I was diagnosed about 10 years ago, at age 50. I take Glucophage [metformin] and Amaryl (a sulfonylurea), and my blood glucose averages about 170. I have had neuropathy for the past several years, causing severe burning in my feet. It is worse at night or when I put my feet up, as in a recliner. I have seen two family practice doctors (my insurance changed), two podiatrists, and a diabetes specialist (physician). Each of them suggests a different approach. One said to take niacin; the next one said that niacin would increase resistance to glucose. One recommended primrose oil; another said that borage oil was better. One said to wear sandals (he could have some made to fit for “only” $200, not covered by insurance). Others, and most things I have read, say not to wear sandals or go barefoot, for fear of damage that I wouldn’t feel. All said to avoid heat.

But: Here is what I have found. Niacin helps the feet feel less painful. Wearing sandals helps to avoid the burning (socks feel like rough hemp underfoot; nylon is agony). And walking around in hot (92-96F) weather in sandals for a couple of weeks made the burning go away, and after more than two months, it is still gone. Avoiding heat during sleep makes my toes feel swollen and wooden, as if injected with novocaine.

Which doctor should I believe, if any? Can I trust my own responses, or am I doing unknown harm?

You have asked a very good question. I would wonder myself which doctor to believe. I can only share with you what I know about neuropathy and the treatments. Niacin can be helpful but can raise the blood sugar. That becomes a problem if your blood sugar remains high. And you say yours is 170 mg/dl [9.4 mmol/L] which, as you know, is too high and has the potential to cause more damage to the nerves of your feet and the blood vessels throughout your body.

I think one of the first things I would suggest is talking again to the diabetes specialist about more aggressive treatment of your blood sugar. Many people with type 2 diabetes are now gaining good control with a combination of three or four oral agents and adding insulin, if needed, to bring blood sugars to target range.

There are other treatments for painful neuropathy. Some medicines can help such as Elavil [amitryptiline], Neurontin [gabapentin] and some creams that contain capsaicin (chili pepper oils). People report back to me various effectiveness, but it might be work=th a try to talk to your doctor about other options.

Regarding the wearing of sandals or open toed shoes, if you have diminished sensation in your feet, it is putting you at increased risk if you expose the foot to possible trauma. The nerves of the feet are your warning system if anything is wrong. If this warning system is not working, your eyes and brain must take over and look for problems and protect your feet from any risk.

I hope I have answered your question somewhat and I encourage you to continue to seek the best way for you.

KS

[Editor’s comment: Also, see Diabetes and Foot Pain (at the Diabetes Monitor) for some additional thoughts about the management of painful diabetic neuropathy.

WWQ]