Pins & Needles

Colin of Kent said:

Hello folks.

I've been keto for nine months now, and I've gradually become more prone to pins and needles over that time. In itself, this isn't really a concern, but about six weeks ago I got it in my right big toe on a permanent basis, and it seems to have got progressively worse, spreading to some other toes in both feet now. I've heard that vitamin B1 deficiency can contribute to neuropathy, and that 'diabetics' are prone to B1 deficiency. But I don't know if the term 'diabetics' means all of us, including Type 1?

I would say I eat a well-formulated keto diet, including plenty of salt, and nothing has changed in my diet in recent months. I've started a B1 supplement, but only a few days ago, so too early to see any results yet.

I also get light-headed more often than I used to, especially when standing from a squat. I know this is related to blood pressure, but I don't know any more than that. I often feel dizzy on waking and can't see properly for a while after I get up.

I don't know if these two problems are related, but I'd be grateful for any ideas or suggestions anyone here might have. Thanks!

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Being as you are T1, I would see a Dr. about those symptoms.
Your body is trying to tell you that something needs attention.
Especially being as you are eating a ketogenic diet, albeit a well formulated one, something could very easily have gone out of whack Keto not withstanding.

This last summer I was coasting along blissfully assuming all was OK,
I had gone Keto in the new year, and BG was perfect as per my glucometer readings, only to have a blood test come back, that my potassium levels (2.5mmol/L - XE2pz) were dangerously low .
(I had continued with my BP medication, not knowing that my kidneys were not holding unto water like before,
Which meant the 2.5mg indapamide I was taking at the time, was now overkill and I was losing too much fluid/electrolytes)
Talk about blissful ignorance, I was completely asymptomatic.
My point is...Its safer to get checked out.

Hi @Colin of Kent, from my diabetes experience and reading, not as professional advice or opinion:
I believe it is low vitamin B 12 (not B1) that can cause what you describe (mayoclinic.com - Peripheral neuropathy). There are various causes of low B12 and your GP is best placed to sort these out with you.
Of course diabetes can be a cause of pins and needles as well.
I have recently started to find drops in my BP between laying flat for 5 minutes and measuring (with a BP machine I purchased from the chemist) and then standing for 5 minutes and repeating the BP measurement, ensuring that on each measurement the BP cuff was on the same arm and that I positioned that arm so that it was resting, not being held up by that arm, at heart level.
I also made sure the BP cuff covered at least 2/3rd s of my upper arm when fitted.
My specialist had warned me to check my BP in this way as he said after my 52 years on insulin sometimes the BP might do this. It is a form of neuropathy affecting the nerves that help control BP during change in posture, such a laying down to standing.
If I experienced a drop in BP of the upper or systolic reading of > 20 between laying down and standing then that was significant. e.g. say, BP of 130/80 laying down, and then of 105/70 standing up a for 5 minutes.
And for some reason the drop is greater some hours after a meal - why he does not know.
So the dizziness might be due to the above or a number of other causes.
Just make sure your GP does not shirk on the way of checking your BP for what is called a postural (change in posture) fall in BP.
Best Wishes in getting both problems sorted.

Have you any previous history of neuropathy?

The following video is one of Dr Bernstein’s in which he suggests that nerve damage may regenerate, if blood glucose control is tight enough, and during that time, the pain may be worse, as the nerves regrow.

Of course, only you and your glucometer will know if your bg control is likely to fit the situation he describes.

Regarding B12
A lot of B12 deficiency in people with diabetes is in T2s with a long history of taking Metformin.
This is because Metformin can, over time, reduce the absorption of dietary B12.
I know that some T1s are prescribed Metformin, but I am unaware that diabetics not on B12 are any more likely than nonDs to be deficient.

Have you had your circulation checked?