Doctors Should not Take Polyneuropathy as a Symptom of Pre-Diabetes

One of the more distressing symptoms of the disease diabetes, and one which is often one of the earliest signs, is polyneuropathy, in which the nerve endings have been damaged by high levels of sugar in the blood.  This gives rise to numbness and tingling in the feet and often the hands, and subsequently, as the disease progresses, to sharp pains which can be very severe.

In diabetes, the person has lost the ability to process carbohydrates in the diet properly, so that glucose from food stays in the blood longer than it should.  This is because the person’s pancreas has stopped producing enough of the hormone insulin (diabetes type 1), which causes sugars to be absorbed out of the blood by the tissues, or because the tissues have ceased being able to respond (type 2).  In either case, the higher levels of blood glucose are detrimental to many body systems and organs, including the heart, the kidneys, the eyes and the nerves.

Diabetic polyneuropathy can be severe, leading to such generalized nerve damage that circulation is lost to the feet and gangrene is a possible result, with amputation then becoming necessary.  On the other hand, the nerve damage can cause the patient to injure himself unawares, leading to open wounds on the soles of the feet that he does not treat because he does not know of them.  This can also lead to severe complications.  As the disease progresses the polyneuropathy may bring about many unwanted complications including facial distortions such as drooping of part of the mouth or an eye, erectile dysfunction, speech impairment and difficulty swallowing, diarrhea and urinary incontinence.

Diabetes is often diagnosed when a patient calls on his doctor complaining of the symptoms of polyneuropathy, the tingling, numbness and pain, and when a patient presents with these symptoms a doctor’s mind often goes directly to diabetes.  Alternatively, he may suspect pre-diabetes, the condition in which a patient has started to show symptoms of type 2 diabetes, such as insulin resistance, without yet having the full-blown disease.

Now a study made at the prestigious Mayo Clinic has suggested this thinking may be wrong, and that polyneuropathy is no commoner in pre-diabetics than in otherwise healthy people.  Researchers say that this symptom cannot therefore be considered a sure symptom of pre-diabetes and that doctors must look to other explanations as well.

The five-year research at the not-for-profitUSclinic examined impaired glucose tolerance and neuropathy in 532 older patients, with 208 of these being type 2 diabetics, 174 pre-diabetic and 150 healthy.  The team found that painful polyneuropathy was just as prevalent in healthy people as in people with pre-diabetes, and that therefore it could not be considered a sure symptom of pre-diabetes.  Doctors seeing patients with polyneuropathy should check for signs of pre-diabetes, but should also explore other possible causes.

People with pre-diabetes commonly show no symptoms at all, and this may be true of full blown diabetes, with some patients going many years without diagnosis.  The one sure way of diagnosing diabetes or pre-diabetes will be the A1c blood glucose test, which determines the level of sugar in the patient’s blood.  Diabetics will commonly be above the normal level, and pre-diabetes will show an unusually high level.

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