Diabetic Neuropathy

Diabetic Neuropathy

According to the experts, diabetic neuropathy accounts for about 50% of all neuropathies. Dr. Todd Levine recently participated in a Facebook chat on the subject of  “Understanding Pre-Diabetes, Diabetes, and Diabetic Neuropathy”.

Some doctors deny the existence of neuropathy from ‘pre-diabetes’ but see the following two references:

1.  Norman Latov, MD PhD  “Peripheral Neuropathy: When the Numbness, Weakness, and Pain won’t Stop”, Professor of Neurology, Weill Medical College, Cornell University, published 2007 The American Academy of Neurology, pages 17 to 22 .

2. “Prediabetes/early diabetes-associated neuropathy” page 341-350 by Dr. Sanka Divisova, Department of Neurology, University Hospital and nine additional experts from around the world in The Journal of the Peripheral Nervous System Vol. 17, No. 3, September 2012.

Finding help for neuropathic pain is one of the most difficult challenges in dealing with diabetic neuropathy.

Dr. Levine mentions the two FDA approved mediations for neuropathic pain due to diabetic neuropathy as : Pregabalin and Duloxetine. Many doctors also use Nortriptyline, Gabapentin and Amitriptyline along with others.

2015 Update: The Foundation for Peripheral Neuropathy in their E News March 2015, noted in a follow up of reported 2013 research a report published in the Annals of Clinical and Translational Neurology and Science Daily, noted that with “two low dose rounds of non-viral gene therapy called VM 202 patients had significant improvement of their pain that lasted for months!

“Those who received the therapy reported more than 50 percent reduction in their symptoms and virtually no side effects,” said Dr. Jack Kessler, lead author of the study.  “Not only did it improve their pain, it also improved their ability to perceive a very, very light touch.

“VM202 contains human hepatocyte growth factor (HGF) gene. Growth factor is a naturally occurring protein in the body that acts on cells, in this case nerve cells – to keep them alive, healthy and functioning.  Future study is needed to investigate if the therapy can actually regenerate damaged nerves, reversing the neuropathy.

“Patients with painful diabetic neuropathy have abnormally high levels of glucose in their blood.  These high levels of glucose can be toxic.

“We are hoping that the treatment will increase the local production of hepatocyte growth factor to help regenerate nerves and grow new blood vessels and therefore reduce the pain,” said Dr. Senda Ajroud-Driss, associate professor in neurology at Feinberg, an attending physician at Northwestern Memorial Hospital and an author of the study.

“Right now there is no medication that can reverse neuropathy,” Kessler said.  “Our goal is to develop a treatment. If we can show with more patients that is a very real phenomenon, then we can show we have not only improved the symptoms of the disease, namely the pain, but we have actually improved function.”

“A future, much larger phase three study will soon be underway. To read the full article Neuropathy: Relief for diabetics with painful condition. ”

Dr. Levine notes that Metanx is a medical food which has been shown to help regrow nerves in small studies in humans as well as in animal models of diabetic neuropathy.

Dr. Levine shares what many patients have discovered in the value of topical medications as they do not have the cognitive side effects of the same medications taken orally when used in the creams. Topical medications include the Lidocaine transdermal patch but Lidocaine is also used in a gel in a topical cream.

As neuropathic pain is an issue in a all sensory neuropathies, here are two links to articles on neuropathic pain which provide helpful information.  See How Neuropathic Pain is Treated: and What is Neuropathic Pain.

The medical professionals I speak with DO NOT recommend the use of the opiates unless there are patient medical contradictions for the use of the other medications.  Every day I have patients write to tell me how desperate they are to get off the opiates!  The opiate drugs will eventually become more of a problem than your PN and the body will keep demanding more and more.  Work with the doctor to discover what does work for you as noted in the articles above.  If your doctor does not work with you on this, find another doctor as every patient is different. Remember for neuropathic pain, if you get 85% relief this is probably as good as it is going to get until medicine discovers better options.

Maybe there is some simple ideas that may help, such as a topical cream that the doctor can order to help with burning pains at night (Dr. Hunter mentioned the ingredients physicians use in these compounds includes Lidocaine, ketamine, gabapentin, and amitriptyline, mixed by a compounding pharmacy in percentages as prescribed by the physician).  Mention the formula to your doctor!

Some patients have found that resting your burning skin in cool tap water (not FREEZING) for 15 minutes before bed to calm the damaged nerves. Other patients find that warm water, (NOT hot) helps rather than the cold water. These ideas come from Dr. Latov’s (MD, PhD) book and the one by Mims Cushing.

Here is a link to an article on vitamins and other alternative medicines you may find helpful Alternative and Complementary Medicines for Neuropathy. Dr. Norman Latov, in his book for patients, speaks of the use of alpha Lipoic acid and the dosage recommended is at 600-800 a day.  But again remember speak to your doctor before trying any supplement is a good idea.  Dr. Latov’s book is our Bible, order a copy and read it from amazon.com under $20.

Did you know that exercise (the wrong kind for neuropathy) will force damaged nerves to work and increase the pain.  See: Exercise and Pain:

Then consider ordering a copy of the brand new DVD from Matt Hansen the expert as his perspective on exercise for neuropathy is perfect and understands what we can and cannot do, yet makes it possible for us to exercise WITHOUT the problems to keep muscles as strong and flexible as possible. Information on Exercise DVD:

References:

#1 Norman Latov, MD, PhD, FAAN Peripheral Neuropathy: When the Numbness, Weakness and Pain Won’t Stop, ANN Press, 2007

#2 Mims Cushing, You Can Cope With Peripheral Neuropathy (Ideas from neuropathy patients), with Dr. Norman Latov, DEMOS Publishing, 2009

#3 “Journal of the Peripheral Nervous System” published by the Peripheral Nerve Society.

#4  Dr. Corey W. Hunter, MD, Pain Medicine, Ainsworth Institute of Pain Management, New York, NY.

#5 Dr. Sean Levine, MD, FAAN, Professor of Clinical Neurological Surgery and Radiology, NYPH, New York, NY

About the Author

LtCol Eugene B Richardson, USA (Retired) BA, MDiv, EdM, MS

Col Richardson has suffered with severe neuropathy for over 45 years. A 27 year military veteran and veteran of the Vietnam War, he was diagnosed with a progressive chronic peripheral neuropathy resulting in severe disability. This diagnosis has been confirmed as due to exposure to Agent Orange. It was not until 2010, 42 years after his exposure to Agent Orange, that his diagnosis was recognized by Veterans Affairs as service connected.

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3 Comments

  1. I’d just like to say thank you to everyone involved with this website it has cleared up a lot of fears I had with my recent diagnosis of diabetic peripheral Neuropathy. I also think I may have autonomic Neuropathy to as I have erectile dissfunction and incontenance of the bowel and bladder. I was just told by my doctor its diabetic Neuropathy with no referal yo any kind of specialists for investigation. My diabetic nurse arranged foot care for the condition and I had to have surgery to remove a big toe nail as I had an ulcer beneath it
    I am left wanting more information and more help. I have been on gabapentin for two months now and I can’t really say it helps yet. Thanks again. N.

    1. Nigel: Thanks for your supporting encouragement. I will send you an E mail to perhaps offer some suggestions and help. Thinking of you.

  2. Wow… what a great post! Thanks for the info, super helpful. I’ve found some decent tutorials on how to fill VA 21-0781 out online here https://goo.gl/CDUwSW

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