Pre-diabetes and PN
 

I have suffered from moderate to severe nerve pain for four years now. I am on 3000 mg of gabapentin.

After having several high blood glucose tests, Dr had me take A1C. This test showed 6.2.

Is it possible that this could be a factor in nerve pain?

Nerve damage can begin to occur any time after your blood glucose goes above 150. Doctors do not tell you that but do some research and you will find that out.

So yes. I don't even have diabetes, nor technically, prediabetes, though I say I AM prediabetic. I have a meter and try to keep my numer below 150.

I have discussed, on numerous occasions--
 

--that there is considerable evidence that neurological symptoms can present well before frank diabetes is diagnosed, while one is in the category of "impaired glucose tolerance" (and that many doctors are unaware of this evidence and think diabetic neuropathy only happens after many years of severe blood sugar dysregulation).

Don't have a lot of time this morning, but searching my name and posts here will bring up links to a LOT of papers and studies about this. It's certainly worth investigating.

I was in your position four years ago. I found my neurologist at Mass General. She is one of the leading pain researchers in the field and pointed to my pre-diabetic status as a possible cause of my nerve pain. As a result, I ended up having Gastric Bypass surgery to take care of my weight issues, which resolved many co-morbid conditions including glucose intolerance, sleep apnea, high cholesterol and high blood pressure. I lost 125 pounds doing this and got into the best shape of my life, despite the nerve pain. It was hoped that my SFN would resolve itself. In many cases it can.

Unfortunately, it seems that my SFN may instead be autoimmune related. I am waiting for more answers from my doctors. Taking care of your blood sugar is definitely an important piece of the puzzle. Good luck.

Pre Diabetic PN
 

My Ruemi said the same thing, even after telling her that my father had PN too, she said "He probably had diabetes and didn't know it", really? My Neurologist I went to 10 years ago Dx'd it as hereditary neuropathy, somehow that makes more sense, since I try to keep my bloodsugar under 110. I have also had PN for almost 30 years, but I could have had high bloodsugar back thenm as I was a sugerhulic back then. I think at the end of the day, if there is no obvious cause, it doesn't much matter what caused it, as they don't seem to have a clue how to cure it... Maybe if I exersises more... ;0)

Since you mention that you were diagnosed ten years ago with a hereditary neuropathy perhaps you should pursue having DNA blood testing to hopefully find out what you have. Sounds like your father also had it. If you do not mind sharing, what other symptoms do you and your father have?

DNA blood testing is expensive. Perhaps insurance would cover the cost. If it turned out to be something such as CMT there is no cure/treatment at this time. There are over 70 types identified so far.

If CMT were the case it can be exacerbated by going too far with exercise. No pain, no gain is not for a CMTer.

Hi januarybabe :)
 

The Neurolagist wanted to do a DNA test, I was and still are a cash patient, they wanted $3,000 for the test, but he also said there was no known cure, so I thought it would be throwing money away. I had already had symptoms for 16 years, so I knew I had some sort of PN. It makes more sense today to get the test, as more is known about the different types of PN, so it might be worthwhile. Probably is cheaper for the test now, too.
My father had the burning pain in his feet, he told me, at one point it felt like a fuse burning up his legs, he lost feeling in both legs. I guess this would be considered large fiber involvement. I am getting a progression of pain up my legs to the knee, but not numbness. He also had widespread muscle pain, similar to FMS or maybe MFS. The tendons were like ropes and the muscles were always constricted. He used to solicite back rubs from us kids, as far back as I remember. I have the same muscle tension in almost every muscle. I was thinking FMS, but I have not had many headaches, and my GI track is fine, it is mostly just e tight ropey tendons and muscles with big knots, that do not untie. In fact I had surgery on both my shoulders to surgically remove the tendon knots on my bicep tendons. They were rubbing on the bone and dislocating my tendons when I lifted my arms. Then the last procedure was infected with staph during surgery, so I had to have two more surgeries and gallons of antibiotic IV's, but that is mother story...
That is why I was surprised my Rhumitologist dismissed the family history with "I don't know your father" I guess meaning I made it all up. She says it is just muscle pain caused by wear and tear, even though it has been like this since I was a teenager, many many years ago...
I am wondering if the muscle involvement was caused by small fiber neuropathy?
Sorry for the long winded answer.

Poor you!
That Gabapentin is like stuffing your scull with cotton! I used to have bad brain fog, before getting on a low carb diet, I have been pretty good for 7 years, then start taking GABA, it was like starting over, couldn't remember names, or even finish sentences. I am glad that was short lived, and I was taken off it. I don't think they will try Cybralta, as this interferes with hypothyroid treatment. So the next level is opioids, and I know 10/325 Vicodin does not even touch the burning pain in the feet. Also, they all give you the evil eye, when you go to the pharmacy, like you are just another drug addict. But I am at that point in the pain threshold level to try anything that helps!
Good luck!

I'm a Vet and the VA gave me Gabapentin, and had to take 3-6 daily. Found out this stuff can "fry your liver" too. This medication is mainly used by epileptics. Please be careful. Its your decision.

I wonder who told you that Gabapentin affects the liver?

This drug is NOT metabolized by the liver, and is excreted whole.
It is very unlike other antiseizure drugs in this regard.
There are a small few anecdotal papers on individuals who had a liver event on gabapentin, but the actual numbers are very small and considered rare. Because nothing in medicine is 100% for everyone, anything can happen. But with gabapentin compared to other antiseizure drugs, the incidence is very unlikely.

Now Cymbalta, is the only antidepressant that can damage the liver and it will do so, if patients drink alcohol or use other drugs like Tylenol that are hard on the liver. Many chronic pain patients take Cymbalta with gabapentin.

Also other drugs in combination with gabapentin may factor into some liver effects.

Hey Jon Sparky :)
 

My pain is mainly in the morning and starts back up in the afternoon to bedtime, then keeps me awake with pain til the wee hours. I was taking Ambien for sleep, the "zombie sleep drug", I just went off it two weeks ago after 2 years. Tough drug to get out of the system. Sometimes the pain is nonstop. Luckily it is just burning pain with only occasional lightning strikes, those are the worse. The hot poker stabbing the feet.
I live in a religious community, so I am surrounded with about 30 people, that is a lot of names to forget! I use the phone list to find the name if I get brain fog.
The brain fog used to be bad before I got the blood sugar under control, the Gabapentin just started it back up all over again, after having it under control for about 5 years.
I go back to the Rheumatologist, see what she has next for me to try.
Does the 3.5 Vicodin help? Or does it just make it bearable? I guess maybe in combination with the Gabapentin...

Just to add--
 

--on drugs such as gabapentin (Neurontin) and pregabalin (Lyrica), it is the kidney function, rather than the liver function, which needs to be watched most closely, as neither of these drugs are metabolized by the liver but excreted more or less whole through the kidneys.

One needs to have good kidney function to take large doses of these drugs. Poor kidney function can be a contraindication.

@mrsd - My neuropathy medication consists of 60 mg Cymbalta, 525mg of pregabalin and approx. 15 tablets of t3's a day. Is my combination hard on the liver? If so I will get my GP to get me on different meds for the neuropathy.

Thank You

That is alot of Tylenol for a chronic use IMO. Really the upper limit is 4000mg a day, and you are over the limit now, but combined with Cymbalta....risky.

There are lower tylenol containing opiates. The new Vicodin or Norco are examples. Only 325mg/tablet of Tylenol with more efficient pain coverage.

I would get some liver tests done, to see what is going on. Some people on Cymbalta react quickly with liver damage, and others don't.

Vicoden 325 and Brain Fog
 

:)

Good afternoon,

It sounds like Vicodin 10/325 is a low dose, I was prescribed the same strength Vicodin. No wonder it does not take care of much.

I had Q-tip brain fog with the GABAPENTIN and that lasted only a week.

I was just forget what I was looking for and have to back track my steps. uglogirl

Remission
 

That's scary about taking Gabapentin that it fries the liver. I imagine that Lyrica does the same

Has you PN ever going into remission and if so for how long.

The burning how long does that last during the day. My comes and goes seems less when I am standing then sitting.

I thought 6.2 would be excellent for an AIC reading
Mine were 6s and 7s one time an 8 and now this dreaded curse.

Gabapentin is very unlikely to fry the liver. Please read all the posts in this thread.

I would like to see good evidence of it before continuing this discussion. Doctors like gabapentin and Lyrica because they are not metabolized by the liver and do not damage it or interfere with other drugs that are metabolized by the liver.

Gabapentin and Lyrica are excreted whole by the kidneys. So any reduction in kidney functions will slow their elimination and build up in the body causing side effects.

When you read things on boards like this you need to have documentation before believing everything people may say. That is why I usually give links in my posts.

I thought 6.2 would be excellent for an AIC reading
Mine were 6s and 7s one time an 8 and now this dreaded curse.

Ideal number for A1C would be 5.4. I lowered my number to that, by going low carb, avoiding all sugar and wheat bread. I wish I knew what glucose level I had when I started getting PN...

A few years ago, there was a proposal to lower that limit to 3000 mg/day, and 2600 mg/day for chronic (longer than 2 weeks) use. Some "lobbying" took place, and now the "official" safe limit is in a range between 3000 and 4000.

It's been suggested (and I do this myself) that anyone taking acetaminophen at those levels—or long-term (longer than 2 weeks)—take N-Acetyl-Cysteine (NAC) to help protect the liver.

Doc