Carmela's home

Preventing Complications: Nerve Disease
Posted by Christine McKinney, M.S., R.D., C.D.E. on Mon, Nov 20, 2006, 10:23 am PST

One of my clients - we'll call him Dave, a fictitious name - has diabetic neuropathy, a condition that causes pain or numbing, usually in the hands, legs, and feet. I met Dave about a year ago, when he came to our medical center to consult an endocrinologist because his blood glucose levels were very high.
At the time, Dave was on disability and hadn't worked for the past six months. He was about to lose his job if he didn't go back to work. He had left his job as a custodian because he could no longer stand for any length of time. He could barely walk into our clinic that day because his feet hurt so much. The feeling he described is that of pins constantly sticking his feet as he walked.
Being on disability was a financial strain on Dave and his family - especially the cost of his diabetes medications and food. He had lost about 60 pounds in the last six months from high blood glucose levels and now was very underweight. We started him on insulin that day and a higher calorie and protein diet. Every month that Dave came back, we saw improvements in his blood glucose levels, weight, and neuropathy. Eventually, Dave was able to return to work.
About 60 to 70 percent of people with diabetes will develop some form of nerve damage. There are two types of nerve damage. Peripheral neuropathy, which is what Dave has, a pain or weakness in the arms or feet. Almost 30 percent of people with diabetes over age 40 lose sensation in their feet. More than 60 percent of amputations that are not from trauma are from diabetes. Autonomic neuropathy, the second type of neuropathy, affects the nerves that control our body's involuntary functions like digestion, sweating, bladder control, even sexual function.
Once again, the focus for prevention of diabetic neuropathy is controlling your blood glucose levels. I'm starting to sound like a broken record, and that's good because it means you're getting the message! So, repeat after me:
Know your A1C level. Your doctor should measure your A1C every 2 to 3 months or every six months if the level has remained below 7 percent.

Test your blood glucose levels at home. This can help you detect trends in your blood glucose levels and what time of the day may be a problem area for you to work on.
To prevent neuropathy, it is essential to take good care of your feet. Check them every day for cuts, blisters, or sores. If you have problems seeing the bottom of your feet, use a mirror on the floor to see your feet. If you see or feel anything unusual call your doctor or see a podiatrist.
Some clients tell me that their doctor doesn't check their feet. My best advice is to take off your shoes and socks as soon as you get into the exam room - your doctor is sure to always check your feet then. Always wear well-fitted shoes and socks to protect your feet, and keep them clean and dry to avoid fungus buildup from too much moisture.
Finally, seek help from your doctor at the first sign of any problems, such as a cut that won't heal in a few days. Don't wait like Dave did. Be aware of diabetic neuropathy.