At this point it is not a given I will even have the biopsies. My neuro doing the EMG/NCV testing just mentioned them when I asked what else can be used to find the cause if the tests he was performing we inconclusive.

Will the treatment be significantly different if I do or do not have them done? What I mean is, once it has become an issue of small fiber damage, aren't there basically a set of treatment options that really do not change if you have the test or if you don't?

This word is misleading when it comes to small fiber damage.

The only real treatment is removing the offending substance, and creating
an environment where the nerves may heal.

http://neuroskinbiopsy.mgh.harvard.edu/smallfiber.htm

1) if a toxin or drug is causing this...removing it has to be done.

2) if an autoimmune process is going on (gluten) or other, then that should
be measured. Some immune suppressing drugs may help (or may not).
Going gluten free for those reacting to gliadin, often helps. We had several people in the past for whom this worked wonders.

3) Prediabetes, insulin resistance, and frank diabetes must be handled appropriately. The sorbitol pathway is what damages the nerves.

4) nutritional challenges, such as low B12, MTFHR folate genetic errors ID'd,
thiamine deficiency, low iron, EFA deficiency all can be remedied and healing
may occur and damage ended. Some patients find mitochondrial supports very effective. (l-carnitine and CoQ-10)

Therapy for small fiber as it stands today involves typically symptom relief.
There is a list of treatments in the stickies. They are called "treatments" but they are only symptom relief...they do not change the course of PN.

The only REAL treatment is IVIG.

This sticky has some good posts on it:
http://neurotalk.psychcentral.com/thread177-2.html
post #13 is an old list I used to have up a couple of years ago.

I'd add to it, but we have an edit time of 24 hrs.
(I would add r-lipoic acid instead of alpha lipoic, and benfotiamine to the thiamine entry). R-lipoic acid is very effective for insulin resistance.

Many people over 40 (some experts say all people over 40) have some degree of insulin resistance. While it is not diabetes yet, it has potential for causing the beginnings of sensory PN. It will show up with a fasting INSULIN level being taken--which will be elevated. Often changes in diet, tending to less carbs and more protein and 10% more good fats will keep it in check. Some people use oral antidiabetic drugs for this..like metformin, or Actos. Females with polycystic ovary disease
often have insulin resistance.

So I think it is a good idea to have the skin biopsy if you have significant issues. It will tell you if damage is present. And then you go from there.

Mrs. D.

How much R.Lipoic should a person with Type 2 take??

Thanks much.

Melody

Once people are on medications, for diabetes, r-lipoic acid has to be used
very carefully. It will lower blood sugar, and perhaps then your medications would need to be adjusted.

In your particular case, you are in that ACCORD study....don't they have rules
that you cannot take things that interfere with the blood sugar?
Most of the time studies are very strict and restrictive.

You should ask your doctors there if it is allowed.

The benefits of course of r-lipoic on the PN itself have been published for quite a while now. (as alpha lipoic acid). R-lipoic just requires much lower doses.

Here is a new paper from Russia in fact:
and here is an interesting paper... switching patients from alpha lipoic acid
to more costly less useful drugs..

Actually, the ACCORD study is not primarily about diabetes, it's about heart disease in diabetic women. And about Blood Pressure. ACCORD stands for Action to control Heart Disease in Diabetic Women.

They are trying to determine who gets a heart attack first, the people who are in the intensive study, or the people in the conservative study. I was in the conservative study, but my body responded like I was in the intensive study.

Then, a few months ago, something happened and they STOPPED the intensive study and put everybody in the conservative study. Didn't affect me because I'm doing good. Thank god for that. But I'd like my blood sugar to be around 100 when I wake up in the morning. That's why I asked about the r-lipoic.

I see them on May 30th. I'll run it by them. I don't expect to find any problems. They are quite proud of me because I completely changed my way of life and broke their protocol. Something about my a1c going down lower then was expected in the protocol. They said "not good for the study, but very good for YOU".

And, from what I've gleaned from speaking to them about supplements, they have no faith in them whatsoever.

Don't worry,I'm not taking anything till I speak to them.

Thanks much.

Melody