--if you are experiencing neuropathy as a result of impaired glucose tolerance, which is certainly possible (I've posted before a lot of links about neuropathic symptoms occurring well before people are diagnosed with frank diabetes), it would likely effect the small, unmyelinated fibers first, and these are not measurable by standard EMG/nerve conduction studies, which only measure gross abnormalities of larger, myelinated nerves.

There is other testing that might be brought to bear, including quantitative sensory testing, which is designed to ascertain the responsivity of the small fibers that subsume temperature sensation, and skin biopsy to determine density and condition of intraepidermal small fibers.

Hi Glenn,

Could you elaborate on "quantitative sensory testing"? What is it? How is it done?

Thanks,

--is designed to measure the responsivity of the small fibers that subsume the sensations of pain and temperature.

Generally, electrodes are attached to fingers, toes, other parts, and electrical impulses of known temperatures are sent through them. The test relies on patient self-reporting; the patient is supposed to tell whether the electrodes produce sensations of cold, warm, hot and pain. By gradually or rapidly raising or lowering the temperature and listening to the patient reports, the tester can get an idea if those nerve fibers are responding within normal ranges--certain rapid temperature raisings or lowerings, for example, should produce a sensation of pain if fibers are responding normally.

See:

http://peripheralneuropathycenter.uc...nt/index.shtml

http://mcgs.bcbsfl.com/?doc=Quantita...sory%20Testing

http://www.neurology.org/content/60/6/898.full


Unfortunately, as the second link points out, a lot of insurances consider the procedure experimental and are unwilling to pay for it.

Hi Glenn,

Thanks for the great explanation. I am so glad you are here.

Burk

I would get the EMG...it is the basic neuro "101" test for nerves

I've had 5 done in the past 2 years...it is "irritating" but it does not hurt..you will survive

your EMG results will at the very least give a clue to your neuro what you do NOT have as well as what you might have

it will also establish a baseline EMG test so if your symptoms increase in severity/duration down the road your neuro could order a 2nd EMG to compare with the first

I have stated many times "not knowing what is wrong with you is often worse than knowing what is"

if I were you I would call your neuro back and schedule it...you have nothing to lose