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Old 10-06-2007, 03:18 AM #1
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Hi Jasonius and welcome to the forum,
Your sugar levels above normal range could indicate Prediabete's, which a lot of doctors ignore but it can cause the same symptoms as a full blown diabetic, burning feet is one of the symptoms and should NOT be ignored.
Excessive insulin levels can be very dangerous and that should be evaluated properly, it can lead to real problems like Diabetes amongst others and seeing you felt a differance in temp feeling with his neuro test, i am surprised that he never ordered Quanitive Sensory testing, your burning feet is a typical sign of peripheral small fibre damage to the extremities.
this explains QS testing - http://millercenter.uchicago.edu/lea...nt/index.shtml
I would have a good talk to my GP about those Insulin levels and definatley find another neuro that is a real expert in PN.
good luck,
Brian

Last edited by Brian; 10-06-2007 at 03:37 AM. Reason: spell
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Old 10-06-2007, 07:06 AM #2
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Default I underline everything that Brian says--

--and he certainly has first hand experience in this realm.

There is increasing evidence that high insulin levels, especially as revealed during glucose challenge, may well be the first step on the path to diabetes, but that one can get neuropathic symptoms--especially small-fiber sensory ones--well before a frank diagnosis of diabetes can be made, when one is in the realm of "impaired glucose tolerance". And subtle abnormalities of glucose/insulin relationship may not be observable except through such extended glucose tolerance testing (in other words, your "fasting" glucsoe levels and hemoglobin A1c readings may be nicely in range, and you can still have a problem).

High insulin levels (that are not caused by insulinoma, which is very rare) are usually due to insulin resistance--the body's cells have become inured to its actions, meaning much more must be produced to get glucose into cells past resisting cell walls so as to keep blood glucose within tolerable levels. Without dietary and/or exercise intervention, resistance often will increase until the glucose levels can no longer be kept within non-diabetic ranges.

Here are some papers that talk about pre-diabetic neuropathy (so you can show the nuero):


http://www.massgeneral.org/neurology...dOaklander.pdf

http://appneurology.com/showArticle....leId=188500771

http://care.diabetesjournals.org/cgi...full/24/8/1448

http://www.neurology.org/cgi/content/abstract/57/9/1701

http://www.medpagetoday.com/Neurolog...rology/tb/3538
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Old 10-06-2007, 08:17 AM #3
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Originally Posted by glenntaj View Post
--and he certainly has first hand experience in this realm.

There is increasing evidence that high insulin levels, especially as revealed during glucose challenge, may well be the first step on the path to diabetes, but that one can get neuropathic symptoms--especially small-fiber sensory ones--well before a frank diagnosis of diabetes can be made, when one is in the realm of "impaired glucose tolerance". And subtle abnormalities of glucose/insulin relationship may not be observable except through such extended glucose tolerance testing (in other words, your "fasting" glucsoe levels and hemoglobin A1c readings may be nicely in range, and you can still have a problem).

High insulin levels (that are not caused by insulinoma, which is very rare) are usually due to insulin resistance--the body's cells have become inured to its actions, meaning much more must be produced to get glucose into cells past resisting cell walls so as to keep blood glucose within tolerable levels. Without dietary and/or exercise intervention, resistance often will increase until the glucose levels can no longer be kept within non-diabetic ranges.

Here are some papers that talk about pre-diabetic neuropathy (so you can show the nuero):


http://www.massgeneral.org/neurology...dOaklander.pdf

http://appneurology.com/showArticle....leId=188500771

http://care.diabetesjournals.org/cgi...full/24/8/1448

http://www.neurology.org/cgi/content/abstract/57/9/1701

http://www.medpagetoday.com/Neurolog...rology/tb/3538
Brian,

Thanks for the help. The first three and last links there don't work. They have the three dots breaking them up.

I know pre-diabetes is linked to PN. That is why I asked my family doctor for the 3 hour glucose tolerance test. He said no but I insisted to have it. It did come back positive and then he diagnosed me as pre-diabetes.

Also I asked him about the abnormal ratio of the albumin and globulin in the blood test which tests for kidney malfunction. He ordered a urine analysis and then a 24 hour urine analysis. They came back high and he wrote me a prescription for a Nephrologist.

So for pre-diabetes I've been avoiding sugar and bread and having mostly fish and vegetables and exercising. I am normal body weight. I wonder what else would cause high insulin levels though besides insulin resistance. Also why do people with pre-diabetes get PN when people with long standing diabetes don't get it? Obviously I have high insulin production and also the beginning of PN.
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Old 10-06-2007, 09:08 AM #4
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Hi Jasonius and welcome to the forum,
Your sugar levels above normal range could indicate Prediabete's, which a lot of doctors ignore but it can cause the same symptoms as a full blown diabetic, burning feet is one of the symptoms and should NOT be ignored.
Excessive insulin levels can be very dangerous and that should be evaluated properly, it can lead to real problems like Diabetes amongst others and seeing you felt a differance in temp feeling with his neuro test, i am surprised that he never ordered Quanitive Sensory testing, your burning feet is a typical sign of peripheral small fibre damage to the extremities.
this explains QS testing - http://millercenter.uchicago.edu/lea...nt/index.shtml
I would have a good talk to my GP about those Insulin levels and definatley find another neuro that is a real expert in PN.
good luck,
Brian
Brian, thanks for the info. That site says that QST uses temperature to test the small fibers and vibration to test the large fibers. He didn't use QST but he used hand held tools to test temperature and vibration and asked me for feedback. My legs were positive on the temperature and not the vibrations.

I don't understand how his test was positive for small fiber peripheral neuropathy, which is what I have, but yet he reported back to my doctor that he found no signs of it.

Help me with this. I have had an impossible time getting doctors to help me with PN the last couple months. Is there a medical record that doctors can access for information on patients. Mine would say "hypochondriac" for sure. I don't think there is such a record or anyway for doctors to get that information. Does anyone know if there is something like this? If there is I am SOOL.

By the way here is the neurologists website: http://www.med.upenn.edu/apps/facult...hp/g324/p11842

"Description of Clinical Expertise:
The diagnosis and management of peripheral neuropathies."
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Old 10-06-2007, 06:47 PM #5
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Brian, thanks for the info. That site says that QST uses temperature to test the small fibers and vibration to test the large fibers. He didn't use QST but he used hand held tools to test temperature and vibration and asked me for feedback. My legs were positive on the temperature and not the vibrations.

I don't understand how his test was positive for small fiber peripheral neuropathy, which is what I have, but yet he reported back to my doctor that he found no signs of it.

Help me with this. I have had an impossible time getting doctors to help me with PN the last couple months. Is there a medical record that doctors can access for information on patients. Mine would say "hypochondriac" for sure. I don't think there is such a record or anyway for doctors to get that information. Does anyone know if there is something like this? If there is I am SOOL.

By the way here is the neurologists website: http://www.med.upenn.edu/apps/facult...hp/g324/p11842

"Description of Clinical Expertise:
The diagnosis and management of peripheral neuropathies."
I also had a hell of a time convincing doctors that i had real problems, i went to 6 GP's none of them had a clue, one rheumie, that couldn't find anything wrong and one Professor of Neurology, who done a Nerve Conduction test and said, " i showed no signs of PN,[ nerve conduction only tests for large nerve damage] another idiot that actually said to me " i don't think you have burning feet, the test [NC test] proves that , it was the Internet that helped me find out what was wrong, in particular the PN forum i stumbled across in my desperate search for answers, the experts here pointed me in the right direction, thank god, so i insisted that my local GP send me to a PN expert which i eventually got to see [ after a battle with him ]and he diagnosed "Prediabetes" as the cause after a 3 hour Glucose tolerance test,
& i was running real low on B12 as well.
The reason why your feet are burning is that the small nerve's are damaged and are sending confused signals, your small nerve job is to sense heat, cold & pain, a clear indiction was when you felt that neuro's tool feel differant above your knee, he should have picked that up and sent you for a QS test.
I have to get going , pretty busy day today, but others will explain more.
Brian
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Old 10-06-2007, 08:20 PM #6
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Default Hey Jason--

--sorry about several of those links not working with the ellipses; I copied them from another post on this board in which they did seem to be working.

Let's try again:

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

http://www.ncbi.nlm.nih.gov/sites/en..._uids=16448668

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

http://www.ncbi.nlm.nih.gov/sites/en...d_AbstractPlus

Couldn't get the original link for the fifth one, for reason, but these four should provide a basis if you ever need one.

Here's another link:

http://www.ncbi.nlm.nih.gov/sites/en...RVAbstractPlus

And I think Brian Paul's post is a very cogent explanation of why so many of us have had to go through the diagnosis merry-go-round that Dahlek talks about.

Still, an informed patient who is willing to challenge a doctor for not looking beyond the borders of the box is still in a better position, even if the doctor's hackles get raised, than an uniformed patient who just unquestioningly follows every physician pronouncement. It is absolutely vital that one always gets one's test results, that one examines them closely, and that one not feel intimidated in suggesting certain other tests to a physician or in contributing to the running of a protocol. Good doctors do not mind an informed patient--most rather appreciate it. Those that object and take the "I'm the expert--just do what I say" route are generally not only forgetting that we are the ones who live in our own bodies, and so are, in the end, the final experts on them, but are engaging in an egoistic and obvious self-justification.

Last edited by glenntaj; 10-07-2007 at 06:28 AM.
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Old 10-06-2007, 08:40 PM #7
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Default Living proof

Glenn's statement about being willing to challenge a doctor is the beginning of how I was finally diagnosed. The neuro I was using at the time basically had given up on me. Tests were all negative that he ran. But I was in terrible pain with symptoms of small fiber sensory neuropathy. I had been diagnosed with Sjogren's Syndrome previously. Thru the help I received on this board and my own research, I was able to print off a series of applicable documents that showed the relationship of neuropathy to Sjogren's Syndrome. I mailed them to the neuro who had given up along with a cover letter telling him that I had spoken to his nurse and she said she didn't think he'd mind receiving some current literature relating to the problem (which was true).

The neuro called me on a Sunday afternoon. Told me he'd read my research and he was referring me to one of his associates who was a neuromuscular specialist. She ran a few tests of her own and told me she agreed with the research I'd found. But we had no way to prove it. She decided to refer me to Mayo Clinic. I eventually received an appointment with the help of a close physcian friend. Mayo diagnosed me with Small Fiber Sensory Neuropathy caused by Sjogren's Syndrome.

It was thru my being willing to challenge the doctor and educate him that I finally received the diagnosis. I continue to educate my neuro and my rheumatologist about the devastating effects of Sjogren's on the nervous system. They are both willing to learn. I feel thru my efforts to educate them both, I am perhaps helping someone else with this illness.

Billye (didn't mean to write a book)
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Old 10-07-2007, 08:35 AM #8
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Lightbulb your drug use...

Risperdal may be the culprit. Please answer the questions I posed a bit earlier so I can understand your predicament better.

Also I just learned that the new fats included in food, (to effect the trans fat
removal that is currently in effect) called interesterified fats on labels,
can raise blood sugar 20%!

http://www.sciencedaily.com/releases...0116131545.htm

These would be in restaurant foods, cakes/cookies, some processed food, some peanut butters.
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Old 10-07-2007, 12:37 PM #9
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I also had a hell of a time convincing doctors that i had real problems, i went to 6 GP's none of them had a clue, one rheumie, that couldn't find anything wrong and one Professor of Neurology, who done a Nerve Conduction test and said, " i showed no signs of PN,[ nerve conduction only tests for large nerve damage] another idiot that actually said to me " i don't think you have burning feet, the test [NC test] proves that , it was the Internet that helped me find out what was wrong, in particular the PN forum i stumbled across in my desperate search for answers, the experts here pointed me in the right direction, thank god, so i insisted that my local GP send me to a PN expert which i eventually got to see [ after a battle with him ]and he diagnosed "Prediabetes" as the cause after a 3 hour Glucose tolerance test,
& i was running real low on B12 as well.
The reason why your feet are burning is that the small nerve's are damaged and are sending confused signals, your small nerve job is to sense heat, cold & pain, a clear indiction was when you felt that neuro's tool feel differant above your knee, he should have picked that up and sent you for a QS test.
Thanks again Brian and everyone.

Brian, I brought my GTT test, blood, and urine tests to the neuro. He said the tests didn't show anything related to the neuropathies. My family doctor said a few weeks ago that the GTT test shows that I likely have Pre-diabetes and that might have to do with the neuropathies. I had to ask my family doctor a couple times before he got me the GTT test. He didn't seem to know Pre-diabetes doesn't have to show up in a regular blood test. Since I was on Risperdal so long I wanted that test for Pre-diabetes. I'm glad that your PN expert diagnosed Pre-diabetes as your cause based on your GTT test. Was that all he needed to make the diagnosis?
Quote:
I have to get going , pretty busy day today, but others will explain more.
Brian
Hope you got to relax a bit. Take care.

Last edited by Jason; 10-07-2007 at 01:10 PM.
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Old 10-08-2007, 03:20 AM #10
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Thanks again Brian and everyone.

Brian, I brought my GTT test, blood, and urine tests to the neuro. He said the tests didn't show anything related to the neuropathies. My family doctor said a few weeks ago that the GTT test shows that I likely have Pre-diabetes and that might have to do with the neuropathies. I had to ask my family doctor a couple times before he got me the GTT test. He didn't seem to know Pre-diabetes doesn't have to show up in a regular blood test. Since I was on Risperdal so long I wanted that test for Pre-diabetes. I'm glad that your PN expert diagnosed Pre-diabetes as your cause based on your GTT test. Was that all he needed to make the diagnosis?

Hope you got to relax a bit. Take care.
Thanks mate, i am glad that you were on to the side affects of that drug and you pushed for the GTT, with those results it's real important to keep that weight off, no high sugary carbs, eat sensibly which you are and as Mrs D said, eat lots of Low GI foods especially,the benefits are that the blood glucose level rises and falls gradually, providing a slow release of energy from carbohydrate into the body.
My neuro sent me off with a long list of blood tests to get done as well as the
GTT, all the rest come back ok, but of course my sugar levels were not.
Brian
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