Diabetes Complications

Being able to walk is something that all of us who have diabetes take for granted, at least until something makes it hard to do or even impossible. That something is often neuropathy, probably the most common complication of diabetes. But new treatments can prevent serious problems.

About 12 percent of us have neuropathy when we learn that we have diabetes, according to the Centers for Disease Control and Prevention at The Prevention and Treatment of Complications of Diabetes Mellitus. This U.S. government organization goes on to say that about 60 percent of us will have neuropathy after 25 years of living with diabetes.

The good news is that neuropathy isn’t inevitable, and the way to prevent it is clear, although not always easy. That way is to keep our blood sugar level normal, especially when our body gives us a warning.

That warning is often a foot ulcer. That was the way a friend of mine, Wayne Coggins, learned that he had diabetes. When I asked Wayne how he would describe himself, he replied, “I am pastor, counselor, and author … and newly discovered diabetic.” He founded Cornerstone Family Ministries in Kenai, Alaska, and wrote Adventures of an Alaskan Preacher.

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The cholesterol issue is at the heart of every dietary recommendation for the past 30 years, says Dr. Jonny Bowden. “When you think about it — and I have thought about it — it has influenced everything we have been taught about what to eat and what not to eat.”

Together with Stephen Sinatra, M.D., a board certified cardiologist with more than 30 years of clinical practice, they wrote a new book, The Great Cholesterol Myth, which Fair Winds Press published on November 1. Alternatively, you can get a Kindle edition, which is what the publisher sent me for review.

Dr. Bowden has a Ph.D. in nutrition and is the author of 10 books with some of the soundest advice on what to eat that I have ever read. His book Living Low Carb is one of the very best books on the lifestyle that I follow and recommend. My only regret is that I failed to discover it when it came out, so I haven’t reviewed it. Dr. Bowden tells me, however, that a revised edition is in the works, and I will certainly review it as soon as I get my hands on it.

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If we’re lucky, we will get diabetic neuropathy in our lifetimes. Nearly 60 percent of people with diabetes in America have it after a quarter of a century.

Neuropathy may be the most common complication of diabetes and can make walking difficult as well as leading to even more serious problems like losing a limb. Diabetic neuropathy is damage caused to the nerves, and it can result in numbness, tingling, burning, and pain. Until now the painkillers that we could use don’t work well for everyone.

Now, however, a study from the University of Calgary shows evidence supporting a new drug therapy to treat diabetic neuropathy. The drug is called nabilone.

“My pain was so severe that I could barely walk a block,” says Leslie Bonenfant, who has type 2 diabetes and participated in the study. “After taking nabilone, I can manage my pain and I can function day to day,” she says.

Leslie Bonenfant (left) during a medical exam with Dr. Cory Toth

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Diabetes doesn’t hurt. That’s one of the biggest problems we have in taking this insidious disease seriously.

But when we don’t manage our diabetes, some of its complications can be painful. And about 40 percent of us have acute or chronic pain. That’s the bad news.

This bad news comes to us in a new study of more than 13,000 adults with type 2 diabetes in the Kaiser Permanente, Northern California system. About 42 percent of them reported that they had acute pain and about 40 percent said their pain was chronic. The most common complication they mentioned was fatigue, about 25 percent, followed by neuropathy, about 24 percent.

The findings, “Symptom Burden of Adults with Type 2 Diabetes Across the Disease Course: Diabetes & Aging Study,” will appear in the Journal of General Internal Medicine and is now available online. The lead author is Rebecca L. Sudore, M.D., and her assistant sent me a copy of the full-text.

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When you keep your blood sugar level as low as the levels of people who don’t have diabetes, your have little risk of having a heart attack. But when you let your sugar level rise just a little, that risk goes up a lot.

Healthy people who don’t have diabetes have a fasting blood sugar level of less than 6 mmol/l, according to researchers at the University of Copenhagen. That’s the equivalent of an A1C level of 5.4. The Journal of the American College of Cardiology just published their study in the issue for June 19/26, 2012.

The researchers drew on three observational studies that included 80,522 Danes. Observational studies cannot prove a cause, but the researchers went further. They used “a Mendelian randomization approach … to circumvent confounding and reverse causation.”

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