I am an active, slim, 39 year old who has had type�1 diabetes for 20 years. During the last five years, despite good control, I have developed extreme sensitivity to temperature on my knees and feet. I have no loss of feeling or stiffness. However, despite wearing neoprene-type pads, I suffer a dull but persistent ache, which greatly disturbs my sleep. My own doctor and my diabetes specialist have made no clinical investigation and offer only painkillers or sleeping tablets. Is this condition related to diabetes? What is it and can anything be done?

I think there is a possibility your increased sensitivity pains may be from diabetic neuropathy. These symptoms tend to be worse at night. Fortunately, they are usually temporary. However, temporary may be for months.

Sleeping medications, if not habit forming, are reasonable to try. However, pain medications, especially pain medications of the opiate class, can be habit forming. Simple nonsteroidal antiinflammatory medications may not be enough. Even improvement in blood sugars can raise the pain threshold and decrease your pain. Talk to your doctor about more specific medications used to treat diabetic neuropathy. Used chronically, and not just at the time of the discomfort, they can prevent the development of pain. Making a specific diagnosis can be tricky because diabetic neuropathy can look a lot like other kinds of neuropathy. Findings, using an electromyogram (EMG), are not always specific. This can be a tricky business. However, with some persistence on both sides, patients can usually get some relief.

JTL