January 31, 2006
Complications, Type 2
Question from Calgary, Canada:
I was diagnosed with type 2 five months ago. I did not have any symptoms, no fatigue or weight loss. It was an incidental finding while working in the laboratory and I found my own urine sample positive for sugar which I was using as a negative control for my some experiments.
I am 26 years old, 5 feet, 8 inches and weigh 72 kg (158 pounds) now, having lost 12.5 kg (27 and a half pounds). My BMI has reduced to 24.1. My A1c was 7.9 when I was diagnosed with marked dyslipidemia, but my recent tests show that my A1c has dropped down to 6.3. My fasting levels were normal for the last few weeks and my postprandial levels are usually less than 10 mmol/L [180 mg/dl] and then usually less than 8 mmol/L [144 mg/dl] after two and a half hours. My lipid profile has also improved although my LDL is still on the higher end of what is recommended (131 mg/dl). My recent microalbumin/creatine was 0.9 (0 to 30 range), normal GFR, and no evidence of retinopathy.
Right now, I am on metformin 500 mg twice a day. Should I still continue a strict diet regimen and try and lose more weight? Secondly, I do feel some burning sensations on by both legs. My doctor says it may be psychological. It’s important to mention that I was a negative control in my family since my mother has had type 2 for three decades and my brother was also diagnosed three years ago. So, checking my sugars (urine and glucometer) was routine until June 2004. After that, I left home and didn’t pay much attention for a year or so until my July 2005 diagnosis. Is it possible that I have neuropathy? I do feel numbness in my legs, more so in my feet.
Answer:
Neuropathy can be present at the time of diagnosis with type 2 diabetes. There is such an imprecise onset to the condition that many people have had the disease for years before it is diagnosed. Previous studies have suggested that the person with type 2 diabetes may have had diabetes up to six years prior to diagnosis. The problem is making an accurate diagnosis of diabetic neuropathy. There are a lot of other things that may give you the vague symptoms of distal symmetrical polyneuropathy from diabetes. If you work in a laboratory, you are up on your feet all day; you can have nerve compression from a previous injury or a repetitive injury. The only way to be sure is to do more definitive neurophysiology studies, such as nerve conduction studies. Most people do not need these. It is true that people with symptomatic pain, such as the pins and needles or burning sensations, respond well to blood sugar lowering. Numbness, once it persists, is less likely to respond to anything. Only those who have pain that exceeds their ability to tolerate it are candidates for chronic pharmacologic therapy. You might have symptoms from something else. Continue to work towards normalizing your hemoglobin A1c. I would also continue to work hard with lifestyle changes. It benefits your overall cardiovascular risk (and your dyslipidemia). If you don’t keep it up, your metformin may not be able to work well at the current low dose.
JTL
