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March 10, 2008

Complications, Other Illnesses

Question from Los Angeles, California, USA:

I am 27 years old and in relatively good shape. I was diagnosed with type 1 diabetes 13 months ago. Since then, I have had good blood sugar control, maintaining an A1c of 6.5 or below. I am currently on an insulin pump and I test my sugar about eight times per day. I have good blood pressure and my cholesterol is now in the target range for a diabetic patient (it was never bad, but a little too high for someone with diabetes). I also have Hashimoto’s disease although since I was diagnosed, I have not needed synthetic thyroid. My levels have been tested regularly and they’re good.

Raynaud’s disease also runs in my family and though I’ve always had bad circulation in my extremities, I’ve never had the classic symptoms (white, blue, red skin). About a month ago, my circulation seemed to get worse. I was experiencing extreme cold, especially in my feet, sometimes followed by extreme heat and redness and swelling in my toes. I also frequently get mild tingling and numbness in my lower legs, feet and hands. So, I was tested for nerve damage last week and the results said that I have the beginnings of neuropathy in both of my lower legs.

How did this happen? I have good control and I’ve only had diabetes for one year. Could this problem be related to some other disease that nobody is spotting? And, if it is because of the diabetes, what does this mean for the long term? Is my control not as good as I think it is? Should I be consulting with a vascular specialist or rheumatologist?


From: DTeam Staff

I think that the point you are making is that a short duration of type 1 diabetes is not usually associated with long-term microvascular complications, like peripheral neuropathy. The other part of this is that you have good control. It is true that neuropathy is more likely when control is not good. There may be another cause for your neuropathy. For instance, you have shown a predisposition to autoimmune disease. Type 1 diabetes and Hashimoto’s thyroiditis are only two such autoimmune diseases. However, they can come together in the same patient. Additionally, other autoimmune problems can occur. One of them is pernicious anemia. This is an autoimmune manifestation involving the gut that makes it difficult to absorb vitamin B12. B12 levels and a CBC are usual part of neuropathy work-up. I would also consider seeing a neurologist because they are more familiar with some of the autoimmune manifestations of neuropathies associated with diabetes.

You are right to think outside the box. You probably need to speak with a specialist about these issues. I would seek the opinion of a neurologist.