September 24, 2007
Aches and Pains, Hyperglycemia and DKA
Question from Cozad, Nebraska, USA:
I recently had a doctor’s appointment to check my A1c. At the time of the appointment, I visited with my doctor about some severe joint pain in my knees and nodules that have appeared on the first knuckles of all my fingers. He had the laboratory run blood tests. He took x-rays of my knees, which basically showed no problems except for a little calcification on one knee. He prescribed Ultram QID as needed for pain. When the laboratory results came back, he called me with some abnormal readings in the following areas: C-reactive protein – 10.1 with normal being 5; sedimentation rate – 26 with normal being 0 to 20; and uric acid – 6.5 with normal being 5.7. My A1c was 7.6 with normal being 6.5. He said I tested negative for rheumatoid arthritis. My sugars have been running high since the joint pain has become bad. I am currently on Humalog at meals and Lantus at bedtime, as well as 1500 mg of metformin daily. I take Lisinopril for high blood pressure and 100 mg of trazadone at bedtime to aid with sleep as I have sleep apnea and use a CPAP unit at bedtime.
Could the joint (knee and leg) pain be from my diabetes? If not, what could cause the high readings in the areas shown? I plan a follow-up visit with the doctor, but would like to go armed with a little information as I am unsure how to proceed. I am still having a lot of discomfort and I don’t wish to remain on pain medication for an extended period of time. I would like to be able to get appropriate treatment as this is affecting my quality of life in the areas of work and family time.
Answer:
It sounds like you may potentially have an inflammatory arthritis. This is the reason for the elevated sedimentation rate and C-reactive protein. During a flair of arthritis, you can have worsening of your blood sugars, if your pain is great enough and you are not able to exercise or have regular sleep. It will be important for you to get your blood sugars under good control. This may or may not have benefit on your joints. A less likely scenario is that the diabetes is causing this. However, this should not cause such high C-reactive protein levels. People use this as a marker for vascular disease with diabetes, but it is also an acute marker of inflammation that may be from the arthritis. You should probably be clear with your physician that the pain continues. There are several types of arthritis that are not associated with positive blood tests.
JTL
