From Gainesville, Florida, USA:
I am 28 years old and have had Type 1 diabetes since age 12. For the past six years or so I have been in poor control with average blood sugars around 240 or so. Recently I have been working to achieve better control and my blood sugars have come down to about 160-170. Since then I have developed several neuropathies. I sometimes experience sharp abdominal pain that eventually goes away. I believe nerve damage has led to an inability to completely empty my bladder. Also, I feel dehydrated most of the time regardless of my blood sugar levels. I have been experiencing occasional pain in my legs. My doctor has suggested taking vitamin E.
Could these conditions have been brought on by my improved blood glucose control? I have read that neuropathies will tend to get worse with improved blood glucose control. Can I expect these symptoms to eventually improve as I continue to have better blood glucose control or will these conditions just get worse? Also, are there treatments other than vitamin E?
The development of diabetic neuropathies (nerve diseases) parallels the duration and severity of high blood sugar and then the average metabolic control. Damage to the nerves due to diabetes mellitus comes in two ways. One kind is damage to nerves that control involuntary processes, such as heart rate and digestion. This is called autonomic neuropathy. The other kind is damage to nerves in areas away from the central nervous system, such as the hands, arms, feet and legs. Peripheral neuropathy is nerve damage to the extremities. Neurogenic bladder (autonomic neuropathy) can lead to urinary retention. Diabetic patients with involvement of autonomic nervous system can also show abnormal sweat pattern and/or anhydrosis (absence of sweating).
Management of autonomic diabetic neuropathies includes improvement in glycemic control and a transient worsening of symptoms has been described. Nevertheless, the DCCT has shown that an intensive insulin regimen (multiple injection therapy or insulin pumps) resulted in a 60% reduction in the risk of neuropathy, and delay in the progression of neuropathy irrespective of patient age, sex or duration of disease.
I think that if you keep on with your good metabolic control your symptoms will be improving over the future time (weeks to months). Vitamin E (or the vitamin B complex) can help, as well as correction of other risk factors such as hypertension, smoking, elevated cholesterol levels, alcohol consumption. Specific treatments for gastrointestinal motility disorders include diet modifications, erythromycin, bethanecol chloride, metoclopramide, domperidone and cisapride. For bladder dysfunction a urologist consultation is advisable.
Original posting 17 Sep 1998
Posted to Complications
Last Updated: Tuesday April 06, 2010 15:09:00
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