I’m 18 years old, and I have had diabetes since I was nine. I have never been able to get my blood sugars in good control and always feel like diabetes is hindering me from leading a normal life. My A1cs are always above 10%, and I know something needs to change. Lately, I have been feeling pain in my left big toe, but my circulation is fine. I am knowledgeable about diabetes, but I am just finding it hard to control consistently high blood sugars without feeling like it is interrupting the way I want to live my life. If I start taking better care of myself, will the pain in my foot go away, or could it be permanent?

Anytime you decide to take care of your diabetes — glucose levels — your body gets a chance to start healing. It sounds like you may have a condition called diabetic neuropathy or diabetic neuritis. This occurs when high sugars for many years damage the nervous system. If it affects the nerves controlling your stomach, you could have severe diarrhea or constipation as well as problems emptying your stomach and intestines. If it affects the nerves that control pain sensation, then you could have burning pains in that nerve. If it affects the nerves going to the muscles, then you may have muscle weakness etc. Similarly, blood vessels in the eyes, kidneys and around the heart as well as to the brain can be damaged by high sugars in a fashion similar to damage from smoking, high cholesterol and high blood pressure.

We learned from the DCCT and many other similar studies that high sugars are directly related to such problems. If your hemoglobin A1c has been in the 10% range for so many years, it is likely that you are at high risk for such problems. You should discuss this directly with your diabetes team since they know which tests to be done to check out how the rest of our body has responded.

Once you decide to really take care of yourself, you may need to be completely reeducated, change your style of eating, learn about carb counting, take more frequent insulin injections or use an insulin pump, all based upon what your real goals are, how easy or hard they are to achieve, and all based upon frequent blood glucose testing so that you are no longer guessing. Lastly, you should know that sometimes some of these complications seem to get worse before they get better as the body starts to heal itself. So you need a good dilated retinal exam from a retina specialist who works with your diabetes team and with you to get baseline information and then follow what happens to your eyes closely as things improve.

Go for it! It’s worthwhile even after many years.

SB