Is managing diabetic neuropathy so difficult that we need more drugs? Some, but not all, of our diabetes professionals say that it is.
"We have no licensed treatment for diabetic neuropathy," Rayaz A. Malik, professor of medicine at the University of Manchester, in December told the World Congress of the International Diabetes Federation World. “We have witnessed failure after failure of numerous clinical trials despite great experimental data. None of these drugs has been translated into therapies that we can prescribe to our patients.”
He explained that the treatments we have for neuropathy offer only symptomatic relief. He says that at best only half of the people with diabetic neuropathy get just 50 percent pain relief. And the drugs we have don’t reverse the nerve damage that causes the pain.
While some people advocate blood sugar control, "at best it prevents progression in type 1 diabetes," he says. "But not in type 2 diabetes."
This is a strange statement. Consider that the U.S. National Institutes of Health says that diabetic neuropathy appears to be more common in people who have problems controlling their blood sugar levels.
About 60 to 70 percent of those of us who have diabetes have some form of neuropathy, the NIH says. While not all of us have symptoms, the longer we have diabetes, the greater the risk. About 71,000 people with diabetes had a lower-limb amputation not caused by an accident in 2004, the most recent year that the NIH cites.
So why don’t our medical professionals recommend that we get our blood sugar levels down to normal to manage and even reverse diabetic neuropathy? Some of our leading professionals do.
"Why aren’t we talking about controlling blood sugars to improve diabetic peripheral neuropathy?" Stephen Freed wonders. He is a Certified Diabetes Educator, BSPharm, and publisher of Diabetes in Control, the website that about 100,000 clinical subscribers who treat diabetes use.
"Let’s talk about reducing our carbohydrate intake and increasing our physical activity and just taking control of our blood sugars as one of the best treatments to treat neuropathy and many of the other complications," Steve says. "Does that mean aggressive treatment? Yes. Now, not all patients are the same, so we have to individualize each patient’s treatment as far as how aggressive we can be.
"If we go back years, a fasting blood sugar of 180 mg/dl was the diagnosis of diabetes. Then it was lowered to 140 mg/dl, and today it is 126 mg/dl, and we even have a new disease called pre-diabetes, which is diagnosed with a blood sugar of 100-125 mg/dl. So we are coming to the reality that normal blood sugars are beneficial.
"So do we need more drugs? Sure, why not! But let’s not forget that the foundation in controlling neuropathy and all the other complications from diabetes is nutrition, physical activity, and most of all, the best treatment is knowledge." With these tools we can manage our blood sugar levels.
Diabetes in Control sponsors the monthly webcast by Dr. Richard K. Bernstein, one of the world’s leading diabetologists. Dr. Bernstein himself has had type 1 diabetes since 1946. He writes that he cured his diabetic neuropathy.
"The reason I don’t have it right now is because I’ve had normal blood sugars, more or less for the past forty years. Prior to that, I had severe neuropathies."
It won’t work with what the American Diabetes Association calls "normal" blood sugar. In its current Clinical Practice Recommendations the ADA sets an A1C level of 7.0 "as a reasonable goal" for most of us. "The ADA normal blood sugars only make neuropathy worse because they are too high," Dr. Bernstein writes.
Elevated blood sugar levels cause metabolic neuropathy, Dr. Bernstein explains. The actual destruction of the nerves due to prolonged elevated blood sugar causes anatomic neuropathy.
"The metabolic neuropathy can be reversed in a matter of weeks," he writes. "However, the anatomic neuropathy takes years to reverse, because it requires the re-growth of nerves. In a young, healthy non-diabetic, nerves re-grow at the rate of a millimeter a day. So, from the tip of your toe to your spine might measure one meter, or 1,000 millimeters, and it would take 1,000 days to regenerate those nerves. But if you’re older and in poor health it might take 2,000 days, which is a lot of years."
Reversing years of diabetic neuropathy can certainly take years. It’s a long process that can also be painful as numbness in our feet turns temporarily to pain. Working through it requires aggressive blood sugar control and discipline. Is it worth the effort? It’s your call.
David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.