Diabetes and you

Did you know that about 34 million children and adults have diabetes in the United States? Trinidad & Tobago has its own challenges with this health condition. Evidence of this is diabetes is often referred to as one of the comorbidities present in Covid-19 fatalities.

World Diabetes Day is being observed Sunday, November 14. Catholic News’ reporter Kaelanne Jordan sought information from the American Diabetes Association— a US-based nonprofit that seeks to educate the public about diabetes and to help those affected through funding research to manage, cure, and prevent diabetes—on a series of topics related to diabetes.

Do persons with diabetes develop neuropathy? “That’s a great question. I would say that depending on how long someone has diabetes, most people will develop some neuropathy and that may be so subtle that they don’t notice it, but if they are tested in special way, you could detect there is some neuropathy.”

This according to Dr Robert ‘Bob’ Gabbay, Chief Scientific and Medical Officer for the American Diabetes Association (ADA), during a live ‘Ask Dr Bob’ episode Wednesday, October 27 via the Association’s Facebook page. Dr Gabbay’s talk was on ‘Diabetic Neuropathy and Chronic Pain.’

Diabetic neuropathy is a disease of the nerves that occurs in diabetics. Dr Gabbay identified three branches of this: sensory, the things you feel; motor, the things that move us; and autonomic, things that occur automatically within the body e.g., one’s heart rate.

Diabetic neuropathy can affect each of those nerve systems in different ways.

He explained, “The first one, sensory… that’s a very common form of neuropathy and it’s most commonly experienced as tingling of hands and feet. Those are the sensation nerves that are affected by diabetes.”

‘Bell’s Palsy’ is an unexplained episode of facial muscle weakness or paralysis because of nerve damage.

‘Gastroparesis’, the paralysis or weakness of the gastro tract is another common form of autonomic neuropathy among diabetics. Gastroparesis occurs when the stomach does not empty “at a normal rate”.

“It does not move the food along as quickly as possible and that can be a big problem for people with diabetes. And it can lead to a lot of symptoms: feeling full because food is not exiting the stomach, nausea…a whole host of problems. When it’s even worse [is] to the point of vomiting,” Dr Gabbay said.

He added that Type 1 and Type 2 diabetics all have the potential to develop neuropathy.

Dr Gabbay underscored that there are ways to avoid complications from diabetes. This can be achieved by managing one’s blood sugar levels.

Asked to discuss the warning signs of diabetic neuropathy, Dr Gabbay mentioned the “most common feeling” as tingling or the feeling of pins and needles in the feet and hands.

He said there is a “simple test” that can be performed by one’s health care provider for neuropathy. This involves gently pressing a piece of wire on the patient’s foot.

“It doesn’t hurt at all, but it tests whether you can feel that pressure. And if you can’t, you have some significant neuropathy.”

There are, however, treatment options for patients with chronic pain associated with diabetic neuropathy. Dr Gabbay listed medications such as Metformin, Gabapentin, Lyrica, and Capsaicin cream. Capsaicin is an ingredient found in different types of hot peppers such as cayenne pepper.

“Capsaicin is an irritant of the nerves. And there are particular nerves that recognise capsaicin…They confuse the nerves in a sense, so you don’t feel the pain.”

A nutritional supplement called alpha-lipoic can also help with neuropathy.

Overall, improving one’s glucose level is critical, Dr Gabbay stressed.

Amputation

According to Dr Gabbay, diabetes is the leading cause of amputations. He cited that Black Americans are three times more likely than Whites to undergo amputations. He said amputations are usually necessary when diabetics lose sensation in their feet.

“And that can be a real problem because we depend on feeling things in our feet to know if something is a problem. People with neuropathy, many times they get to the point they don’t feel anything or that pebble in their feet which sits there and can form an ulcer. Once an ulcer forms, you can get infection. And when infection gets to the bone, that’s one of the causes of amputation.”

Dr Gabbay recommends diabetics with neuropathy check their feet daily for lesions, calluses, ulcers or breaks in the skin. Early detection can significantly prevent amputations. He also suggested diabetics avoid trimming their toenails to avoid injury. He recommended the services of a podiatrist for this.

Overall, Dr Gabbay underscored while diabetic neuropathy tends to be progressive, it can be treated with a healthy blood glucose reading. If the nerves have died, however, it cannot be treated.