Pre-diabetes, small fiber neuropathy
 

HI, I am a newbie. Diagnosed as pre-diabetic 1.5 weeks ago. I have burning feet. Also some in arms. I am awaiting skin biopsy results from Cleveland Clinic any day. Doctor suspects SFN. I have been having symptoms for about 10-12 weeks. I am 46 year old male 5'9" 168 lbs (have lost 18 lbs in this time from worry & stress). My glucose tolerance test came back at 180. I am otherwise pretty healthy-no smoking-2 glasses of wine on Saturdays-eat my share of junk food. I don't really understand how I got here. I am taking gabapentin 300mg twice a day- helps some. I am very depressed and scared and am also taking an anti-depressant for the 1st time in my life-1 a day very low dose. I have also decided to win this battle. I am excercising daily and have started watching my carbs and diet. I am looking for guidance on what I should expect and possible supplements that might help. Can my nerves heal? Thanks in advance for any advice!

Hi crewski & welcome to this forum.

Yes nerves can heal over time and it is a slow process, but once the cause of the nerve damage is taking away it does give the nerves a chance to heal.
Mine was caused also by prediabetes with mostly small fibre damage, plus some large nerve damage as well, going by an EMG.

Supplements that have helped are,
B12 methylcobalamin 1 -5 mg daily [ on an empty stomache ]
gamma-linolenic acid - 480 mg daily [ 2x 240 mg]
R lipioc acid - 100 mg daily
Thiamine 100 mg x 3 tabs daily.

It is very hard at first to work out if the nerves are healing or flaring up, at least in my case I couldn't tell the differance for at least 8 months then the symptoms become less severe and less often which went on for a few years until they were completly healed.

best of luck to you
Brian :)

Thanks Alot, I will look into supplements. Any tips on where to get them?

Hi
The absolute first thing you MUST do is get your glucose under control. You are diabetic. I don't think there is such a thing as pre-D. It's like being pregnant. Either you are, or you aren't. Keep your carbs to 45 or less per meal, use your meter to see what a certain food does to your glucose. If its white, don't bite. Rice, pasta, bread, potatos. Fruit in moderation. Excercise if you can.

The supplements could help. I don't know much about them. I do know with good control your nerves can improve. *edit*

Every so often--
 

--I break out my list of material on impaired glucose tolerance short of frank diabetes and neuropathy, a condition becoming increasingly recognized.

Even blood sugar readings that would not be considered in the range of frank diabetes, but would just be considered "impaired glucose tolerance", such as those in the range of around 100-125, have been associated with peripheral neuropathy, particularly those of the small fibers, which tends to be burning, lancating, and electrical in symptoms, and not necessarily the stereotypical "numb". There's been a lot of research coming out about this in the last few years; I keep a list of papaers and studies on this that includes:


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

There are a lot more, but you get the idea.

Certainly, a long glucose tolerance test is called for; I have mine done for at least four hours with glucose and insulin levels taken at baseline and then every half-hour through at least three hours. Often, it's the pattern of ups and downs of the glucose and its interaction with the insulin response that's most revealing.

Supplements
 

I get my B12 (and all the others) from
www.iherb.com

-Jarrow sublingual Methyl-cobalamin B12
1000mcg (1mg), to 5000mcg (5mg)- daily
(on an empty stomach)

-R Lipoic Acid (100mg - take with food)

-CoQ10 (100mg)

-P-5-P B6 (50mg - no more than a combined total with others
such as B Complex or multi-vits of 100mg daily)

-Benfotiamine (thiamine replacement, 150-300mg)
-Fish Oil (2400mg)

Thanks for the advice, Are you basing my carbs on my weight etc? I have read so many different things I have been confused- I see things that say 6/12/12 which is break. lunch dinner & I think I will starve- other things say 300 a day!
I have been excercising aggressively 40+ minutes a day on treadmill-usually burning 200+ calories.

You can reverse your prediabetic state by eating the right foods, exercising loosing any excess weight and keeping it off.

If you have not got a glucose meter yet I would get one and test your reactions to differant foods 2 hours after the first bite of food of every meal until you get the idea of what & how much food you can eat to keep your sugars at moderate level, never skip meals as low sugars also damage the nerves as well.
I know that a lot prediabetics & diabetics count carbs but I personaly don't, I just know what foods are high GI and just don't have much of them and fill myself more with protein and other low gi foods... soft drinks, fruit juices etc, are full of sugar and will really spike your sugars, there is plenty of info on the net about what foods you can eat.

Its can be a bit over whelming when changing your diet at first but it doesn't take long to get used to it all, one thing that helped my post meal sugar levels was just a 15 minute walk after each meal.

Okay, Thanks- I will be getting prescription for meter soon, From what I hear strips are covered by insurance. Has anyone heard of burning symptoms spiking when you start to get glucose leves down or are my symptons just accelerating from initial onset?

a diet that has a proven track record is The Zone.

it uses the glycemic index, meal size, protein and good fats well.

It is important to control meal sizes to keep sugars after meals under
high levels. consumption of good fats keep the stomach from emptying
too fast and spiking your sugars.

I think you should also track your A1c levels which
give a good way to guide you.

I'm typing on my son's tiny netbook,and just can't get the hang of it :confused: I'll be back tomorrow ;)

I just re-read your first post and that score of 180 seems well above the pre-diabetic range of under 126, more like frank diabetes 2, our glucose measurements are differant than the USA measurements, so someone correct me if I am wrong, maybe speak to your doctor about some metformin to help.

As you mentioned in your initial post " worry and stress " can certainly aggravate your symptoms.

Okay Thanks, What are AIC levels and how do I track them?

An A1C test measures how much glucose has been sticking during the past 3-4 months to hemoglobin, the substance in the red blood cells that carries oxygen to the cells of the body, just gives an average reading over that time, your doc can order this test.

Okay I will check with my gp on that. The things I read on the internet in the states say over 200 reading on ogtt test indicate DM. Of course all of this is probably semantics if it has caused my problem and it seems that is the case. Brian if you don't mind me asking where all did you have small fiber problems? Thanks to everyone for the help and information.

Sorry mate no sleep last night [ the old brain was playing tricks on me lol ], it is 200 as you said, but getting a bit close for comfort though all the same.

Mine started in feet then pretty quickly went up my legs.
I had the burning and electric like jabbing also numbness mostly around the soles of my feet.
I was low in B12 so that probably explains the large nerve nerve damage found on the emg.

Yes 180 is way too close! I am thinking about going ahead and getting meter b4 I get prescription. I really want to see quickly how my last 1.5 weeks of low carb etc. is impacting my#'s. Also did you take gabapentin or neurontin or can anyone else tell me is it possible to confuse symptoms w/ effects of med? I am feeling so many different little hot & cold sensations in feet and legs that i wonder if some can be from med and confusing me.

Not sure how it works in US but in OZ you can buy a glucose meter in a pharmacy or over the net but we get a script to suit the meter from a doc for the testing strips, the needles can be purchaced over the counter at any pharmacy.
I did try low dose Neurontin at first but it made me feel awfull, so the doc put me on Tramadol SR [slow release] and Endep as well, they worked very well for me, meds are an individual thing, what works for some may not work for others.

The hot/cold sensations is proof that your small fibre nerves are affected as their job is to send messagers of sensation [ hot, cold, pain ] to the brain, if they are damaged they send confused signals which the brain misinterprets.

Well, I got a meter this morning and two hours after 1st bite my reading was 83. For breakfast I had two slices of whole wheat toast (18g's carb total minus fiber) and 1 cup cheerios (23 g's carb minus fiber) in 2 oz skim milk (3 g's carb) and two thin slices of ham 96% fat free no carbs. This is a cheap walgreens meter & I have not tested control solution yet. Should I take this as good or too low? I am going to excercise, eat a small snack then lunch later then test again. Also is it expected that with the SFN my feet still feel normal hot and cold sensations (if I touch something hot & cold)? I know this is a mouthful-just trying hard to understand all of this- I am a purchasing mgr and a baseball/basketball coach so all of these things are greek to me! Thanks again for all help and support!

You should test a fasting rate first thing in the morning. (no food after midnight). This will show if you are having too much insulin (if very low) or if your liver is starting too much gluconeogenesis just before you wake up. Do a fasting every day for a week and see what dinners the night before affected.

Sometimes prediabetics show low readings at first (except for perhaps the fasting morning one) for a while. This is because you are making MORE insulin than you should. These lows are really also bad for the nerves.

None of your readings can be considered accurate until you calibrate that machine (testing solution) and strips.

When you are prediabetic the HbA1C is a very good indicator of overall risk of diabetes. If it is over 7 and you are 60 and above, that is the start of type II.

There are other food things that can cause burning in the hands/feet.
1) gluten intolerance -- this can be acquired, and is insidious and complex.
Avoidance of wheat, rye and barley in everything sometimes helps. We have a Gluten forum with information at the top of that page.

2) some people have food intolerances. The biggest for me was Nightshade vegetables. I cannot really tolerate potatoes anymore. I get burning the night of the day I have them. I still cheat now and then but 90% of the time I am potato free. Some concentrated tomato sauces will do it to me too, but not all of them. Each person may have some food issue: eggs, chocolate, soy, dairy are all potential culprits. The only way to find out is to do an elimination diet, remove one group for a month, and reintroduce it and see what effects if any there are.

Okay, Iwill check tomorrow am when I wake up. My reading 2 hrs after lunch was 104. I counted 45 carbs in that meal. I will also take an AIC test. Do you have SFN and you are saying some foods aggrevate the condition or that these foods cause burning etc on their own w/out SFN. Thanks for you help.

I am not sure how the SFN and food link manifests for each person. I've had PN for 30+ yrs.... and it was only recently that the burning got out of control for me. I've had insulin resistance for many years, and control it with the Zone Diet. Most of my PN prior was PAIN, and not burning. So with time this other issue appeared, and the trigger for me was the potatoes. (I found this by following suggestions in Dr. Jensen-Kittley's book:
http://obesitysanswer.com/

Her suggestions to eliminate certain foods, and also use Inositol were very helpful for me specifically. It has been a long road and much effort for my solutions. I use this as an example so you don't expect a quick one, necessarily.

Well, I checked some recent medical records and my gp had already ordered an a1c test on November 13th and my score was 5.7. At the time she told me all was normal- but some things I am reading say this score could be leaning towards pre-D. Is this true and in light of my OGTT score of 180 does all of this add up? My fasting score w/ my meter this a.m. was 84. So it appears my diet excersise routine is working correct? Yesterday after breakfast 83 lunch 104 dinner 94. I had a 60 carb breakfast this a.m.-yesterday was 45 carbs- to see what happens. Thanks for all the help, I think I am starting to understand some of this.

The A1C does go up with age. Yours seems quite good. Mine is 6.2, and has stayed there for a while.

The biggest problem is large portions per meal. This will spike sugar...called the postprandial spike, and the newer goals for Type II are to keep this down. One way is measuring everything, but another is to eat 5 small meals, spread out during the day, instead of 3 big ones.

This is a good calculator:
https://www.accu-chek.com/us/glucose...lculator.html#

This one shows a table form:
http://www.rajeun.net/HbA1c_glucose.html

Hi All, It has been a while since I last posted. I have had a whirlwind month since then. I had my small fiber confirmed by Cleveland Clinic(mild to moderate)- a 1 week bout and hospital stay w/ pancreatitis- switched from neurontin to cymbalta to now nothing except supplements. Also had bad experience w/ capsaicin-WOW was that hot! I am now however doing much better and have learned to control blood sugar. Cymbalta made me sick and not able to urinate- did help some w/ pain. Right or wrong I at least have myself convinced that pain has decreased-don't know if this is due to supp's- sugar under control or my imagination. I am excercising regularly. I wanted to express my appreciation to all who replied when I was way down around Christmas- you will never know how much your support and information helped! I still feel I got a raw deal w/ A1C of 5.7 180lbs and never any Diabetes suggestion and feeling fine and wham SFN out of blue- but I have gotten to the resolved to beat it stage! Thanks again!