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Question:

From Ohio, USA:

I am a 31-year-old type 1 diabetic of 13 years. A1c's during that time have ranged from 6.2 to 8.6, with the average probably being about 8.1 and the last six months showing evidence of significantly decreasing blood glucose averages (last A1c - 7.4). I also have controlled high blood pressure. In about the last year, I have begun feeling intermittent pain in my feet and tightness in the muscles of my calves. After very good results with the monofilament test (no evidence of lost sensation in feet and toes, according to my doctor), my doctor ordered an electromyography (EMG) with nerve conduction velocity (NCV) tests. Prior to these tests, the neurologist conducting them tested reflexes in my knees and near my ankles, noting good reflexes in those areas. The NCV tests revealed mildly delayed reaction to electrical impulses transmitted to a cluster of nerves slightly to the right of the tibia of my right leg. The neurologist, however, did not mention anything regarding the EMG results. He opted not to perform any NCV studies of the left leg. With the result of the NCV test on the right leg, the neurologist diagnosed neuropathy, presumably connected with the diabetes.

I have dramatically increased the amount of exercise I do each week (probably a good four to five hours weekly of light to intense aerobic activity), significantly improved my dietary habits, and have really started to get the A1c near (and hopefully soon below) the 7.0 level. Is the tightness in my calf muscles likely related to peripheral neuropathy? With the efforts I've undertaken, is it possible to reverse or slow the progression of any peripheral neuropathy connected to diabetes, if I get the A1c consistently under 7, continue the increased exercise regimen, and continue to eat better?

Answer:

The diagnosis of diabetic peripheral neuropathy is a diagnosis of exclusion. The EMG results are not specific for neuropathy. The test is also to look for other causes that can be separated from neuropathy. It is also true that pain thresholds go down when the blood sugars are higher. After getting your blood sugars down, if you still have pain, there are medications that can be used to treat the pain. Good blood sugar control can slow the progression of neuropathy. However, if you can keep doing your exercises, this will help stretch the muscles, keep the blood flow good, and work to keep your blood sugars down with the minimum of medications.

JTL

DTQ-20100801124936
Original posting 11 Aug 2010
Posted to Complications

  
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Last Updated: Wednesday August 11, 2010 09:56:38
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