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December 31, 2001

Complications

Question from the USA:

I've have had diabetes for 22 years, and my hemoglobin A1cs have averaged 6% consistently for the last three years only. Before that, they averaged about 8.5 or 9%, with the occasional 10% here and there. Also, have had three DKA [diabetic ketoacidosis] episodes, the first being eight or nine years ago, and the last one was four years ago. Adding to the typical DKA symptoms, I experienced red-hot burning pain from deep within the muscles of my neck, shoulders and upper arms, down to my elbows. It was such a deep-rooted pain it felt as if it originated deep in my bones and radiated outward. On a pain scale, I'd put it as worse than either childbirth or my two broken legs! Up until about a year ago, those DKA episodes were the only times I'd felt that unspeakable pain. A year ago, I started having bone-deep, hot, burning pain in shoulders and upper arms just about every time my blood sugar gets the least bit high (even at 180 mg/dl [10 mmol/L]). The current pain is nowhere as intense as the DKA variety was, but it's of the same type, makes me cry, and is the worst pain I experience now. I check my sugar often and, if it's high, it's been high for only a matter of hours. So, the painful burning ache is not the result of a several days worth of high blood sugars, headed-toward-DKA binge, it develops in mere hours. The unspeakable muscle pain is my first warning that my blood is high. I check it, take however much Humalog I need, and, When my blood sugar lowers, the pain goes away. This takes about an hour from start to finish. I've never heard of this pain being a symptom of DKA, let alone of a merely slightly high blood glucose that's been elevated for only a few hours at most. What can you tell me about muscle pain as a symptom of DKA? Do you know why I'm now reacting in such a painfully dramatic way to moderately high blood sugars?

Answer:

22 years of diabetes makes me wonder if the pain is cardiac in origin. If you haven’t been checked for that, please see your physician and describe your pain in detail.

LD

[Editor’s comment: You might also have a form of neuropathy, and the slight elation in blood sugar may be the result of stress related to pain. Because you are seeing the numbers after you experience the pain, you surmise the elevation is causing the pain and not vice versa. Please ask your physician for a referral to a neurologist skilled in the diagnosis and management of neuropathy. There is treatment available.

SS]