Neuropathy, good hBa1c and glycemic variability

[Crocodile]

Hi Everybody,

Thanks for welcoming me to this forum. I've already gleaned a lot of helpful information and now time to put something back. For the record I was diagnosed with type 2 after several months of strange and unexplained symptoms that weren't really causing me too much trouble but worrying enough to see my GP. I had constant prescription changes to my glasses, weight loss faster than I thought I should be and peeing a lot.

I also began developing numbness in my toes and fingers. Not painful but just a strange sensation. My GP was quick to blame my diabetes and ordered a HbA1c test. When it came back at 6.0 and all my previous ones were similar ( except for the first two after diagnosis, 9 and 7.5 ) he sent me to a neurologist. I had nerve conduction studies which were normal and a raft of blood tests. Some strange antibodies were found ( PR3 ANCA ) but were so small that they were dismissed after showing no signs of vasculitis related to these antibodies.

I asked the neurologist whether it was possible to have good HbA1c and short term temporary spikes leading to nerve damage. He admitted it can't be dismissed but not much research has been done specifically in this area. I immediately went ahead and took a much more aggressive approach to BG and over a couple of months the neuropathy improved.

Over Christmas I got a little caught up in the party mode and wasn't quite as fussy. Slowly the neuropathy deteriorated. Once again took control and it is now on the improve again. I decided to look for myself and see if there had been any new studies in this area and came across one that seems to confirm my suspicions. If the study is correct, there does appear to be a causal link between glycemic spikes and neuropathy even though HbA1c is well controlled.

 

[Crocodile]

https://dmsjournal.biomedcentral.com/articles/10.1186/1758-5996-6-139

 

[Mike d]

Just what was the HbA1c @Crocodile ?

 

[Crocodile]

Hi Shintaro, 9 just after diagnosis, 7.5 next and all the rest around 6. Due for another in March.

 

[Mike d]

Glenn, (and the tag is @Mike D) that isn't your HbA1c. Otherwise I'd be throwing flowers on your grave. They read as finger tests. I mean bloods as in full bloods with samples taken and analysed.. Should be (for you) in the 40s (lucky if it is) or maybe 50s

Full bloods are taken 3 months apart to record blood sugars over that period, not on the day

They are related (in a fashion) but strip and dailies are nothing more than records of what meals do to you so you know what you can and cannot tolerate.

...... The HbA1c is a longer term reading

 

[Crocodile]

Sorry Mike D, I just saw the Shintaro pic and was carried off with childhood memories and expecting Tombei the Mist to appear as well.

I'll convert the units from % to mmol/mol for you.
9 = 75
7.5 = 58.5
6 = 42

Depends on the lab I suppose

 

[Mike d]

I had all the gum cards too Worth a LOT of money now and they were all mint Such were the days

That's good ... BUT time spread?

 

[Crocodile]

Every 90 days or close to it. First one Dec 2015 90 days after initial diagnosis.

Conversion is linear with an offset % = (mmol/mol) x 0.0915 + 2.15

Glenn

 

[Mike d]

Then **** ... good improvement @glenn. Gettin' close to non diabetic classification, though of course you always will be. Least you have lots of spare specs

Mike

 

[Crocodile]

" Least you have lots of spare specs "
I re-used the frames. Most of them are wrong since they were made before I twigged I had a problem. Apparently the sugar causes the lens to swell and refocuses the light.

You're right, I always will be T2. It will wander back up with a lapse in vigilance. I've also lost 12 kg down from 106 to 94. Aiming for mid 80s and want a1c half a point lower.

Glenn

 

[Mike d]

The eyes do change but get back to normal @Crocodile

You'll see a bigger HB improvement than that if I'm anything to go by. Weight is an enormous factor Glenn

Dropped 18 kilos in no time and now very normal

 

[Juicetin]

Hi Crocodile, your symptoms sound very similar to mine. I'm Pre-D and have neuropathy in both feet, numbness to the balls of feet and pain sometimes. I have seen podiatrists, neurologists and had nerve studies done. The diagnosis was small fibre neuropathy likely caused by higher than normal blood sugar with temporary spikes being the main culprit.
I am taking a host of supplements now , including B12, D3 and Alpha Lipoic Acid and I am , of course, trying to avoid high carb foods.
Take care.

 

[Begonia]

I had cold feet about 9 months ago which progressed to painful feet when walking. The neurologist diagnosed 'mild neuropathy'. I was very low in vit D and quite low in B12 at the time and I was prediabetic. Over about 6 months I brought my HBA1c down to well within normal (31) through LCHealthyF diet and took vit D3, B12 and R-ALA.

For the last few months I have had very little discomfort in my feet. I don't know if its due to lowering the blood sugar or to the supplements or a combination. I do know if I let my BG go up I start to feel my feet a bit.

 

[Bluetit1802]

@Crocodile you may find this interesting
http://www.phlaunt.com/diabetes/14045678.php

It is also established that it is the standard deviation that is important. More so than the HbA1c which will hide all the spikes if there are also some lows. Keeping levels inside a fairly narrow band at all times is better than the roller coasters - even though a narrow band diabetic and a roller coaster diabetic may well have identical HbA1cs. (the fallacy of average!)

It is perfectly possible for someone with good HbA1c results in the mid to high 30s to have the roller coaster scenario, so a non-diabetic may well get nerve damage if he spikes post meal but has sufficient lows to keep his HbA1c down..

 

[Crocodile]

@Bluetit1802
Thanks for the link. It's interesting and confirms my own experience. My numbness definitely worsens when BGs are up. I noticed this around Xmas with all the party food and also some months earlier when I first saw my GP about it and not knowing the cause. Both times the numbness improved gradually as BGs come back to normal. I'm due to see my neurologist 1st March and I'll show him these articles. He's a good guy and will appreciate it. Just yesterday I started on R-ALA as well. I'll see if this does anything too.

 

[Crocodile]

@Juicetin
What you describe re numbness and occasional pain is almost a carbon copy of me. I have it in my fingers as well but so slight it is hardly noticeable. Keeping BG down is definitely helping.

 

[Jix200903]

For me, all of this points (as well as low-carbing) towards lots of exercise to warm the muscles and improve absorbtion of BG after meals. This sensitising of the muscles to allow them to gobble up the glucose is another part in the jigsaw.
I have noticed cold feet and my retinopathy scan said "things have changed" but nothing has yet gone wrong, even though my successful and unmedicated HbA1c of 44 this week. On the other hand, it is winter...
I also make sure my main carby meal is at lunch, when I have a hope of working it off, instead of in the evening when exercise is limited.

 

[Crocodile]

Hi Everyone, My R-ALA arrived last Thursday arvo ( Here in Aussie it's Saturday arvo now ). After two days of this stuff I'm already noticing some improvement. I'm keeping tight control of BG as well. If this keeps up I'll be impressed. Thanks for the information about this.

Glenn

 

[Brunneria]

I can’t add to what has been said above, except for a couple of things:

You may find that investing in a Freestyle Libre would be very informative, if you can get hold of one. It would give you much better info on your bg fluctuations, 24/7, on a graph. So would allow you to really get an understanding. They are expensive at £50 a sensor, but you might only need one to know what is happening.

Secondly, I get stabbing pains in my feet if my bg fluctuates too much. It eases off after a few days of keeping bg steady. When I first experienced it I got rather morose. Inevitable decline... gloom... the thought of stabbing pain indefinitely...

Then I clamped down on bg and food and the pain when away. (Although I t did come back again for a few days after a week of holiday food).

Nowadays I am actually rather pleased it happened. It gave me a glimpse into a painful future if I don’t keep control. And it showed me that lack of control causes undetectable damage before I know it, with the pain showing up only after the damage is already done.

Talk about motivating!!!

 

[Crocodile]

Hi Brunneria, I'm getting a Libre soon just to get a glimpse of what happens. I have a good mate who is type 1 and he's getting it for me. Your story is so close to mine it's not funny. My neuropathy worsened over Xmas with all the party food too. Took control again and it got better after a few weeks. Started the R-ALA and even better again.

Glenn