5 January 2012

Preventing or slowing down the rate of nerve damage that occurs with diabetes is important.

CAN’T remember the last time you said “ouch”? Do you seem to have lost your senses or have a delayed response when touching something hot or sharp? It may be that your nerves are damaged, especially if you’ve diabetes. This is called diabetic neuropathy.

“People with diabetes have about a 60% chance of getting neuropathy of any kind,” says Dr Dace L. Trence, an endocrinologist and director of the Diabetes Care Centre at the University of Washington Medical Centre in Seattle. “It’s probably an equal risk of getting neuropathy with type 1 and type 2 diabetes.”

The majority of the peripheral nerves are responsible for sensations you feel such as touch, pain and temperature. There are literally millions of these nerve endings in your fingers, hands, toes and feet, which are designed to keep you out of danger and away from the things that are hot, cold, sharp, etc.

You may have tingling, pain, or numbness in your feet and hands – common signs of peripheral neuropathy. Or you may have damage to the nerves that send signals to your heart, stomach, bladder, or sex organs, called autonomic neuropathy. Nerve damage can also be “silent”, meaning you have no symptoms at all.

How can you tell if you have nerve damage?

Doctors diagnose nerve damage on the basis of symptoms and a physical examination. During the examination, your doctor may check blood pressure, heart rate, muscle strength, reflexes, and sensitivity to position changes, vibration, temperature, or light touch.

Experts recommend that people with diabetes have a comprehensive foot examination each year to check for peripheral neuropathy. People diagnosed with peripheral neuropathy need more frequent foot examinations. A comprehensive foot examination assesses the skin, muscles, bones, circulation, and sensation of the feet.

Your doctor may assess protective sensation or feeling in your feet by touching your foot with a nylon monofilament – similar to a bristle on a hairbrush-attached to a wand or by pricking your foot with a pin.

People who cannot sense pressure from a pinprick or monofilament have lost protective sensation and are at risk for developing foot sores that may not heal properly.

The doctor may also check temperature perception, or use a tuning fork, which is more sensitive than touch pressure, to assess vibration perception. The doctor may perform other tests as part of your diagnosis, including nerve conduction studies, heart rate check, and even ultrasound of the bladder, etc.

Damage control

The good news? Many of the risk factors for diabetic neuropathy are under your control. So while you may not be able to prevent nerve pain and damage completely, you may be able to help slow it down.

You can reduce your risk of nerve damage and other diabetes complications by keeping your blood sugars under tight control, says the National Diabetes Information Clearinghouse (NDIC).

A healthy lifestyle helps lower your risk of heart disease, stroke, and other diabetes complications, as well. So know your risk for complications, and work to control the ones you can control.

About 60-70% of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk increases with age, as well as the duration of diabetes.

The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood sugar, as well as those with high levels of fat, those who suffer from high blood pressure, and those who are overweight.


How are diabetic nerve damage (neuropathies) treated? The first step is to bring blood glucose levels within the normal range to help prevent further nerve damage. Blood glucose monitoring, meal planning, physical activity, and diabetes medicines or insulin will help control blood glucose levels.

Symptoms may get worse when blood glucose is first brought under control, but over time, maintaining lower blood glucose levels helps lessen symptoms. Good blood glucose control may also help prevent or delay the onset of further problems.

Japanese scientists have recently discovered that damaged nerves can be regenerated with a simple supplement known as mecobalamin or methylcobalamin, the active form of vitamin B12.

With mecobalamin, the liver does not need to convert the inactive form of B12, cyanocobalamin, to mecobalamin as it is already orally active. Mecobalamin protects against neurological (nerve) disease and ageing by a unique mechanism that differs from current therapies. Some of the disorders that may be preventable or treatable with this natural vitamin therapy include peripheral neuropathies. Take one capsule of 500mcg three times daily.

Are you at risk for diabetic neuropathy?

1. You have high blood sugar.

The risk: Who are the people at highest risk of nerve pain and damage from diabetes? Those who have trouble controlling their blood sugar.

2. You’ve had diabetes for many years.

The risk: Nerve pain and damage is more common in people who have had diabetes for more than 25 years.

3. You’re overweight.

The risk: Being overweight is double trouble for people with diabetes. It puts you at higher risk of diabetic nerve damage, as well as higher risk of deadly diabetes complications like heart attack and stroke.

4. You’re off-target with your blood fats.

The risk: The wrong levels of fats in your blood put you at higher risk of diabetic neuropathy. Often, people with diabetes have high levels of the blood fat called triglycerides. To make matters worse, an elevated LDL (“bad cholesterol”) can increase the risk of a heart attack. A grim fact is that about 65% of deaths in people with diabetes will be due to a heart attack or stroke.

5. You smoke. The risk: Smokers are at greater risk of nerve damage from diabetes. And as you no doubt know, smoking has been linked to heart disease for years.

6. You drink a lot of alcohol.

The risk: Alcohol can seriously affect blood sugar levels. Even more sobering? Alcohol can raise your level of unhealthy blood fats called triglycerides.

This article was published in www.thestar.com.my on 13 November 2011.