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Hitting A Nerve

Author: Avery Hurt
Except from: Diabetic Living, Summer 2007

Think of cells as tiny power plants and glucose as the fuel that runs them. When the cells get too much fuel, they release waste that causes nerve damage or neuropathy.

Neuropathy is one of the best arguments to fight blood glucose control. It's a nerve disorder that can affect almost every system in your body. It results from bursts of high blood glucose that cause oxidative stress to the nerves.

"The mitochondrion is the power plant of the cell," says Eva L. Feldman, M.D., Ph.D., professor of neurology and director of the Neuropathy Center at the University of Michigan Health System in Ann Arbor. "Glucose is the fuel for this power station. When the power plant gets too much fuel, it exudes waste products, causing oxidative damage - much like a city's power plant causing damage by releasing waste products into rivers and streams."

From Your Toes to Your Heart

The nerve damage caused by these oxidative waste products is either peripheral or autonomic. Peripheral neuropathy can affect the toes, feet, legs, hands, and arms. Symptoms include tingling, burning, and/or numbness.

Autonomic neuropathy can affect the nerves that control blood pressure and blood glucose levels, as well as internal organs such as the heart, stomach, and bladder. Autonomic neuropathy produces a wide range of symptoms that are often mistaken for other ailments. Digestive troubles, difficulty regulating blood pressure, problems with balance, weakness, lack of bladder control, and impotence can all be signs of neuropathy.

Perhaps the most troubling fact is neuropathy in its early stages often causes no symptoms at all.

Jim Edwards, 29, of Tpsilanti, Michigan has had diabetes for 20 years. He discovered he had neuropathy of the heart during a health examination prior to joining a clinical trial. "Often you don't notice that you have peripheral neuropathy." Jim Says. "You wouldn't notice a failure to detect heat or cold, for example."

Key to Prevention

The National Institutes of Health estimates that 50 percent of people with diabetes have some type of neuropathy, even though it can be prevented. "The Diabetes Control and Complications Trial (a large, long-term, NIH-funded study) demonstrated that we can reduce autonomic damage by up to 60 percent with tight glucose control," says Aaron Vinik, M.D., Ph.D., director of the Strelitz Diabetes Research Institute at Eastern Virginia Medical School in Norfolk. "Glycemic control is crucial to preventing and limiting the damage of neuropahty."

Take Care

Neuropathy of all kinds can be subtle, so you need to take precautions. If you've lost feeling in your feet, you may not notice when you injure yourself. "Often when I examine a patient, I discover an ulcer on the bottom of the foot that the patient didn't even know was there." Feldman says, "When you visit your doctor, take off your shoes and let the doctor have a look," she says.

Make sure your doctor checks with a monofilament, a small tool that's like a straw from a broom. A recent study of more than 7,000 patients with type 2 diabetes found that doctors who don't check their patients' feet with a monofilament miss more than half of all neuropathy cases.

"One substance still under study that may prove to help is an antioxidant called alpha-lipoic acid." Vinik says. In fact, he says, antioxidants show a lot of promise for an eventual treatment to counter the oxidative damage that contributes to neuropathy. For people with diabetes who have nerve damage or are at risk, that's very promising news.


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