[SoftTalker]

Oh boy

Can't see my endocrinologist until August.

And I am an established long term patient.

Have been pre-diabetic for many years; due to prednisone I have been taking for years.

Working all the time to keep blood sugar low. Have never quite tipped into full blown diabetes.

Wondering; I know diabetes may cause PN. What about pre-diabetes?

Just a new PN Peep (me) asking.

Thanks.

SoftTalker
aka
SoftWalker (for PN purposes)

[Ragtop262]

Many articles I have read indicate that "diabetic" PN can occur in people with impaired glucose tolerance. (You may not test out as "diabetic" on a normal fasting glucose test or an A1C test, but may "fail" a glucose challenge test.) From what I have read, this is somewhat common in people who are diagnosed as "pre-diabetic" based on the standard tests.

[Neuroproblem]

from other forums, the people who had diabetes, said the Diabetic neuropathy takes years to accumulate, burning pain starts in your feet first, hence why people have to get diabetic footwear, early on. its ascending neuropathy.
you should get your glucose levels checked, and urinalysis for glucose.

[mrsD]

Here are some studies, which lend validity to pre-diabetes as
an instigator of PN....Keep in mind that not all diabetics get PN, or some of the terrible cardiac or vision deteriorations.

2008:

Neurologist. 2008 Jan;14(1):23-9. doi: 10.1097/NRL.0b013e31815a3956.
Impaired glucose tolerance and neuropathy.
Smith AG1, Singleton JR.
Author information
Abstract
BACKGROUND:

Peripheral neuropathy is common. Diabetes is the most common cause, accounting for approximately half of cases, but up to 1/3rd of neuropathy patients have no identifiable etiology. Among this population, impaired glucose tolerance (IGT or "prediabetes") is observed in approximately 40%. The exact nature of the relationship between IGT and neuropathy is debated.
REVIEW SUMMARY:

A variety of evidence suggests IGT causes neuropathy. Neuropathy may occur early in diabetes. The neuropathy associated with IGT is clinically similar to early diabetic neuropathy, with preferential injury to small nerve fibers resulting in pain and autonomic dysfunction. IGT and diabetic neuropathy patients share abnormal microvascular endothelial dysfunction. Treatment of IGT subjects with diet and exercise reduces risk of progression to diabetes, and those with neuropathy experience a short-term improvement in small fiber function with sustained benefit for pain. An evolving literature links other aspects of the metabolic syndrome to peripheral neuropathy.
CONCLUSIONS:

IGT is common in peripheral neuropathy patients. The extent to which IGT directly causes nerve injury as opposed to being a covariant with other equally or more important features (eg, obesity, metabolic syndrome) remains to be determined. Preliminary data suggest diet and exercise counseling may be a useful treatment strategy.

PMID:
18195653
[PubMed - indexed for MEDLINE]

from http://www.ncbi.nlm.nih.gov/pubmed/18195653

2010:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797976/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2797976/
.....In conclusion, neuropathic changes predominantly affecting small fibers appear to occur more commonly in those with IGT than in the normal population, and ongoing prospective studies should provide confirmation of these initial observations. If confirmed, an internationally agreed definition as to what constitutes IGT neuropathy is required, and the noninvasive techniques of corneal confocal microscopy and LDIflare may be useful in assessing longitudinal cohorts and potential pharmacological interventions for what is often a painful condition.

2012:
http://onlinelibrary.wiley.com/doi/1...12.00390.x/pdf

And the debate continues. I'd like to know how many of these patients are on statins when they are evaluated? hmmmm?
How many had Cipro, or Levaquin recently?

The studies always go round and round. But controlling sugar and high glycemic carbs in the diet seem to help many people who come here looking for information. Cutting back is not a drug, doesn't cost BIG PHARMA bucks, and provides a potential
way to reduce pain and discomfort and not suffer the side effects of Lyrica or other drugs.

It is certainly worth trying IMO. By the time the answers are more forthcoming on this subject, they will have changed all the parameters being used now, for pre-diabetes. I personally think that medicine is overly aggressive with this. But that is my opinion. I think anyone coming here should clean up their diet, and if they feel better, then that is the answer for THEM. Everyone is different after all.

[janieg]

SoftWalker/SoftTalker,

If any good has come from this neuropathy crap it's that I've discovered I'm insulin resistant well before any screening criteria would have even categorized me as pre-diabetic. (FBG low 80s, A1C 5.2)

At some point in time, I developed reactive hypoglycemia. I stupidly didn't think much about it. "I'm getting old." When the small fiber neuropathy hit and I learned diabetes and pre-diabetes were primary causes, I started digging deeper. (Because of my screening values, doctors weren't looking at it.)

I bought a glucose meter at Walgreens and spent a lot of time learning about normal and abnormal blood glucose levels. I was definitely not normal. After a high carb meal, my blood glucose level skyrockets and remains elevated for hours. Enough to do nerve damage? I don't know. It's not like there are magic numbers that define when nerve damage occurs.

I'm on a low carb diet now, and after a lot of finger poking, know what I can and can't eat to keep my blood glucose at reasonable levels.

It's been about 7 months, and I haven't seen improvement in my neuropathy, but it also hasn't gotten worse. One thing that I HOPE is for sure, though, is that I've avoided a future diabetes diagnosis.

[glenntaj]

--this issue comes up here, and I feel obliged to refer people back to the many threads we've had in the past about impaired glucose tolerance and neuropathy occurring short of a diagnosis of frank diabetes,

Here's one of them:

http://neurotalk.psychcentral.com/sh...1828#post21828

And, here are some more references in which this is discussed; there is actually a fair amount of literature pointing to neuropathy, especially painful small-fiber types, happening at early stages of glucose dysregulation:


http://intl.neurology.org/cgi/content/abstract/60/1/108

http://www3.interscience.wiley.com/c...TRY=1&SRETRY=0

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=16448668

http://www3.interscience.wiley.com/c...07929/ABSTRACT

http://www.ncbi.nlm.nih.gov/entrez/q...d_AbstractPlus

[janieg]

I'll give one word of caution on the Oral Glucose Tolerance Test.

Someone like me with Reactive Hypoglycemia (self-diagnosed as it was) should only take this test with caution. The purpose of it is to see what your blood glucose is at various intervals after consuming a very sweet drink. If you're diabetic or pre-diabetic, your blood glucose will remain at high levels two hours later. If you're a reactive hypoglycemic like me, your blood glucose will tank...which is exactly what mine did. I developed hypoglycemia symptoms while driving home.

Fasting: 80 mg/dL
1/2 hour: 144 mg/dL
1 hour: 181 mg/dL
2 hour: 71 mg/dL

This does not happen to me when I eat something like a high carb meal, just something very sugary that causes a quick glucose spike. High carb meals send me into the 170s and 180s,and I stay elevated over 140 for hours.

Unfortunately, your other links aren't working, Glenn. The websites must have restructured.

I haven't discussed my glucose issues with my neuro yet. I won't see him again until October. By then, I'll have been low carb for a year and see if anything has changed symptom-wise.

[mrsD]

Here they are fixed:

http://onlinelibrary.wiley.com/doi/1....1137/abstract

http://www.ncbi.nlm.nih.gov/pubmed/1...t=abstractplus

http://onlinelibrary.wiley.com/doi/1....1136/abstract

http://www.ncbi.nlm.nih.gov/pubmed/1...t=AbstractPlus

One of them is indeed gone however.

[SoftTalker]

Thanks for the replies and info.

I am reading, reading, reading

This group is great.

I am on my endocrinologist's list for ASAP appointment, due to a cancellation.

xxxxx
xxxxx's
Those are my fingers crossed.

[glenntaj]

--can actually be a sign of pre-diabetes or impaired glucose regulation.

Often, in those whose tissues are becoming more resistant to the effects of insulin (with concomitant raised fasting blood sugar levels), it will take more insulin to maintain relatively stable glucose readings. Then, when a person undergoes glucose challenge (either in testing or just eating a meal), the pancreas will overcompensate by producing more insulin than necessary, driving blood sugar levels down to hypoglycemic levels a few hours after eating. People may or may not have symptoms of low blood sugar then, but the extreme swings in both blood sugar levels and insulin levels are not good for body tissues in general, or for nerves in particular.

One of the ways this can be discovered is to have a much longer glucose tolerance test with more frequent draws, such as a 5-hour glucose tolerance test with baseline glucose AND insulin levels measured and then blood draws at .5, 1, 1.5, 2, 2.5, 3, 4, and 5 hours. It is the cycles of blood sugar levels and insulin responses that are instructive--typically, people prone to this have elevated fasting insulin levels to start and then show an exaggerated insulin spike to the glucose challenge somewhere around 1-1.5 hours, with a corresponding big dip to initially raised glucose levels (which may or may not reach diabetic levels), which drives down glucose levels in the 2-2.5-3 hour area. Eventually, insulin levels recede and glucose levels become more normal--that is why one needs the 4/5 hour draws, to confirm this.

And, Mrs. D, thanks for fixing the links.