Are these typical symptoms of Diabetic Neuropathy?

[Rodney2015]

Age 50. Type 2 Diabetes over 15 years.
Taking Metformin. Glucose under control (7.0 A1C average last few years)

Symptoms:
In the last month , experiencing sharp shooting stabbing pain in the left lower front ankle/foot. Pain is always in the same location. (See pic below).

Pain is intermittent. Pain typically lasts from 2 to 10 seconds. Twice in the last month, the pain has awakened me in the night.

Are these intermittent symptoms consistent with Diabetic Neuropathy? Once again, the pain is very brief (2 seconds) and intermittent.
(About 10 episodes in the last 7 days.)

The treatment plan is gabapentin for the nerve pain and continuing to managing glucose levels...

The Neurologist tested my hands and feet with EMG and Nerve Conduction Study (NCS).

Nerve Test Report:
Hands -- EMG normal. NCS normal.
Feet -- EMG normal. NCS "Mild Neuropathy".

" Test revealed a neuropathic process on both lower extremeties related to diabetes and this leg pain might be related to underlying neuralgia..."

I am curious as to the likelihood that the nerve pain is NOT due to diabetes, given that the diagnosis is "mild diabetic neuropathy" and Doctor Report
says it "might be diabetic neuropathy" but it does not make a definitive conclusion. I have normal sensation in my feet.

Could it be something else like a nerve compression? The MRI was normal but don't know if MRI shows compression.

Will seeing a Podiatrist be helpful?

 

[ButtterflyLady]

Age 50. Type 2 Diabetes over 15 years.
Taking Metformin. Glucose under control (7.0 A1C average last few years)

Symptoms:
In the last month , experiencing sharp shooting stabbing pain in the left lower front ankle/foot. Pain is always in the same location. (See pic below).

Pain is intermittent. Pain typically lasts from 2 to 10 seconds. Twice in the last month, the pain has awakened me in the night.

Are these intermittent symptoms consistent with Diabetic Neuropathy? Once again, the pain is very brief (2 seconds) and intermittent.
(About 10 episodes in the last 7 days.)

The treatment plan is gabapentin for the nerve pain and continuing to managing glucose levels...

The Neurologist tested my hands and feet with EMG and Nerve Conduction Study (NCS).

Nerve Test Report:
Hands -- EMG normal. NCS normal.
Feet -- EMG normal. NCS "Mild Neuropathy".

" Test revealed a neuropathic process on both lower extremeties related to diabetes and this leg pain might be related to underlying neuralgia..."

I am curious as to the likelihood that the nerve pain is NOT due to diabetes, given that the diagnosis is "mild diabetic neuropathy" and Doctor Report
says it "might be diabetic neuropathy" but it does not make a definitive conclusion. I have normal sensation in my feet.

Could it be something else like a nerve compression? The MRI was normal but don't know if MRI shows compression.

Will seeing a Podiatrist be helpful?

Hi Rodney and welcome to the forum.

Are you on medications for any other conditions? I think it would be best to go back to the neurologist and ask more questions so you fully understand the nature of the condition, its prognosis, and the range of possible treatments, including podiatry. There is also a good thread on the forum about neuropathy that you may be able to find by using the search function.

Your HbA1c of 7% or 53 is a bit above the target level to keep the risk of complications low, which is 6.5% or 48, I believe. Many of us try to get lower than that, even. This can be done by reducing carbs and losing weight if needed, or sometimes by adding other medications, but these come with their own pros and cons.

I will tag @daisy1 who will post our information for new members.

Again, welcome, and I hope you find the forum helpful.

 

[Rodney2015]

Thanks for response. I am not on other medications, only Metformin.

Was wondering what the typical progression of diabetic neuropathy. Is it numbness and then followed by pain?
Because I am not experiencing any numbness -- just intermittent pain in the left leg. Does diabetic neuropathy typically affect both legs? If so, about how much time before it affects the other leg?

The neurologist tested my hands and feet with Electromyography (EMG) and Nerve Conduction Study (NCS). EMG tests were normal for both hands and feet. The NCS for feet indicated "mild diabetic neuropathy".

I do not have the option of seeing the Neurologist again in the near future. I asked him if I can come back for more tests and he told me he has done everything from his side. He has lots of patients and it takes at least a month to get an appointment with him.

At this point, the treatment plan is to deal with the pain taking the prescribed gabapentin. Don't think the Neurologist can do any more at this time. The Neurologist seemed to be quite happy with my hand nerve conduction test results. I asked him why my nerve pain is so severe if his diagnosis was only "mild diabetic neuropathy in the lower extremeties." He said patients experience pain differently so a "mild" diagnosis does not necessarily mean mild pain.

But I am just curious as to what the typical progression and symptoms of diabetic neuropathy are, how often does it resolve on its own, etc (assuming glucose control).

 

[daisy1]

@Rodney2015

Hello Rodney and welcome to the forum Here is the information we give to new members and I hope you will find it helpful. It will give you advice on carbohydrates which it is important to reduce as they can help keep your levels under control. Reducing these could help your neuropathy.


BASIC INFORMATION FOR NEW MEMBERS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you’ll find over 150,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.
There are two approaches to controlling your carbs:

• Reduce your carbohydrate intake
• Choose ‘better’ carbohydrates

Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

Another option is to replace ‘white carbohydrates’ (such as white bread, white rice, white flour etc) with whole grain varieties. The idea behind having whole grain varieties is that the carbohydrates get broken down slower than the white varieties –and these are said to have a lower glycaemic index.
http://www.diabetes.co.uk/food/diabetes-and-whole-grains.html

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 8.5 mmol/l

Blood glucose ranges for type 1 diabetes (adults)

• Before meals: 4 to 7 mmol/l
• 2 hours after meals: under 9 mmol/l

Blood glucose ranges for type 1 diabetes (children)

• Before meals: 4 to 8 mmol/l
• 2 hours after meals: under 10 mmol/l

However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:

• structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
• self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to bloodglucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic

Note: This post has been edited from Sue/Ken's post to include up to date information.

 

[viviennem]

In my case the neuropathy that 3 out of 4 Health Care Professionals insist is "diabetic" is in fact caused by lumbar spinal stenosis trapping several nerves in my right leg. It takes the form of numbness and tingling, with a "hot" pain that starts in my right hip and sometimes goes down the nerve to my knee. I don't always have the pain, but it's getting to the point of "usually". The numbness and tingling go from the knee across the front of the shin down to the foot, but no pain there yet.

Despite the fact that my blood glucose control is very good (HbA1c was 5.5 recently - usually about that), several HCPs have told me that you can still get diabetic neuropathy no matter how good your control! So why are we bothering?!!
I don't believe that, though I'm not medically qualified. On the other side of the equation, my brother has right leg neuropathy but he's not diabetic - not even pre-diabetic!

In your place I would be looking for a second opinion. Search out a really well-qualified podiatrist and ask her/him. If good, they really understand foot anatomy and will be able to suggest any alternatives to go back to your GP with. I go privately at the moment because of a bad experience with the NHS service - expect to pay around £30 to £35 for a first session. You don't have to go again if you don't want, and it's worth it to have your feet checked out professionally.

Finally, watch the Gabapentin. I know it's widely used for nerve pain, and some people have very good results, but it crippled me. I got to the point, after about 6 weeks, when I was walking as if my ankles were tied together and I had hardly any balance - my muscles just weren't responding. Read the leaflet carefully. If you decide it's not suitable for you, you have to come off it very slowly. It's taken me 12 months after stopping it to get back to somewhere near where I was when I started, as far as mobility goes. Also, my present GP says he would never use it for a diabetic, but I haven't yet found out why! When I do, I'll get back to you.

Best of luck

Viv13

 

[ButtterflyLady]

In my case the neuropathy that 3 out of 4 Health Care Professionals insist is "diabetic" is in fact caused by lumbar spinal stenosis trapping several nerves in my right leg. It takes the form of numbness and tingling, with a "hot" pain that starts in my right hip and sometimes goes down the nerve to my knee. I don't always have the pain, but it's getting to the point of "usually". The numbness and tingling go from the knee across the front of the shin down to the foot, but no pain there yet.

Despite the fact that my blood glucose control is very good (HbA1c was 5.5 recently - usually about that), several HCPs have told me that you can still get diabetic neuropathy no matter how good your control! So why are we bothering?!!
I don't believe that, though I'm not medically qualified. On the other side of the equation, my brother has right leg neuropathy but he's not diabetic - not even pre-diabetic!

In your place I would be looking for a second opinion. Search out a really well-qualified podiatrist and ask her/him. If good, they really understand foot anatomy and will be able to suggest any alternatives to go back to your GP with. I go privately at the moment because of a bad experience with the NHS service - expect to pay around £30 to £35 for a first session. You don't have to go again if you don't want, and it's worth it to have your feet checked out professionally.

Finally, watch the Gabapentin. I know it's widely used for nerve pain, and some people have very good results, but it crippled me. I got to the point, after about 6 weeks, when I was walking as if my ankles were tied together and I had hardly any balance - my muscles just weren't responding. Read the leaflet carefully. If you decide it's not suitable for you, you have to come off it very slowly. It's taken me 12 months after stopping it to get back to somewhere near where I was when I started, as far as mobility goes. Also, my present GP says he would never use it for a diabetic, but I haven't yet found out why! When I do, I'll get back to you.

Best of luck

Viv13

I tried gabapentin recently and had to come off it because of extreme drowsiness.

 

[Rodney2015]

Even if one's glucose is currently under control, the Neurologist told me that diabetic nerve damage is often caused by high glucose levels in the past...And that nerves may take long time to heal (2 years)...

I have now discovered that I can sort of reproduce the foot pain by bending over to touch my toes. So I am beginning to suspect
"lumbar radiculopathy (sciatica)". I have heard that diabetics are more susceptible to back nerve issues...

I get the feeling that maybe Doctors are too quick to attribute pain to diabetic neuropathy when it could be related to back/compressed nerve issue... Although I am not sure if the treatment plan would be any different...

Gabapentin also made me extremely drowsy and I've stopped it. I am now able to tolerate the pain because pain now only lasts a few seconds and not several minutes of severe throbbing pain as before. Hopefully the severe pain will not return.

If the severe pain returns, I will ask for something other than Gabapentin.

So right now I am not on any medication other than the diabetic medication -- Metformin and Glipzide tablets.

 

[Rodney2015]

My understanding is that Diabetic Neuropathy most commonly starts with toes and moves upwards. It is preceded with loss of sensation and then followed by pain.

I have normal sensation in the foot and so I was wondering if others have experienced foot pain without preceding numbness/tingling/pins&needles symptoms. I do not have those symptoms and the Neurologist said I had only "mild diabetic neuropathy" in the legs and that the hands were normal.