Diabetes: Is the ADA Shifting its Stance About Carbs?

Carbohydrates are a very touchy subject with diabetics. And for me at least, understanding carbs in a diabetic diet is more difficult than quantum mechanics (or double-entry accounting if you’re not a science type). Diabetologists and dieticians, too, have differing views. I found this article by LAURA DOLSON very instructive and am reproducing it here for those who may have missed it. You can find the lively discussion that followed the article’s publication here.

You may be surprised to know that for the past couple of decades, the American Diabetes Association has been sort of a cheerleader for carbs. Yes, I'm talking about the organization who's mission it is to promote education and research in ways aimed at preventing diabetes and alleviating the suffering of diabetics.

What is diabetes? It is essentially a disorder of the body's ability to process carbohydrates. This includes Type 1 and Type 2 diabetes, pre-diabetes, metabolic syndrome, insulin resistance, and all the other points on the diabetes spectrum. (The Endocrine Society suggests that anyone with a fasting blood glucose of 89 or above is at risk for damage to their health.)

In light of this, you'd think that limiting carbohydrate intake would be a priority in educating people about handling these disorders. And yet, the ADA jumped right onto the Food Pyramid bandwagon and began to advise people to get at least 55% of their calories from carbohydrate, such as in the Food Pyramid for Diabetes (see illustration above).

In 2008, they made one exception: diabetics trying to lose weight could follow a low-carb diet for up to one year; this was later loosened further to two years. But still they did not recommend a low-carb diet for health, blood sugar control, or preventing progression of the diabetes.

Now, in the March 2011 edition of the ADA magazine "Diabetes Forecast" are three rather remarkable articles. The first is called The "ADA Diet" Myth, which claims that there is no such thing as the ADA Diet! (Who else was having this hallucination?) Instead, Stephanie Duncare, director of nutrition and medical affairs for the ADA says, "For more than 15 years now, ADA has recognized that people with diabetes should eat in a way that helps them reach their blood glucose, cholesterol, blood pressure, and weight goals. For some, this means a relatively higher-carbohydrate diet, and for others, the diet may be lower in carbohydrate". Well, hallelujah to that, especially if the goal is "normal blood glucose" (normal meaning "a blood glucose level that will not cause further damage in the pancreas").

Even more bold is an article called, "Are Carbs the Enemy?" which attempts to cover the debate. They first present a sort of wimpy pro-carb stance. This section of the article has a notable absence of anything to do with science, instead relying on statements such as "Gone are the days of 'diabetic diets' that were meager and confining" and "as long as people eat less or cover their carb intake with medications, they can keep blood glucose levels in check with a healthy diet" ("healthy" in this case meaning "high-carb").

The article then goes on to describe a low-carb approach, citing Dr. Richard Bernstein. This section cites actual evidence, and makes what I think is a much stronger case for controlling blood glucose by limiting carbohydrates. The article goes on to a section on saturated fats which is much more balanced than usual, and then the normal "we don't have the long-term studies". The article concludes with the statement: "In the end, the best diet is the healthy one you're able to follow."

The only thing I would add is that people need support in making those changes, and as far as I can tell they are still leaving an awful lot up to the individual to figure it out for themselves. There has been quite a defeatist attitude coming from the organization that is supposed to be helpful - along the lines that it is asking just too much of people to cut carbs in any significant way. Are dietitians now actually going to support people in finding a diet that achieves as close to a normal blood glucose as possible? It would be a very big change if this happened any time soon.

But wait, there's more! A follow-on short piece called "Eating With Diabetes: 3 Approaches" lists the low-carb approach first, and then follows with "Moderate-Carb" and "Vegan/High-Carb". The weird thing is that the three approaches are described as "less than 10% carb", "40-50% carb" and "75% carb". What about people who normalize their blood glucose with 20% carb or 30% carb? Why not just say, "it's a spectrum disease, with a spectrum of carb that will treat it effectively"? In any case, I don't want to complain too loudly, because this is SO great to see in an ADA publication!

Now, to be sure, the ADA is not yet changing their basic stance. Nowhere on the latest update of the diabetes.org Web site is it stated that diabetics should follow a low-carb diet. On the other hand, there is no longer anything I can find that says to eat over half of calories from carbohydrate, either. The former food pyramid, as far as I can tell, has vanished, and there are several hints that low-carb eating is becoming a bona-fide option.

There are statements such as, "Understanding the effect of carbohydrate on blood glucose levels is key to managing diabetes. The carbohydrate in food makes blood glucose levels go up." Although diabetics are still advised that "a place to start is at about 45-60 grams of carbohydrate at a meal.", (yikes) it goes on to say to adjust from there. Even though this is not what most of us would call a low-carb diet, for most people it is a reduction from their previous advice.

[Side note: I also notice it doesn't actually say 45-60 g/meal is a good place to start. If that actually controls someone's blood glucose, that's great, but I would think that in the cases where it doesn't, it would be more disheartening to subsequently take more carb away. Why not start lower, and then add? Also, most likely, the person for whom this works is losing weight - a phase which doesn't last forever.]

To me this looks like the beginnings of a real change in approach from the ADA. The Titantic may actually be turning around! This could make a difference to the health of millions of people, and nothing could make me smile more than that.

By Laura Dolson/about.com
Image courtesy about.com

Self-Monitoring Blood Sugar: Is 'Second Drop' and Squeezing Finger to Draw Blood OK?

I’ve been regularly testing my blood sugar at home for nearly a decade now. At times when I get an error message on the glucometer (thanks to incorrect technique but more often because of insufficient blood), I never hesitate to squeeze out a second drop of blood on a fresh strip to get a “proper” reading. All the while I was blissfully unaware that both my actions are a matter of debate in Diabetes Self-Management Education (DSME) pundits.

It seems there is no general agreement regarding the use of the first or second drop of blood for glucose monitoring. The American Diabetes Association and other groups say that people should thoroughly wash and dry their hands, and then test the first drop of blood that comes from the finger. However, they do not have advice on what to do when you cannot wash your hands.

Now a new study suggests if soap and water are nowhere to be found, using the "second drop" of blood may be OK.

As for squeezing the finger, the researchers found that too much pressure did appear to interfere with accurate test results. On average, blood sugar readings were lower when people put pressure on the finger. The finding, according to the researchers, is in line with advice to avoid firm squeezing of the tested finger.

For the study, Dutch researchers at the Isala Clinics Diabetes Center at Zwolle in the Netherlands had 123 people with diabetes test their blood sugar under various conditions: after thoroughly washing and drying their hands; without hand washing; after handling fruit, which leaves sugar on the fingers; and after washing their fruity fingers.

The participants also tested their blood sugar using varying amounts of pressure to squeeze a drop of blood from the tested finger. (In general, guidelines advise against squeezing the finger too hard to get a blood drop because it may distort blood sugar readings.)

Overall, the study found, clean hands and the first drop provide the most accurate result. But compared with tests of clean hands, 11 percent of study participants had test results that were at least 10 percent off when they tested the first drop of blood from their unwashed hands. The same was true of 4 percent of study participants when they used the second drop of blood.

Based on that, the researchers recommend that people wash and dry their hands before testing, then use the first blood drop. But if they cannot wash up for some reason, it's "acceptable" to use the second drop after wiping away the first.

But what about fruity hands? In that case ‒ or whenever hands are visibly dirty ‒ a good washing is necessary, according to the researchers. They found that when study participants tested fruit-exposed hands without washing, 88 percent had blood sugar levels that were at least 10 percent off from their clean-hand readings ‒ at least when using the first drop of blood.

They fared better when using the second drop. But 11 percent still had results that differed substantially from their clean-hand measurements.

As for squeezing the finger, the researchers found anywhere from 5 to 13 percent of study participants had a significantly different blood sugar result (versus no squeezing), depending on how much pressure they put on the finger. On average, blood sugar readings were lower when people put pressure on the finger. The finding, according to the researchers, is in line with advice to avoid firm squeezing of the tested finger.

The findings are published in the early online edition of the journal Diabetes Care.

SOURCE: Diabetes Care

Diabetes & Steroids

Some conditions (e.g. Addison's disease, severe asthma, rheumatoid arthritis, lupus) are treated with steroids. If you have diabetes, you may well find that your blood glucose levels rise while taking high-doses of steroids for periods of time.

This should not stop you taking steroids if your doctor has prescribed them, even if your blood glucose levels are affected, but you should discuss with your doctor how best to manage your diabetes while taking steroids. You may need an increase in medication or your medication to be changed.

If the steroids have been prescribed for a short period to manage a deterioration in your condition, your blood glucose levels will usually return to normal when you stop taking them. The drugs he’d been prescribed, glucocorticoids, are a type of steroid. And many people will take glucocorticoids not knowing a common side-effect is type 2 diabetes.

In fact, steroid-induced diabetes is “very common”, says Dr David Price, a diabetes expert at the Morriston Hospital at Swansea, UK. “Glucocorticoids are life-saving in many situations. But the unavoidable consequence is that they raise blood sugar.” The drugs mimic the hormone cortisol, which is produced by the adrenal gland.

Cortisol is known for its anti-inflammatory effect, which is why these medications are prescribed for inflammatory conditions such as arthritis and asthma — but it also affects the way the body metabolizes sugar.

“Cortisol is a stress hormone,” says Dr Price. “When you’re stressed, it acts to free up glucose from the liver because you need this energy to get to the muscles.” As a result, blood sugar levels go up. And while many people on glucocorticoids see their blood sugars drop back to safe levels once they stop taking steroids.

When older people are put on a big dose of steroids, for example, a significant minority would become diabetic. And if someone is already diabetic, they may go from being on tablets to having to inject themselves. Patients should be warned of the risks.

This is what a British man ‒ who was asthmatic but did not have diabetes ‒ was not told.

Tony had developed asthma in 2000; he was then diagnosed with bronchiectasis, a condition where some of the air passages become permanently widened, meaning extra mucus builds up and the patient is more prone to chest infections.

He was given inhalers to keep the conditions under control, but these weren’t enough. “I ended up in hospital four times with severe attacks,” recalls Tony, 65, a semi-retired communications consultant from London.

In hospital he was given oral steroids in the form of prednisone, to reduce the inflammation in his airways. He then developed nasal polyps and so started taking prednisone more regularly. Polyps are swellings in the nasal cavity which can cause a runny nose and, in Tony’s case, loss of sense of smell. “Doctors told me the steroids could help to shrink the polyps,” he recalls. “I took them only if my chest was troubling me, or when I travelled overseas for business meetings, to spare myself the embarrassment of a dripping nose.”

Tony’s doctors warned him not to take them too often because of serious side-effects such as a hormone disorder called Cushing’s syndrome, so he kept to no more than once every three months. But his doctors never mentioned another serious risk: that, in fact, glucocorticoids can cause diabetes.

“During a trip to South Korea, a day after taking a dose, I found myself very thirsty and tired, and needing to go to the loo a lot. I didn’t think much of it, but when I got home my jet lag didn’t recover. I was exhausted and I started losing weight. After two weeks of this, I Googled my symptoms. Straight away, diabetes came up,” recalls Tony

Concerned, Tony bought a home blood sugar test and found his levels were much higher than normal. He went to see his GP, who did more tests and confirmed he had type 2 diabetes.

Not only was Tony showing the symptoms of diabetes, a urine test showed the presence of ketones — acids which build up in the blood when a diabetic patient’s insulin is dangerously low. Ketones can lead to ketoacidosis, a cause of diabetic coma and even death.

“I told my doctor about my medication and he said: ‘You’ve got steroid-induced diabetes.’ I’d never heard of it,” says Tony. The GP sent Tony to the diabetes clinic at the local hospital. He was given insulin and shown how to administer the injections. Within days his tiredness and thirst had faded.

Doctors told him his type 2 diabetes would be with him for life. The drugs he had taken to ease his chest problems had left him with a permanent and potentially life-threatening condition. “No one told me the steroids could cause diabetes,” says Tony. “I felt gutted that for the rest of my life I’d have to inject myself.”

“However, in some cases there may be a slight problem with insulin production anyway — this won’t have been an issue before. But the steroids cause an added strain on the pancreas, causing the patient to become permanently diabetic. It can depend on the dose you’re on, and underlying risks like whether you’re overweight and whether there’s a family history of diabetes,” adds Dr Price.

Tony, however, had no family history of diabetes and was not overweight. He’d also had regular blood tests for years during routine medical checks, which he says had always been normal.

Frustrated at his experience, Tony began to question whether there was anything he could do about his new condition. “I knew insulin is a very unstable thing. If you get your doses wrong and your blood sugar goes too low, you can get diabetic ‘hypos’, and if you don’t control your diabetes you can have strokes, amputations, problems with eyesight, all kinds of things.

“On my fourth visit to the diabetic clinic I asked the nurse if I could try reducing my insulin dose slowly over time and see how it went. I did and my blood sugar went back to near normal within two to three weeks.

“The clinic confirmed I no longer needed to inject, but said I was still mildly diabetic, so they put me onto a daily Metformin tablet. That’s been the case for four years.” Tony now avoids glucocorticoids and his asthma has been greatly improved thanks to an inhaled steroid calledSeretide.

Tony is relieved he’s got his diabetes under control, but still wishes he’d been warned about the side-effects of glucocorticoids. “So many people have blind faith in their doctors. I wonder what would have happened if I hadn’t questioned my treatment.”

Adapted from a news report in the Daily Mail

Don’t Take Diabetes Lightly ‒ It Can Even Lead To Suicide

There is a general attitude that diabetes is a treatable disease, that's it's no big deal, that you just take medicine and you have a normal life.

The truth is diabetics have a 2.5 increased rate of death, meaning people with diabetes are 80 percent more likely to die prematurely than those without the disease.

A new British analysis ‒ published in the March 3 issue of the New England Journal of Medicine ‒ confirms that diabetes is associated with higher mortality.

And it's not just diabetes that's killing them. Besides dying from vascular problems caused by diabetes, people with the blood sugar disease are also more likely to die prematurely from many other causes, including cancer, infections, falls, liver disease, mental disorders and even suicide.

Although all the reasons that result in the greater risk of death among diabetics aren't known, high blood sugar and inflammation are key players. These can decrease the body's ability to fight off infections and even cancer.

A team lead by John Danesh, a professor of epidemiology and medicine at the University of Cambridge in the UK analyzed deaths among 820,900 people who took part in 97 studies. Among those in these studies, 123,205 died.

The risk of premature death was closely associated with blood sugar levels, with an excess risk of death at blood glucose fasting levels exceeding 100 milligrams per deciliter. There was no excess risk of death at fasting levels of 70 to 100 mg per dL, the researchers found.

The risk of dying from vascular disease, not surprisingly, was much higher in people with diabetes. But people with diabetes were also at increased risk for death from liver and kidney disease, pneumonia, other infectious diseases and chronic obstructive pulmonary disease, among other ills.

Danesh's team also found that people with diabetes were 25 percent more likely to die from cancer, with scientists finding a moderate association between the disease and death from liver cancer, pancreatic cancer, ovarian cancer, colorectal cancer, and lung, bladder or breast cancer. They were also 70 percent more likely to die from falls than people without diabetes.

In addition, diabetics were 64 percent more likely to die from mental disorders and 58 percent more likely to die from suicide, mostly because they were more likely to be depressed. Indeed, another study showed that management of diabetes can cause chronic stress and strain, which in the long run, may increase risk of depression - the two are linked not only behaviorally but biologically. (See my post 'Diabetes, Depression Can be a Two-Way Street' here.)

Broken down, the hazard ratios for people with diabetes vs. people without diabetes were:
   * 2.32 for death from vascular causes
   * 1.80 for death from any cause
   * 1.73 for death from other causes
   * 1.25 for death from cancer

Summing up, the study authors write: "These findings highlight the need to better understand and prevent the multi-system consequences of diabetes."

The challenge before researchers therefore is to continue to find a cure and to prevent diabetes ‒ it cannot just be managed with drugs.

Aggressive Diabetes Therapy May Raise Death Risk

The BIG news of the day is that intensive blood sugar control doesn't benefit people with both type 2 diabetes and heart disease. In fact, intensive treatment to lower blood sugar is linked to increased mortality, according to a long-running study whose findings were published today.

This reminds me of a discussion that I participated in a TuDiabetes forum a couple of week ago. The issue being discussed was A1c/eAG levels. I had written: “My diabetologist says that diabetics have higher eAG than normal, healthy individuals. Indeed, he says that it is better for diabetics to have an eAG of ~ 180 than ~ 140. He says in his experience diabetics who try to emulate normal eAG levels suffer more complications - cardio, renal, vascular, optho - than those with slightly higher values. He cites the example of a few patients (now age 80+) who have remained at 200+ for 30 years!”

Clinical trials now seem to have validated anecdotal evidence. The New England Journal of Medicine reported today that according to the latest analysis from the long-running ACCORD study, trying to maintain the blood sugar levels typical of people without diabetes can increase the risk of death for people with type 2 diabetes and heart disease by 19 percent.

ACCORD stands for Action to Control Cardiovascular Risk in Diabetes. This study was designed to assess whether intensive blood sugar interventions to bring A1C levels to under 6 percent would benefit people with type 2 diabetes and heart disease.

A1C is a long-term measure of blood sugar control, and the A1C level provides about two to three months of average blood sugar levels. A level of under 6 percent, which is considered normal or non-diabetic, can be difficult for someone with diabetes to achieve.

This brings me to the outlook of many TuDiabetes members (many of who take their management very seriously). Replying to my response mentioned above, one member wrote: “I disagree with the idea that lower blood sugar levels cause more complications….The largest intervention study to date, the DCCT pretty conclusively found that risks of "all" complications could be decreased by reducing blood sugars. Data from the DCCT conclusively substantiated that down to below 7% (154 mg/dl eAG). Further studies have found additional support that additional risk reductions occur all the way down to A1cs of even 5.5%. The American Association of Clinical Endochrinologists in fact suggests that patients "Encourage patients to achieve glycemic levels as near normal as possible without inducing clinically significant hypoglycemia".”

Another quipped: “If your diabetologist is implying that averaging 180 is okay (over the Renal Threshold), then he desperately needs to go on a high-fiber diet.”

Fair enough. All of agree that BS levels should be as close to normal as possible. But do we have to adopt an aggressive approach to diabetes management just because the doctors says so? Ground Zero observations have revealed that many diabetics do NOT suffer complications. (See my earlier post on this here.)

It should not be forgotten that aggressive insulin therapy also necessitates the need of continuous monitors, a luxury most diabetics cannot afford (given the high cost of testing strips). In India where I live, only a minuscule number of people test BS on a daily or even weekly basis. The norm is to test fasting and post-prandial levels only when one visits a diabetologist, which is not more than 2-3 times in a year. (My diabetologist says most of his patients turn up only when they're really sick.)

Of course I’m guilty of poorly paraphrasing my diabetologist’s observations. But essentially he’s right and the recent ACCORD study validates a diabetologist’s long experience of treating a variety of patients in a (clinically) ‘hostile’ environment.

It is interesting to note how the ACCORD study reached its conclusions. The people recruited for the study were between 40 and 79 years old, and their A1C levels were above 7.5 percent at the start of the study. Study volunteers were randomly assigned to either intensive blood sugar control or to a standard diabetes program striving for levels of 7 percent to 7.9 percent.

The study began in 2001 and was halted in February 2008 when researchers realized that people in the intensive treatment group had an increased risk of dying. By then, the intensive treatment group had received 3.7 years of treatment aimed at lowering their A1C levels to below 6 percent.

Achieving such tight blood sugar control often required numerous interventions, such as lifestyle changes along with medication, multiple medications or insulin therapy.

The analysis includes five years of data. For the intensive group, that meant an average of 3.7 years of intense treatment, followed by 1.3 years of standard therapy.

At the time the study was stopped, the intensive therapy group experienced a 21 percent reduction in the risk of heart attacks, but a 21 percent increase in the risk of all-cause mortality.

After five years, the researchers found that the risk of heart attacks was still decreased by 18 percent, but the increased risk of all-cause mortality also persisted. People in the intensive therapy group had a 19 percent increased risk of dying of any cause.

The study's lead author, Dr. Hertzel C. Gerstein, the Population Research Health Institute Chair in Diabetes Research at McMaster University in Hamilton, Canada, said many researchers have tried to tease out why intensive blood sugar control might up the risk of death, and so far, no one has succeeded. Causes that have been ruled out include low blood sugar levels (hypoglycemia) and the rapid change in blood sugar levels.

"This study really reminds us that we always need to be prudent. Even if we think something is the right thing to do, sometimes we may have findings that are unexpected," said Gerstein.

"This study confirms the results of the ACCORD trial over the full duration of the study," said Dr. Vivian Fonseca, president-elect of medicine and science for the American Diabetes Association.

"Overall, this means that the recommendations of the American Diabetes Association hold true. In general, people with diabetes should aim for an A1C goal of less than 7 percent, but clearly individualization is important. One size does not fit all," said Fonseca.

And, the findings suggest that people with type 2 diabetes and heart disease shouldn't attempt to achieve an A1C below 6 percent, the study authors said.

Gerstein and Fonseca noted that the ACCORD findings should not be generalized for everyone with diabetes. People with type 1 diabetes and those with type 2 diabetes and no history of heart disease were not included in this study.

"There is no reason to change current guidelines because of this study, and this study certainly doesn't support ignoring glucose control. We saw benefits in eye disease and many other outcomes with good control," said Gerstein.

More information

To learn more about the connection between diabetes, heart disease and stroke, go to the U.S. National Institute of Diabetes and Digestive and Kidney Diseases

Untreated Diabetes: Millions Risk Early Death Because of Poor Diagnosis and Ineffective Treatment

• In the United States alone, nearly 90% of adult diabetics – more than 16 million adults aged 35 and older – have blood sugar, blood pressure, and cholesterol that are not treated effectively, meaning they do not meet widely accepted targets for healthy levels of blood sugar, blood pressure, and cholesterol.

• In Mexico, 99% of adult diabetics are not meeting those targets.

• Up to 62% of diabetic men in Thailand are undiagnosed or untreated for diabetes. This translates to more than 663,000 people in that country.

A new study, published in the Bulletin of the World Health Organization's March edition, has found that millions of people worldwide may be at risk of early death from diabetes and related cardiovascular illnesses because of poor diagnosis and ineffective treatment.

The objective of the study was to examine the effectiveness of the health system response to the challenge of diabetes across different settings and explore the inequalities in diabetes care that are attributable to socio-economic factors.

Researchers at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, who examined diabetes diagnosis, treatment, and management in the US, Thailand, Mexico, Colombia, England, Iran, and Scotland have come to the conclusion that "too many people are not being properly diagnosed with diabetes and related cardiovascular risk factors. Those who are diagnosed aren't being effectively treated. This is a huge missed opportunity to lower the burden of disease in both rich and poor countries."

The percentage of diabetics in the seven countries studied who are reaching International Diabetes Federation treatment goals for blood glucose, blood pressure, and serum cholesterol is very low, ranging from 1% to 12%. The researchers conclude there are many missed opportunities to reduce the burden of diabetes through improved control of blood glucose levels and improved diagnosis and treatment of arterial hypertension and hypercholesterolaemia.

In an attempt to determine the cause of the low rates of diagnosis and effective treatment, researchers examined a range of factors and were surprised to find that “no large socio-economic inequalities were noted in the management of individuals with diabetes, financial access to care was a strong predictor of diagnosis and management.”

"We were very surprised to see that wealth did not have a big impact on diagnosis and treatment," said Dr. Emmanuela Gakidou, the paper's lead author and an Associate Professor of Global Health at IHME. "And in the three countries where we had health insurance data, we thought it was noteworthy that health insurance actually played a much bigger role than wealth, especially in the US."

In the US, people who had insurance were twice as likely to be diagnosed and effectively treated for diabetes as those who did not have insurance.

The researchers said the findings underscore the need for countries to tackle the growing problem of non-communicable diseases (NCDs) like diabetes, hypertension and cardiovascular diseases in part by gathering better data.

"We don't have enough data from actual physical exams to accurately document the trend in most countries," said Dr. Rafael Lozano, a co-author on the paper and a Professor of Global Health at IHME. "We looked at surveys from nearly 200 countries and only could find data on blood glucose, cholesterol, or blood pressure in seven. We hope that in the build-up to the UN Summit on NCDs this September, countries will make a commitment to more surveys that take blood samples from a representative percentage of the population."

###

IHME researchers gathered data and performed their analysis in collaboration with researchers at the University of California, San Francisco, School of Medicine; the Harvard Global Equity Initiative; the National Institute of Public Health in Mexico; and Ramathibodi Hospital in Thailand.

For more information, please visit the IHME website 

Diabetes: Don't Ignore Diabetic Nerve Pain

Fact: About 50% of people with diabetes have some form of nerve damage known as diabetic neuropathy

Fact: 64% of Diabetic Nerve Pain sufferers report that their pain interferes with the daily activities that matter to them

Fact: 71% of Diabetic Nerve Pain sufferers say their pain interferes with the daily activities and makes it hard for them to fall asleep

Fact: 49% of diabetics had not had a discussion with their doctor about Diabetic Nerve Pain or its symptoms in the last 12 months, according to one survey

Fact: 65% of Diabetic Nerve Pain sufferers say the pain decreases their general motivation

Does Diabetic Nerve Pain get in the way of doing things that you like to do or need to do? Do you find it difficult to work, care for your family, travel, and enjoy hobbies? For many people with Diabetic Nerve Pain, the answer is yes.

When a person has pain that is caused by nerve damage from diabetes, it is simply called Diabetic Nerve Pain or, to use the medical term, painful Diabetic Peripheral Neuropathy (pDPN). Approximately 26% of patients with diabetes have pDPN.

The most common cause of Diabetic Nerve Pain is poorly controlled blood sugar levels. Over time, high blood sugar levels can result in nerve damage. Controlled blood sugar levels may help prevent, stabilize, and delay further nerve damage.

The most common type of diabetic neuropathy is peripheral neuropathy (burning, throbbing, or painful tingling in your hands or feet). In the early stages of peripheral neuropathy, some people have no signs. Some may have numbness or tingling in the feet. Because nerve damage can occur over several years, these cases may go unnoticed. The patient may only become aware of neuropathy if the nerve damage gets worse and becomes painful.

Most diabetic neuropathy is caused by peripheral artery disease, in which the small blood vessels are obstructed or partially obstructed and cannot carry oxygenated blood to areas of the body. These areas have pain or other difficulties due to the lack of oxygen.

Diabetic Nerve Pain may make it hard to do what is needed to manage your diabetes. It can create a cycle where one problem just leads to another problem, which makes the first problem even worse.

• Pain may make it difficult to stay physically active and focus on other areas of diabetes care
• If you are not physically active and focusing on diabetes care, it may be hard to keep your blood sugar levels close to the normal range
• In turn, if your blood sugar levels are raised for long periods of time (many months or years), you may be more likely to develop more health problems. This may include more nerve damage
• Finally, people with Diabetic Nerve Pain also have more risk for symptoms of depression, which can further lower the drive to focus on the day-to-day parts of good diabetes care

Nerve pain is different from other types of pain, like pain from a muscle ache or sprained ankle. Common pain medicines like aspirin may not work for nerve pain. Nerve pain is unique and feels different than muscle pain. Since all pain is not the same and nerve pain treatment is different from muscle pain treatment, it’s important to understand the source of your pain.

Muscle pain is a "protective" form of pain which sends a warning signal that an injury occurred. The pain tells you that more activity might be harmful. Nerve pain, on the other hand, is a "non-protective" form of pain which will not necessarily be improved by changing or limiting your activities.

In fact, with Diabetic Nerve Pain, decreasing your activity level is a problem, making it harder to manage your diabetes. (We all know it’s important to be physically active to keep your blood sugar level under control.) With nerve pain, your nerves repeatedly send extra electrical signals to the brain. These extra signals can cause pain when you do something that is not normally painful, e.g. putting on shoes. If this pain is not properly diagnosed and treated, it can cause difficulties with walking, working, or even being in social situations.

Over time, elevated blood sugar levels could potentially lead to different diabetes complications, like kidney and eye (retinopathy) conditions besides leading to nerve damage, especially in the feet. Therefore annual foot exams are crucial to check for diabetic peripheral neuropathy. Indeed, regular examinations are important because a diabetes patient can have peripheral neuropathy without pain, especially in the early stages of the neuropathy.

Many Diabetic Nerve Pain sufferers try to ignore the symptoms. They may not tell their doctors right away. Or even if they do bring up their pain, the discussion can easily veer toward other important aspects of diabetes management—such as blood sugar control. The sufferer may not get around to asking about pain relief.

Unfortunately, nerve pain can be one of the most intense pains that people feel. Diabetic Nerve Pain can make normal daily activities more difficult.

It is therefore important to discuss ways to reduce your pain at your next doctor’s visit. You may have many topics you want to discuss with your doctor. This list probably includes the very important issue of your blood sugar level control and it may be tempting to put your pain at the bottom of your list. Not a good idea. Avoiding the subject doesn’t make this common complication go away. Indeed, even if your pain seems just bothersome now, the nerve damage can get worse over time.

To be sure, Diabetic Nerve Pain care is an important part of overall diabetes care. And it is a part you may be able to actively improve. With less pain, you’ll feel better and may even increase your physical activity level. This is a key component of good diabetes care.

If you have Diabetic Nerve Pain, it’s very important to keep your blood sugar levels as close to the normal range as possible. This may help stabilize and prevent further nerve damage. It’s also important to keep your pain under control. Then you may be able to return to activities that are important to you.