/32.png) [@Merneith](https://boards.straightdope.com/u/Merneith)\ **Post date:** [May 24, 2014, 8:26pm UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/12 "2014-05-24T20:26:43Z")
> [@Qadgop\_the\_Mercotan](#): > > Diabetic neuropathy is symmetric, and generally starts in the toes. About 15% of diabetics already have it to some extent by the time they’re diagnosed. Numbness, burning, “pins & needles” sensation, loss of vibratory and position and temperature sense are common. When you say it’s symmetric, do you mean it will show up in both feet at once, not just one foot? And what does, “loss of vibratory” mean, please? Just curious. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [May 24, 2014, 8:45pm UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/13 "2014-05-24T20:45:25Z")
> [@Merneith](#): > > When you say it’s symmetric, do you mean it will show up in both feet at once, not just one foot? > > And what does, “loss of vibratory” mean, please? > > Just curious. Symmetric means it generally shows up in both feet/hands at once. If it showed up only on one side, I’d be much more suspicious of a radiculopathy (spinal nerve root problem) or other focal/localized disorder than a diabetic neuropathy. Loss of vibratory sense means you can no longer feel vibrations quite as well as you used to be able to. Proprioception, or ‘spatial/balance’ sense is also often affected. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [May 24, 2014, 10:19pm UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/14 "2014-05-24T22:19:27Z")
From what I know of it, there could be some OTC treatments to help with it. Benfotiamine (a version of vitamin B1, and it has to be this version and not regular store bought thiamine). These were small studies though. > **[Benfotiamine in the treatment of diabetic polyneuropathy--a three-week...](https://pubmed.ncbi.nlm.nih.gov/15726875/)** > > This pilot investigation (BEDIP Study) has confirmed the results of two earlier randomized controlled trials and has provided further evidence for the beneficial effects of benfotiamine in patients with diabetic neuropathy. > **[Effectiveness of different benfotiamine dosage regimens in the treatment of...](https://pubmed.ncbi.nlm.nih.gov/10219465/)** > > The therapeutic effectiveness of a benfotiamine (CAS 22457-89-2)-vitamin B combination (Milgamma-N), administered in high (4 x 2 capsules/day, = 320 mg benfotiamine/day) and medium doses (3 x 1 capsules/day), was compared to a monotherapy with... [http://www.nature.com/nm/journal/v9/n3/abs/nm834.html](http://www.nature.com/nm/journal/v9/n3/abs/nm834.html) alpha lipoic acid > **[Oral treatment with alpha-lipoic acid improves symptomatic diabetic...](https://pubmed.ncbi.nlm.nih.gov/17065669/)** > > Oral treatment with ALA for 5 weeks improved neuropathic symptoms and deficits in patients with DSP. An oral dose of 600 mg once daily appears to provide the optimum risk-to-benefit ratio. > **[Alpha-lipoic acid in the treatment of diabetic polyneuropathy in Germany:...](https://pubmed.ncbi.nlm.nih.gov/10595592/)** > > Diabetic neuropathy represents a major health problem, as it is responsible for substantial morbidity, increased mortality, and impaired quality of life. Near-normoglycaemia is now generally accepted as the primary approach to prevention of diabetic... I don’t have it, I have a different kind of neuropathy. But in researching my condition those two were recommended by various diabetics as a way to reduce symptoms. ---
**Author:** ![Indyellen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/indyellen/32/4176_2.png) [@Indyellen](https://boards.straightdope.com/u/Indyellen)\ **Post date:** [May 25, 2014, 4:19am UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/15 "2014-05-25T04:19:09Z")
> [@Ayatollah Yawuntz](#): > > What kind of levels are you getting? My last A1c was 7.7. For about a month my sugars have been running between 160-250. My doc just changed my meds, and I finally buckled down and I’m (mostly) following my diet again, and they’ve come down some to 125-155. I’ve been having stabbing pains in my right big toe, and itching that scratching doesn’t much help in both feet periodically. It mostly happens during the day, not at night. ---
**Author:** ![Indyellen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/indyellen/32/4176_2.png) [@Indyellen](https://boards.straightdope.com/u/Indyellen)\ **Post date:** [May 25, 2014, 4:21am UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/16 "2014-05-25T04:21:02Z")
Thanks, everyone. I’m getting my usual foot checks with my exams. It’s just started within the last week or two. ---
**Author:** ![Mama\_Zappa](https://avatars.discourse-cdn.com/v4/letter/m/71e660/32.png) [@Mama\_Zappa](https://boards.straightdope.com/u/Mama_Zappa)\ **Post date:** [May 27, 2014, 1:47am UTC](https://boards.straightdope.com/t/diabetic-neuropathy-question/689110/17 "2014-05-27T01:47:29Z")
> [@Indyellen](#): > > My last A1c was 7.7. For about a month my sugars have been running between 160-250. My doc just changed my meds, and I finally buckled down and I’m (mostly) following my diet again, and they’ve come down some to 125-155. > > I’ve been having stabbing pains in my right big toe, and itching that scratching doesn’t much help in both feet periodically. It mostly happens during the day, not at night. Bad Indyellen (:::smacks with rolled up newspaper::🙂 on misbehaving food-wise - we see my father-in-law pull this kind of thing. In his case it’s truly willfull cluelessnes and we want to smack him sometimes. He’s ignored it to the point of causing kidney damage and messing with his eyes. That said: re the itching, I’ve occasionally had that as what appears to be a manifestation of my Restless Legs Syndrome,as it happens when I’m trying to fall asleep, and didn’t take my RLS meds early enough. It’s always one-sided. Running the foot under very hot water usually short-circuits the signal enough to interrupt the itching. In your case, be VERY careful if you try this - if your sensations are impaired it would be easy to use water that is too hot, and leave you with nasty burns. Reading the rest of the thread with interest, as I’m not in the diabetic range but my sugars have been at the higher end of the desirable range for a while, and I _do_ have some neuropathic symptoms (numbless) which appear to be idiopathic.