"Normal" Blood sugar levels can = damage
 

I'm "stealing" Janet Ruhl's thunder in a manner of speaking since I ran across this link that is to her diabetes site that she started and maintains but I thought it might be useful to post here. She has some very interesting info re: blood sugar levels and their affects on organ damage including nerves and PN. The post is a little dated but I think still useful as she cites several studies from Utah (Singleton and Smith's work), Johns Hopkins (Glenntaj's neuro, John Griffin) and Mayo Clinic in AZ that all corroborate each other w/ respect to the importance of oral glucose tolerance testing and PN.

She also has links to info re: blood sugar levels and beta-cell destruction (the cells that produce insulin). As one reads the info from the links it becomes more & more evident that even mildly elevated "normal" blood sugar levels, e.g. a prediabetic designation may already be seriously compromising the body's ability to produce insulin and the cells sensitivity to it - an already slippery slope to potentially developing PN.

Even if you are not diabetic or prediabetic the info may be helpful. I did put this up as a sticky too.

http://www.phlaunt.com/diabetes/14045678.php

Alkymst

Thank you. I posted on the other post about this but thought of something cause this is of interest of me. So would the treatment of this be similar to the person with abnormal blood sugar with a similar way of eating? When people get that under control does it reverse the damage or just not further it?Is there pain just when they get there symptoms or no its a daily issues and when consistent in there health the pain lessens?

Wow, that is really interesting.

I LOVE belinda's thread. I'd never heard about this before.

Reading the research was great. Thank you SOOOOO much.

Daniella
 

I apologize in advance for the length of this post but there’s a tremendous amount of valuable information and answers on this site as well as links to many others so I collected some relevant links from posts in earlier threads to see if I could help to answer your questions. For someone who is pre-diabetic, like myself, as well as for Type I or II diabetics, dietary control of blood sugar levels to as close as normal is always desirable. Together with exercise and meds, if required, it can go a long way to delaying the onset of complications, reducing the severity of the complications and now the latest clinical evidence proves, unequivocally, that diet and exercise can reverse prediabetes and the painful PN associated with it in some cases.
As for a typical diet the ADA or American Heart Association diets are good places to start and you’ll find many good suggestions from forum members along with recipes too. For myself, I try to eat a lot of fresh fruits, vegetables, whole grain breads, whole wheat pasta, lean cuts of beef in moderation, fish, skinless chicken and turkey, pork and stay away from fatty foods, cookies, cakes, candies, most of the normal “snacks” etc.

Here’s one of the early studies to suggest a link between impaired glucose metabolism (prediabetes) and idiopathic painful PN and the authors were among the first to advocate the importance of an OGTT (oral glucose tolerance test) in the diagnoses.
http://www.jabfm.org/cgi/reprint/17/2/127.pdf

I “lifted” several links from earlier threads to excellent articles about improving and even reversing PN from prediabetes.
http://appneurology.com/showArticle....leId=188500771

http://care.diabetesjournals.org/cgi...ract/29/6/1294

http://www.sciencedirect.com/science...d469fd5964375c

http://www.neurologyreviews.com/may06/neuropathy.html

I think the info below which is a direct quote from Smith and Singleton’s study is the best summary I’ve read to date. Their work showed that there were measurable increases both in small nerve fiber densities and length based on comparison of the 3mm distal (ankle) and proximal (thigh) skin punch biopsies after 1 year in the study. All patients experienced improvement and/or reduction in pain except for those people who had the most severe damage at the outset.

“In the present trial, the investigators performed 3-mm skin biopsies at the distal leg and proximal thigh, at baseline and after one year. Baseline distal IENF density averaged 0.9 fibers/mm, and proximal IENF density averaged 4.8 fibers/mm. After one year, distal IENF density had improved by an average of 0.3 mm, and proximal IENF density had improved by an average of 1.4 mm. The improvements were significant.
“By the study's end, the IENFD (intraepidermal nerve fiber density) had increased by about a third for all patients except those with the worst loss of nerve fibers in their extremities. The improvement in proximal IENFD correlated with decreased neuropathic pain and a change in sural sensory amplitude. "Over the first year of follow-up, IGTN (impaired glucose tolerance neuropathy) subjects lost an average of 4% of their body weight and increased exercise from less than 15 minutes to more than 80 minutes per week," said Singleton.
In a press briefing at the AAN meeting, Smith noted that the findings indicate that the effects of IGTN (impaired glucose tolerance neuropathy) may be reversible. In correspondence with Applied Neurology, Singleton echoed Smith's view, commenting that the findings "are of great clinical significance, because the neurology community regards length-dependent neuropathy in general and diabetic neuropathy in particular as irreversible and progressive. The data underscore the importance of identifying neuropathy patients very early in the course of their disease."

With regard to the pain, I’ve read that the pain may actually worsen initially as damaged nerve fibers regenerate and new fibers are produced but eventually the levels do lessen.
Overall, the studies show that in the patient populations examined that DIET and EXERCISE not only improved glucose control and reduced weight, LDL cholesterol and triglyceride levels but that it improved small fiber function, increased intraepidermal nerve fiber density and improved neuropathic pain severity. I think that there is some reason to be hopeful even if the PN is idiopathic and not directly linked to prediabetes.
Hope this very long post helps a little.

Alkymst

Great post Alkymst, being once Prediabetic myself with small fibre damage & some large involvement as well, all of this makes very good sense.
My neuro was confident even 4 years back that if i done the right thing i would be able to fully reverse my PN in time, which has happened to about 98 % of the damage, still got a little healing to do.
I think anyone that fits into this area should take diet, exercise and supplements very seriously and worsening of symptoms is normal as the nerve's regenerate which goes on periodically right through until the nerve's are healed, the same deal with Diabete's 2.
Brian :)

Good Sources!
 

I'm gonna save them for my 'morning coffee' reading tomorrow...tho I've peeked at them - It's gonna take a bit more concentration than I have now.

I've always had pre-D or D-1 'ruled out'....but then I had had the 'thyroid' ruled out as well. Well, Duh?

Really, good reading! - j

Thanks for the links. I should send them to my father and aunt, both of whom are diabetic and are under the illusion that they'll be just fine as long as their glucose levels are below 200. I tried talking to my dad about it this summer, but he sees no reason to alter his diet, choosing instead to believe that insulin will make it all better for him. :eek:

I was diagnosed with type 2 with a glucose tolerance reading of 188, which is considered "pre-diabetic". But because I have gastroparesis, my glucose levels, once elevated, stay high all day long due to food not traveling through my body properly, so there were times pre-diagnosis that I was probably over 200. Now I am extremely careful to keep my glucose levels under 140 at all times.

I figure that if can manage celiac disease, gastroparesis and type 2 diabetes simultaneously, most type 2 diabetics can achieve healthy glucose levels if they are willing to really work hard at it. I've seen enough of the really dire consequences of diabetes (including amputations) in relatives and former co-workers to be plenty motivated to stay as healthy as possible.

Good to know that I may be sparing myself future neuropathy damage as well.

fanfaire
:cool:

Thank you so much for that. Its very imformative. I do feel diet plays a role in how you feel but I think I underestimate it to how much it can. Not only body but mind. Sorry for my late thank you response but its so appreciated.

As some of you may know, I am at my 11th day of being sugar free. I have had two minor episodes of pain in those 11 days, whereas my pain before was so excruciating - daily - that I did not think I could go on living like that. At all. Period. No one could even deal with me I was in so much pain, and I have a very high pain tolerance level.

However, to say that I am sugar free does not mean that my sugar levels are perfect or even within normal range yet. I am working on it and will get them there...but am SO amazed at the difference just lowering them has made. I had not had more than one pain free day at a time in the last 9 months.

My sister, who was worse that I was...is now seeing similar (not completely pain free) results.

I so hope ANYONE WHO IS DIABETIC will give this a try if they have not already done so.

I love eating all foods, as well as sugar-laden ones...more than I can say and am in fact a compulsive overeater. But let me tell you....I will fight and give it all up to have the pain reduced!

Fanfaire:

I just had to respond to what you wrote about your father who thinks he is fine if his sugar is below 200. He sounds exactly like my friend E. E has been diabetic for almost 10 years. Her weight is between 280 and 300 (could be more). Every doctor she has seen has told her "you must lose weight". Her response was "what do you know?". When she tells me this, I just tell her about what happened when I went to Cornell and went into their ACCORD program. I lost most of my weight, never looked better, my sugar is completely fine, I get all testing supplies and meds for free. They examine you from head to toe. They send you to their top eye specialist to check for diabetic retinopathy. I said "now why on earth woudn't you take advantage of this? It's free, and you'll get your sugar down". She once said "they'll make me go on the needle". I use Lantus by the way and it literally saved my life. I explained to her "no, they don't make you do anything you are not comfortable with, it's all up to you, they advise you, they support you, they examine you, but if you want to stay on oral meds, they will give you oral meds".

Her response "well, it's too far to drive into New York City". My response "we can take the access-a-ride, we can go to the appointment at the same time (yes, we can do this, I checked). You can go as my guest". It will just cost you $2.00 each way. For door to door service".

So when you give someone all the opportunity to make their life healthier, better and they shrug and say "No, I don't want to go", well, there's a lot more going on here than diabetes, let me tell you. It's the mind, the craving for the food, they don't want to make any changes in their eatings habits.

She has a diabetic stomach. She is ALWAYS sick. Always in the bathroom. She went to the doctor and they told her 'you have a diabetic stomach, you must lose weight and get your sugar down". Her response to the doctor "what the hell do you know"?? When she told me that I said "you know, no one can tell you how to maintain or even improve your health. You obviously don't want to hear anything from anyone, and that most certainly is your right, but let me explain something to you.......and I explained my neuropathy. Well, she said "well, you have neuropathy, I don't" and I said "what the heck do you think a diabetic stomach is??" I explained gastroparesis and she would have none of it. She claims the doctors don't know anything.

So yesterday (after yet another stomach bout), she calls me up and says "I don't understand why my sugar is 213" I said "you have diabetes, what don't you understand?" She said "but I cook healthy (she makes 15 chicken cutlets for her and her husband, he is 65, healthy as a horse, skinny as a chicken and can eat anyone under the table". She blames him for her diabetes. She says "if I didn't have to cook for him, I'd be skinny"

??????????????????????????????????????

I then said "okay, answer me this one, if you cook healthy, you claim you don't over eat, you claim you eat grilled chicken and vegetables, if this is the case, why are you still overweight?"

Her response: "oh, I like to pick at night, I like chips, and pretzels" I said "well, there you go, this stops tonight, and you'll have a head start.

Yeah, like that is going to happen.

Food is a double edge sword with a lot of people. They simply do not get it. She does not get it and she absolutely will not get it. She is now 63, and getting bigger. It's not going to change unless she wants it to and she does not want it to.

You obviously want it to. Your dad, unforunately does not. It's all in how the mind operates the body. If a person gets scared enough about their disease, they will say "oh, boy, I'm not going to let this disease control my life". That's what happened to me and my diabetes.

And with some people, it's the exact opposite. They control their bodies by NOT EATING. Happened to my closest friend. She's been anorexic since she's 14. I am going to her funeral today. She died two days ago. I was with her the day before. I held her. She could not stop the anorexia. She had cancer, but everyone says that if she had listened to the doctor and put good nutrients in her body,well, she might have had a chance.

Want to hear something that will blow you away???

When I was sitting next to my friend on Tuesday, she weighed at the most 60 lbs. It was nearing the end, hospice people were there and they had a little bottle of morphine which they administer via a dropper into her mouth.

She was sleeping. I will never forget what happened.

As the hospice nurse was putting the dropper into her mouth, she woke up and said clear as a bell "what are you putting into my mouth". The nurse said "calm down, it's not food, it's morphine". She quieted down immediately.

I will never forget this. Eating, Or not eating. It's depression, it's control, it's deadly, if it's not taken seriously.

You are one smart cookie. You will get your condition under control.

I do wish you the best. I'm proud of you.

You also educated me. I was under the assumption that if you get your sugar tested and it's 188, you are automatically considered a diabetic. You just taught me that it's pre-diabetic.

See, learn something new every day!!

be well,
melody

This is a very valuable thread...
 

I have a couple of other things to add...

One is post-prandial sugar spikes. These may be the real culprit to
PN. Newer control measures for diabetics contain ways to prevent huge
spikes in blood sugar right after eating.

Now that I am getting much older..I find I have to have a small bit of carb
now and then. I keep them below 70 cal if I have a snack. The doctor wants me
to have a very sour thing twice a day...so I sneak in a Jolly Rancher.
(to keep my saliva flowing and the glands from swelling).

Cinnamon is now available in capsule form.
I am currently examining this for myself, even.

http://altmedicine.about.com/od/cinnamon/a/cinnamon.htm

My condolences on the loss of your friend. What a long, painful way to go. It's terrible, the psychological effect food can have on a person. I am a former binge eater (no purging, thank goodness).

It's a shame about your other friend too. If she has gastroparesis and she's eating a lot close to bedtime, the food will be trapped in her stomach when she lies down to go to sleep and her glucose levels will be elevated for several hours afterward. She may even have elevated glucose levels when she first gets up as a result of food not being completely digested from the night before. This can lead to all sorts of complications.

There was more I wanted to add, but I'm having a sudden attack of brain fog and exhaustion so must stop here.

Thanks so much for your post.

fanfaire
:cool:

Melody, I'm so sorry for your friend and the family. My heart goes out to them and you.
Great job on 11 days. I really can say I'm a sugar addict. Its such a cycle. My sugar levels though are fine but I feel yuck from it. I'm sure it contributes to my stomach issues and overall bad feeling. My nutritionist said its normal for people who have had long term starvation even after weight restoration to crave it. Something about the brain still being in that mode. My calorie needs are super high too still which I know many would love but is a chore especially when there are still the mental parts I battle.
Anyhow I'm not into diet books but there are a lot of health books now focusing on food and pain. I do like that Dr oz on Oprah he seems great.Like I said on another post I encourage a good and that is the key nutritionist. I really can say without mine and the road map of a meal plan I would be sick still in that way. A good one can help with the mind and body connection. So much is mental when choosing foods.
A ? my endocronolgist said hypoglycemia which I was told I had in the past is not a real issue that its just when you go too long without eating. Can someone explain? Also could an issue like that contribute to pain? I know it can contribute to dizzy.

Hi Daniella;

As someone explained to me, when we have an episode of hypoglycemia (low blood sugar), that also, can inflame the neuropathy. I never knew this. I always thought, high blood sugar, bad day of neuropathy. It never occurred to me that if my sugar reading was like 60 (if it does that, I start to lose my vision), this rarely happens, but it has happened on two occasions. I was asking questions on this topic and someone on the boards explained that when your blood sugar readings are erratic, well, yes then, it can lead to the neuropathy flaring up.

So, wonder of wonders, I got up this morning and my sugar reading was 100. I could not believe it. It is usually 123 to 135. Sometimes it's 117 but never, never has it been 100. I have been good in my eating habits. Don't cheat, I walk every day. I just do it, I don't think about it. I cut out all the refined carbs and sugars a long time ago. Made the decision, implemented it, never looked back. I guess that's how my mind works. I think there's a bit of OCD going on there. But who cares?? Now my Lantus intake is 30 in the morning. When I began the Cornell protocol it was 46 of the Lantus, along with metformin. As I began to lose my weight, they first took me off pills. Now I had been on various oral meds for 15 or 16 years at that time.

I was amazed that they could take me off half my pills. So I began the 46 of the Lantus. Over a period of 2 years, they would lower it by 4 units at a time. They would go according to my A1c which kept lowering. I started Cornell with an A1c of 9.0 and now I'm 6.1. Not bad for a person with diabetes. A non diabetic would be about 5 (at least that is what I have been told). I go again in October. If my sugar continues to be controlled, I believe they will lower my Lantus to 26. Can you imagine?? From 46 to perhaps 26. They even believe I will someday be off all meds. That is if I can achieve a weight loss that is perfect for my body. Now I have no idea if this will occur.

But they explained this to me. As you lower your Lantus, the fact that you are on less insulin, well this means your body will lose weight easier. I never really understood that diabetic meds are a double edge sword. They keep you from losing the weight you wish to lose. The only oral med that doesn't do this is metformin. But in my case, it didn't do a darn thing except keep me in the bathroom, but I didn't lose any weight on it.

But as soon as I began the Cornell Protocol and I took this very seriously (and unfortunately I had to be the age of 56 to do this), well, slowly, very slowly, the weight is coming off. And it's coming off faster now, because I'm on less insulin.

I cannot wait until the day I go there and I weigh what a 5'7 inch person is supposed to weigh. I will probably start hooting and hollering.

I never knew a person of 59 could do this. And yeah, there is some lose skin on my tummy but who the heck cares. A good SPANX product (ever here of this), well, it holds you in and who knows you are wearing this.

You have no idea how it feels to walk into any store and buy something off the rack and if that something happens to be a size medium (a big size medium) but it did happen to me. I bought a skirt and it was size medium. I got it home and it fit. It kind of makes you want to continue on the program.

I don't know what I weigh. Only Alan and my docs at Cornell know what I weight. Alan knows that when I hit a certain number, he can tell me.

If that day happens, well that's great. If it doesn't, well, I will have at least done my darndest to be healthy. That's about all we can do right??

So you all stay fit and fine.

love, Melody

P.S. And about my friend with the diabetic stomach. I am determined to keep any opinions on her diabetes to myself. I mean, if she can tell a doctor "what the hell do you know", what would she tell me? Even if she asks me my opinion, I will say "go and see an endocinologist, that would be your best bet". I don't want her jumping down my throat. I'm just waiting for her to blurt out "I bet you think you are hot shi* because you lost the weight". I can't wait for that to happen. People do that, you know, because if they are obese, well they are not comfortable being around people who have been able to lose the weight. Happens to me all the time. I just smile and say nothing, because you can't win in a conversation when that happens. I just say "now why would you say such a hurtful thing to me". Then they sit back and realize what came out of their mouth. Happens all the time now. Never happens with the thin people though. Isn't that interesting?

I have no idea what your health issues are, but I want to mention that I regularly buy cinnamon (and ginger) since I read that both can help relieve depression. I haven't had any depression in a long time, so maybe these things are to thank in some small part.

That's not what I wanted to say, though.

I wanted to say that since I've been adding the Jarrow whey amino acids to my coffee, with a generous dash of cinnamon, that I've had a lot of pain reduction, and I think it relates to my body needing the anino acids to regrow the nerves. I found an article about that, and it does seem that my back pain decreases after I begin to include more protein in my diet.

I say that because I've experienced that more than once.

This time, I happened to stop having the desserts I could have with my evening meal every day, and somewhat after that the pain decreased, so I have to believe that may have been a contributing factor.

Point? that cinnamon is great in coffee with added amino acids, I guess.

Didn't sleep much, may not be making sense.

A follow-up to MrsD's
 

comments I've included some links to the apparently increasing importance of post-prandial glucose levels from Novo-nordisk and the ADA.

Novo Nordisk
http://press.novonordisk-us.com/internal.aspx?bid=119

American Diabetes Association
http://care.diabetesjournals.org/cgi/reprint/24/4/775
http://clinical.diabetesjournals.org...print/22/4/169
http://clinical.diabetesjournals.org...eprint/20/2/71

I also found this link to an abstract which certainly supports MrsD's comments re: cinnamon

http://www.ajcn.org/cgi/content/abstract/85/6/1552 (abstract only)

Here are a couple of unrelated (to this specific thread's topic) links that I found interesting too.

One describes how a nerve regeneration model was developed using capsaicin - also concludes, as we know, that small-fiber abnormalities are evident long before the frank presentation of symptoms or signs of diabetes are manifested.
nerve fiber regeneration model
http://brain.oxfordjournals.org/cgi/reprint/127/7/1606

The other is a comparison of patients with polyneuropathies, both small-fiber and large fibers and concludes that small diameter fiber loss and the corresponding sensory symptoms (pain, etc) can be more dramatic in patenits with mixed neuropathies, i.e small and large fiber involvement rather than small-fiber alone. The paper also gives a nice description of the compelemtarity of NCS (nerve conduction studies), IENFD (intraepidermal nerve fiber density, and QST (quantitative sudomotor testing) since the tests reflect different nerve fiber involvement, i.e. no one test can determine all neuropathies.

http://www.blackwellpublishing.com/p...mcqs/feb06.pdf

hopefully this may prove useful to the forum.
Alkymst

Very nice catches, Alkymst--
 

--especially that last one, which I'm adding to my database. Interesting paper, and the list of references alone (most of which I've read and are in the database) is a great primer for people who need to learn about sensory neuropathies and how they are detected.

It bears reiterating--the power of this community lies in our collective "snooping" skills--and together our resources overmatch those of most university medical depertments. (And doctors ignore this at their peril. :D)