neuropathy

CBD for Type 2 Diabetes: What Are the Benefits and Risks?

Posted by

0


You probably don’t have to look further than your local drugstore or beauty product supplier to know CBD has taken a starring role in everything from sparkling water and gummies to tincture oils and lotions. Some may even say that cannabidiol (CBD) — which, like THC, is a component of the cannabis plant, but doesn’t contain its psychoactive effects — is the “it” ingredient of our age.

You’ve probably also heard that CBD can help lessen stress, anxiety, and pain. “When people are in pain, they have a stress response, which causes an increase in cortisol and an increase in blood sugar,” says Veronica J. Brady, PhD, CDCES, a registered nurse and an assistant professor at the Cizik School of Nursing at the University of Texas in Houston. Relieving pain can help alleviate the stress response and improve blood sugar levels, as well as aid sleep, she says.

If you’re managing type 2 diabetes, it’s natural to be curious about whether CBD might help you manage those symptoms, too, to help stabilize your blood sugar. In fact, the prevalence of cannabis use increased by 340 percent among people with diabetes from 2005 to 2018, according to one study, which surveyed people on their use of cannabis (CBD or THC, in any form) in the previous 30 days.

But will popping some CBD gummies for diabetes work  Some healthcare professionals say CBD may have a role to play, but it’s important to understand that the only health condition CBD has proved effective for is epilepsy in kids. The jury is unfortunately still out, owing to the lack of comprehensive research on CBD for diabetes.

Still, in the aforementioned survey, 78 percent of people used cannabis that was not prescribed by a doctor. “Diabetes patients might still use cannabis for medical reasons, but not have a prescription,” says Omayma Alshaarawy, MBBS, PhD, an assistant professor in the department of family medicine at Michigan State University in East Lansing, who led the study. Recreational use is another factor. She points to a separate study that found that more than 50 percent of people with medical conditions such as diabetes or cancer use cannabis recreationally.

How People With Type 2 Diabetes Are Using CBD

In Nevada, where Dr. Brady used to work as a certified diabetes educator, her patients with type 2 diabetes used CBD for nerve pain. She says patients would use CBD in a tincture or in oils that they rubbed on painful areas, including their feet. Patients could buy CBD at medical marijuana dispensaries, which would offer dosing instructions. “They worried about the impact on their blood sugars,” says Brady.

Ultimately, though, Brady says that her patients reported that CBD reduced their nerve pain and improved their blood sugar. She adds that those people who used CBD oils for nerve pain also reported sleeping better.

Heather Jackson, the founder and board president of Realm of Caring in Colorado Springs, Colorado, a nonprofit that focuses on cannabis research and education, senses a community interest in CBD for diabetes. “In general, especially if they’re not well controlled, people are looking at cannabinoid therapy as an alternative, and usually as an adjunct option,” says Jackson. Callers have questions about CBD for neuropathy pain, joint pain, gastrointestinal issues, and occasionally blood glucose control, according to a spokesperson for Realm of Caring.

The organization receives thousands of inquiries about cannabis therapies a month. It keeps a registry of these callers, where they live, and their health conditions. Jackson says that people with type 2 diabetes are not a large percentage of the callers, but they currently have 540 people with diabetes in their database.

Jackson says that Realm of Caring does not offer medical advice, and it does not grow or sell cannabis. Instead, it offers education for clients and doctors about cannabis, based on its ever-growing registry of CBD users, their conditions, side effects, and administration regimen. “We are basically educating,” says Jackson. “We want you to talk to your doctor about the information you receive.”

Scientific Studies on CBD and Type 2 Diabetes and Barriers to Research

Despite interest among people with type 2 diabetes, large, rigorous studies showing how CBD may affect type 2 diabetes are lacking, says Y. Tony Yang, MPH, a doctor of science in health policy and management and a professor at George Washington University School of Nursing in Washington, DC. Specifically absent are randomized controlled trials, which are the gold standard of medical research.

At the very least, a case report from 2021 suggests that CBD is unlikely to cause harm or worsen diabetes control. (The American Diabetes Association also stresses that CBD should not be considered a replacement for traditional diabetes management.)

Other research suggests the use of CBD for diabetes is indeed worth further study. For example, a small study in the United Kingdom looked at 62 people with type 2 diabetes and found that CBD did not lower blood glucose. Participants were not on insulin, but some took other diabetes drugs. They were randomly assigned to five different treatment groups for 13 weeks: 100 milligrams (mg) of CBD twice daily; 5 mg of THCV (another chemical in cannabis) twice daily; 5 mg CBD and 5 mg THCV together twice daily; 100 mg CBD and 5 mg of THCV together twice daily; or placebo. In their paper, the authors reported that THCV (but not CBD) significantly improved blood glucose control.

Other CBD research is still evolving. Some research on CBD for diabetes has been done in rats, which leads to findings that don’t always apply to human health. Other research has looked more generally at the body’s endocannabinoid system, which sends signals about pain, stress, sleep, and other important functions. Still other studies have looked at marijuana and diabetes, but not CBD specifically.

That there are so few studies of CBD in people with type 2 diabetes has to do with a lack of focus on CBD as an individual component. Historically, cannabinoids (a group of chemicals in the cannabis plant) have been lumped together, including CBD, THC, and more than 100 others. The 1970 U.S. Controlled Substances Act classifies cannabis as a Schedule 1 drug with the highest restrictions, according to the Alcohol Policy Information System. Currently, 38 states allow cannabis for medical use, and 24 states and the District of Columbia have passed legislation allowing cannabis for recreational use, per CNN.

The 2018 Farm Bill removed industrial hemp from the controlled substances list, clearing the way for more production and research of CBD. Meanwhile, growers and manufacturers are better able to isolate CBD, mainly by cultivating industrial hemp that is high in CBD and very low in THC, says Jackson. So, perhaps in the coming years, more research on CBD and diabetes will emerge.

How the FDA Views and Regulates CBD for Disease Treatment

Yet, as evidenced by a previously cited study, people with type 2 diabetes aren’t waiting for further study to hop on the trend. Brady says her patients have been open about using CBD, particularly the younger patients. She says one of her older patients was initially uncomfortable about buying CBD in the same shop that sold marijuana but eventually gave in. Brady adds that many people associate CBD with smoking marijuana, despite their distinctly different effects on the body.

The U.S. Food and Drug Administration (FDA) approved the first CBD medication in 2018, for treating childhood epilepsy. Currently, there is no other FDA-approved CBD medication for diabetes or any other condition, according to the FDA. In December 2018, the FDA said it was unlawful under the Federal Food, Drug, and Cosmetic Act to sell food or dietary supplements containing CBD. But in January 2023 the FDA concluded that a new regulatory pathway for CBD is necessary and that it intends to work with Congress to develop one.

“The FDA, for the time being, has focused its limited enforcement resources on removing CBD products that make claims of curing or treating disease, leaving many CBD products for sale,” wrote Pieter Cohen, MD, and Joshua Sharfstein, MD, in The New England Journal of Medicine. Dr. Cohen is an assistant professor of medicine at Harvard Medical School in Boston, and Dr. Sharfstein is the vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health in Baltimore.

Precautions for People With Diabetes Looking to Try CBD

For the CBD products already on the market, Jackson says it’s often difficult to know what’s inside. One study found that only 30 percent of CBD products were accurately labeled, with under- and over-labeling of CBD content, and some products containing unlisted chemicals such as THC.

Vaping liquids were the most commonly mislabeled CBD products in the study. The Centers for Disease Control and Prevention (CDC) warns that consumers should not purchase any vape products from unregulated and illicit markets or attempt to modify vape products outside of how the manufacturer intended. The Associated Press has shown that some CBD vapes have synthetic marijuana.

Jackson points out that CBD may affect certain cholesterol and blood pressure drugs, and research has detailed these interactions. Other side effects of CBD include tiredness, diarrhea, and changes in weight or appetite, the researchers write.

“What you put in your body is really important,” says Jackson, adding that’s especially true for people with major health conditions like diabetes. Jackson speaks from personal experience as a mom finding CBD treatments for her son’s epilepsy. She says consumers should ask manufacturers whether CBD products are free of mold, pesticides, and other toxins.

Realm of Caring, Jackson’s nonprofit, created a reference sheet for evaluating products and manufacturers. It also endorses products that adhere to standards such as those from the American Herbal Products Association and the FDA’s Current Good Manufacturing Practice regulations.

“There is little known about cannabis health effects, especially among patients with chronic conditions. Research is growing, but still solid evidence evolves,” says Dr. Alshaarawy. For these reasons, she recommends that patients talk to their doctors so they can discuss the benefits and potential harms of cannabis and monitor their health accordingly.

How to Talk to Your Healthcare Provider About Using CBD for Type 2 Diabetes

Jackson and Brady advise people who are considering CBD for diabetes to ask their providers about the complementary therapy before adding it to their treatment plan. Brady says it’s difficult to find research about CBD and type 2 diabetes, even in her capacity as a diabetes educator. Still, in her experience, if people are looking for a natural way to manage pain, it’s worth a conversation with their healthcare provider. “It’s something that should be talked about, especially if they’re having significant amounts of pain, or really any pain at all associated with their diabetes,” says Brady.

“It’s a reasonable alternative,” says Brady. “As it gains in popularity, there needs to be some information out there about it.

Can physical therapy help treat neuropathy?

Posted by

0


Neuropathy refers to symptoms caused by nerve damage, such as severe and chronic pain, tingling, numbness, cramps, and weakness. Physical therapy may be able to help reduce the symptoms of neuropathy. However, more high quality research is required.

Research into the effects of physical therapy on neuropathy is ongoing. Researchers have found that physical therapy may reduce some of the symptoms of neuropathy and improve a person’s quality of life.

However, evidence of these effects is limited. Studies on the efficacy of physical therapy to treat neuropathy are of mixed quality, and some may be unreliable.

This article examines whether physical therapy can help treat neuropathy and what kind of physical therapist a person may need. It also looks at exercises, finding a physical therapist, and covering the cost of physical therapy.

Can physical therapy help treat neuropathy?

Luis Alvarez/Getty Images

According to a 2021 systematic review and expert consensus, physical therapy can help reduce the intensity of neuropathy symptoms.

Authors of a different 2021 reviewTrusted Source note that physical therapy may be helpful as a complementary treatment when performed while taking medications to treat both the underlying causes and the neuropathic pain.

The authors also state that further research is required to define the treatment strategy for neuropathy.

How can it help?

Specific exercise programs may help alleviate pain, improve physical well-being, and aid in the recovery of damaged nerves, which may all effectively improve symptoms of neuropathy.

However, the various potential causes of neuropathy have a range of characteristics and may cause different individuals to respond to exercise and treatment in different ways.

Different exercise programs, and exercises of different intensity levels and frequency, can also produce a range of effects in people with neuropathy.

For these reasons, people must work with a physical therapist to develop an individualized exercise program that best suits their needs.

Exercise may help improve symptoms of neuropathy in several ways. These include:

  • Increasing blood flow and decreasing vasoconstriction: Vasoconstriction occurs when muscles around the blood vessels tighten and shrink the space inside them. Increased blood flow and circulation may help alleviate neuropathic pain.
  • Increasing muscle strength: This can help improve symptoms of neuropathy, such as weakness.
  • Improving balance: Improving balance can help decrease the risk of fall and injury.

What kind of physical therapist do I need?

A person with neuropathy should contact a neurological physical therapist.

Neurological physical therapists specialize in evaluating and treating people who have movement problems related to damage or illness of the nervous system.

Exercises

According to the Foundation for Peripheral Neuropathy, physical therapy exercises that focus on aerobic capacity, flexibility, strength, and balance may be beneficial to people with neuropathy:

  • Aerobic exercises: These help work muscles and increase breathing and heart rate. Examples of aerobic exercises a physical therapist may recommend include:
    • swimming
    • brisk walking
    • cycling
  • Flexibility training: People also refer to flexibility training as stretching. This helps keep joints flexible, which can reduce a person’s risk of injury.
  • Strengthening exercises: Strength training helps strengthen muscles. Examples include:
    • bodyweight exercises, such as squats and pushups
    • weightlifting
    • resistance band activities
    • stationary weight machines
  • Balance exercises: These can help a person maintain and improve strength and coordination. This can also help decrease fall risk and improve a person’s functional mobility.

A person should check with a physician before starting any exercise program.

Finding a physical therapist

Finding the right physical therapist for each individual can involve a variety of factors. These include:

  • what insurance the therapist accepts
  • whether they treat neuropathy or specialize in neurological conditions
  • what geographic location a person is in

Some healthcare professionals may have a list of physical therapists in their area whom they recommend, and insurance companies typically provide a list of physical therapy locations that are part of specific health plans.

Covering the cost of physical therapy

If a person requires physical therapy, Medicare Part B can help cover the cost. Medicare does not have a spending limit for physical therapy.

A person will have to pay a 20% deductible of the Medicare-approved amount.

The amount a person will owe can depend on:

  • how much the physical therapist charges
  • the facility where the physical therapy takes place
  • any other insurance a person might have

Summary

Physical therapy may help treat neuropathy and could improve some of the symptoms, such as pain and weakness. However, the cause of neuropathy and the specific content of a person’s exercise program may affect the efficacy of physical therapy.

A person may benefit from doing physical therapy in combination with taking medication to treat the underlying causes of the neuropathy and the symptoms, such as pain.

Research on the efficacy of exercise to treat neuropathy is uneven and limited due to the variations in causes of neuropathy and types of exercise.

Certain types of exercise, such as those focused on aerobic capacity, flexibility, strength, and balance, may help improve symptoms, improve overall health and well-being, and reduce injury risk.

Insurance may help cover some of the costs of physical therapy. However, a person would need to confirm with their insurance provider and find a physical therapist covered by their plan.

Neuropathy primary driver behind higher fatigue in adults with diabetes

Posted by

0


Adults with diabetes experience more fatigue compared with those without diabetes, with diabetic neuropathy being the primary driver for increased fatigue, according to a speaker.

In findings from a study presented at the AACE Annual Scientific and Clinical Conference, researchers used the Norfolk Quality of Life (QOL) – Fatigue tool to measure the cognitive, physical and emotional aspects of fatigue of people with diabetes compared with healthy controls without diabetes.

Diabetic neuropathy is associated with worse fatigue.
Adults with diabetes and neuropathy experience significantly more fatigue than those with diabetes and no neuropathy and people without diabetes. Data were derived from Casellini CM, et al. Utilizing a quality of life tool to examine the presence of fatigue in subjects with diabetes mellitus. Presented at: American Association of Clinical Endocrinology Annual Scientific and Clinical Conference; May 12-14, 2022; San Diego.

“We think the Norfolk QOL – Fatigue questionnaire has the potential to identify the impact of chronic diseases such as diabetes and neuropathy on the development of different components of fatigue,” Carolina M. Casellini, MD, assistant professor at the Strelitz Diabetes Center at Eastern Virginia Medical School in Norfolk, Virginia, said during a presentation. “Assessing the different components is especially relevant to clinicians caring for subjects with diabetes as fatigue can interfere with numerous factors affecting diabetes control and diabetes outcomes.”

Casellini and colleagues conducted a cross-sectional survey of adults aged 18 to 79 years living in the Hampton Roads, Virginia, region from 2018 to 2022. Participants included 400 adults with type 1 or type 2 diabetes and 140 healthy controls without diabetes. The Norfolk QOL – Fatigue tool was conducted in-person at the Strelitz Diabetes Center before the COVID-19 pandemic and virtually after the pandemic started. The questionnaire includes 35 items in five domains: subjective fatigue; physical and cognitive problems; depression; reduced activities; and activities of daily living. Respondents scored each item on a scale of zero to four, with a higher score indicating greater fatigue. Demographics including height, weight, BMI, waist circumference and duration of diabetes were self-reported. Participants with diabetes also completed the Norfolk QOL – Diabetic Neuropathy questionnaire to assess the impact of neuropathy on fatigue.

The diabetes group had a higher overall fatigue score in the questionnaire compared with the control group (mean score, 52.83 vs. 29.11; P < .0001) as well as higher scores in all five domains of the fatigue questionnaire. Of those with diabetes, 311 had neuropathy and 89 did not have neuropathy. Participants with diabetes and neuropathy had a higher overall fatigue score (mean score, 59.72 vs. 27.83; P < .0001) and a higher score in all five individual domains compared with those with diabetes and no presence of neuropathy.

Within the control group, women had a higher fatigue score than men. However, no differences between men and women were observed within the diabetes cohort. There were no differences in fatigue score between racial-ethnic groups.

When evaluating other demographics, younger participants were more likely to have a worse fatigue score compared with older adults. No associations were observed for weight, BMI or duration of diabetes.

“There are several theories around this,” Casellini said of the association between higher fatigue and younger adults. “Fatigue symptoms may be perceived as less severe by individuals who experience them for a longer time, and there may be potential generational differences in everyday responsibilities and life stressors.”

Casellini said more studies are needed to assess fatigue in cohorts with other comorbidities and to evaluate the utility of the tool against other tools for evaluating fatigue.

Gene Therapy Shows Promise in Treating Neuropathy From Spinal Cord Injuries

Posted by

0


Summary: Gene therapy that inhibits targeted nerve cell signals effectively improves symptoms of neuropathic pain without negative side effects in mouse models of spinal cord injury or peripheral nerve damage.

Source: UCSD

An international team of researchers, led by scientists at University of California San Diego School of Medicine, report that a gene therapy that inhibits targeted nerve cell signaling effectively reduced neuropathic pain with no detectable side effects in mice with spinal cord or peripheral nerve injuries.

The findings, published in the May 5, 2022 online issue of Molecular Therapy, represent a potential new treatment approach for a condition that may affect more than half of patients who suffer spinal cord injuries. Neuropathy involves damage or dysfunction in nerves elsewhere in the body, typically resulting in chronic or debilitating numbness, tingling, muscle weakness and pain.

There are no singularly effective remedies for neuropathy. Pharmaceutical therapies, for example, often require complex, continuous delivery of drugs and are associated with undesirable side effects, such as sedation and motor weakness. Opioids can be effective, but can also lead to increased tolerance and risk of misuse or abuse.

Because physicians and researchers are able to pinpoint the precise location of a spinal cord injury and origin of neuropathic pain, there has been much effort to develop treatments that selectively target impaired or damaged neurons in the affected spinal segments. 

In recent years, gene therapy has proven an increasingly attractive possibility. In the latest study, researchers injected a harmless adeno-associated virus carrying a pair of transgenes that encode for gamma-aminobutyric acid or GABA into mice with sciatic nerve injuries and consequential neuropathic pain. GABA is a neurotransmitter that blocks impulses between nerve cells; in this case, pain signals.

The delivery and expression of the transgenes — GAD65 and VGAT — was restricted to the area of sciatic nerve injury in the mice and, as a result, there were no detectable side effects, such as motor weakness or loss of normal sensation. The production of GABA by the transgenes resulted in measurable inhibition of pain-signaling neurons in the mice, which persisted for at least 2.5 months after treatment. 

This shows dna
There are no singularly effective remedies for neuropathy. Image is in the public domain

“One of the prerequisites of a clinically acceptable antinociceptive (pain-blocking) therapy is minimal or no side effects like muscle weakness, general sedation or development of tolerance for the treatment,” said senior author Martin Marsala, MD, professor in the Department of Anesthesiology in the UC San Diego School of Medicine. 

“A single treatment invention that provides long-lasting therapeutic effect is also highly desirable. These finding suggest a path forward on both.”

COVID-19 Infection Linked to Higher Risk of Neuropathy

Posted by

0


Summary: A number of patients who contracted COVID-19 in the early months of the pandemic reported symptoms of neuropathy, including pain, tingling sensations, and numbness that lasted up to three months after recovery. The findings suggest COVID-19 may have lingering effects on peripheral nerves.

Source: WUSTL

Adding to a growing body of evidence that, for many, problems related to COVID-19 linger longer than the initial infection, researchers at Washington University School of Medicine in St. Louis have found that some people infected during the pandemic’s early months experienced peripheral neuropathy — pain, tingling and numbness in the hands and feet — during and following their bouts with the virus.

In a study of more than 1,500 people who were tested for SARS-CoV-2 during the first year of the pandemic, the researchers found that those who tested positive for the virus were about three times more likely to report pain, numbness or tingling in their hands and feet as those with negative tests.

The findings are reported online March 24 in the journal Pain.

“Several viral infections — such as HIV and shingles —  are associated with peripheral neuropathy because viruses can damage nerves,” said senior investigator Simon Haroutounian, PhD, chief of clinical research at the Washington University Pain Center.

“We found that nearly 30% of patients who tested positive for COVID-19 also reported neuropathy problems at the time of their diagnosis, and that for 6% to 7% of them, the symptoms persisted for at least two weeks, and up to three months, suggesting this virus may have lingering effects on peripheral nerves.”

Haroutounian, who also is an associate professor of anesthesiology and director of the department’s Division of Clinical and Translational Research, said some patients who traced the start of their neuropathy symptoms to a COVID-19 infection have sought treatment at the Washington University Pain Center. Most of those in the study, however, reported problems that were rated as mild to moderate and may not have sought help from a pain specialist.

“It is important to understand whether a viral infection is associated with an increased risk of neuropathy,” he said. “In the case of HIV, we didn’t realize it was causing neuropathy for several years after the AIDS epidemic began. Consequently, many people went undiagnosed with neuropathy and untreated for the pain associated with the problem.”

He said the same may be true now for patients with neuropathy following COVID-19. There is no established diagnosis of neuropathy related to COVID-19, but Haroutounian explained that, regardless of the cause, current treatments for neuropathy are somewhat similar. Pain specialists use the same types of medications to treat peripheral neuropathy, whether it’s caused by diabetes or HIV or the cause is  unclear.

“There is a high likelihood we could still help these patients, even though at the moment there are not clear diagnostic criteria or even a recognized syndrome known as COVID peripheral neuropathy,” he said.

The research team surveyed patients who were tested for COVID-19 on the Washington University Medical Campus from March 16, 2020, through Jan. 12, 2021. Of the 1,556 study participants, 542 had positive COVID-19 tests, and 1,014 tested negative.

Many of those who tested negative were tested because they were undergoing surgery or were already hospitalized with cancer, diabetes or other health problems, Haroutounian said. Because of those existing health problems, many who tested negative already experienced chronic pain and neuropathy unrelated to COVID-19, he said.

This shows a woman in a facemask surrounded by covid
Most of those in the study, however, reported problems that were rated as mild to moderate and may not have sought help from a pain specialist. Image is in the public domain

Study patients who tested positive tended to be healthier and younger, and 29% reported symptoms of neuropathy at the time of their diagnosis. That compared to neuropathy problems in about 13% of the participants who tended to have health challenges but tested negative for COVID-19. He said this finding strengthens the possibility that the virus may be involved in causing symptoms of peripheral neuropathy.

Because the study was conducted at a single center, Haroutounian said more research will be needed to replicate the findings. In addition, much of the data was gathered when outpatient clinical research had been halted due to the pandemic, meaning that study patients were evaluated according to their responses to a survey rather than via in-person interviews and physical exams.

“We also finished our data collection before vaccinations became widespread and before the delta or omicron variants arrived, and it’s difficult to say what effects those variables may have,” he said. “So we want to follow up with some of those patients who have lingering nerve symptoms and learn about what is causing their pain so that we can better diagnose and treat these patients moving forward.”

Odozor CU, Kannampallil T, Abdallah AB, Roles K, Burk C, Warner BC, Alaverdyan H, Clifford DB, Piccirillo JF, Haroutounian S. Post-acute sensory neurological sequelae in patients with SARS-CoV-2 infection: an observational cohort study. Pain, March 24, 2022.

HOW TO TREAT PAIN FROM DIABETIC NEUROPATHY

Posted by

0


Are you struggling with pain in your feet, legs, or hands from diabetic neuropathy? This is an especially frustrating condition that is both under-assessed and undertreated. And for those that do seek relief, it’s typical to have to try many different treatments before hitting on a combination that works.

Diabetic neuropathy pain is exactly the sort of condition where you might need the wisdom of people that have been there before. We reviewed more than a hundred comments in our Facebook group and forum to get an idea of how our community, made up of regular people with diabetes, deals with this problem.

This article will explore both the mainstream science of neuropathy pain mitigation and the everyday advice of Diabetes Daily community members.

What is Diabetic Neuropathy?

Diabetic neuropathy is a type of nerve damage common in people with diabetes. Neuropathy can affect many parts of the body, including the digestive system, the heart, the eyes, the bladder, the sweat glands, and sexual organs.

The nerve damage that mostly affects the feet, hands, legs, and arms is referred to as peripheral neuropathy. This condition is often very uncomfortable, with patients feeling pain, tingling, burning, prickling, numbness, and complete loss of feeling in the extremities. The pain may be worse at night. These symptoms are generally noticed first in the feet.

Diabetic neuropathy, like other diabetes complications, is ultimately caused by chronic high blood sugars. If you’ve begun to notice the pain associated with this condition, you should visit your doctor or endocrinologist soon. Diabetic neuropathy may indicate that you are also at risk of other serious complications.

Blood Sugar Control

If there’s one treatment for neuropathic pain that the Diabetes Daily community can wholeheartedly endorse, it is optimal blood sugar control.

Diabetic neuropathy is primarily caused by high blood sugar. Achieving a lower, healthier blood sugar is the best way to address the root cause of neuropathy, and may offer both short- and long-term relief. It is unclear if nerve damage can be reversed, but further damage can be prevented through superior blood sugar control.

If there’s another good reason to prioritize blood sugar control, it’s the fact that diabetic neuropathy is an early warning sign of some very dangerous diabetes complications. The feet of a patient with neuropathy may be less capable of healing wounds, which can ultimately “lead to limb compromise, local to systemic infection, and septicemia, and even death.” Several of our community members have had terrifying battles with septicemia.

Prescription Drugs

Don’t hesitate to speak to your doctor about prescription medication for this condition. Pharmaceuticals don’t work for everyone, but they might work for you.

In our community, the most popular pharmaceutical treatment seems to be gabapentin (Neurontin). Gabapentin is an oral prescription medication that acts on the brain, changing the way that it perceives pain. It is also used as an anti-convulsant, to prevent seizures in patients with epilepsy and related conditions.

Your doctor is likely to start you on a low dose, and you may need to increase that dose in order to feel an effect, or if the condition gets worse.

Gabapentin doesn’t work for everyone. A rigorous study found that only 35% of study participants enjoyed significant pain reduction, compared to 21% who were given a placebo, and that “over half of those treated with gabapentin will not have worthwhile pain relief.”

Gabapentin can have side effects, including skin issues, dizziness, and drowsiness. A small minority of users experience intense mood changes that may include suicidal thoughts.

Lyrica (pregabalin) may be the second most popular drug neuropathic pain in our community. Lyrica is related to gabapentin, belonging to the same class of anti-convulsants.

The evidence suggests that Lyrica and other pregabalins have a similar impact to gabapentin. A large review concluded that “Some people will derive substantial benefit with pregabalin; more will have moderate benefit, but many will have no benefit or will discontinue treatment.”

The American Academy of Neurology (AAN) officially recommends three other types of drugs for the treatment of diabetic neuropathy. These three are less commonly prescribed, and as a result, are less commonly discussed in our community:

  • Serotonin-norepinephrine reuptake inhibitors (SNRIs), including duloxetine, venlafaxine, and desvenlafaxine. SNRIs are anti-depressants that are prescribed for a variety of mental health issues, including anxiety and obsessive-compulsive disorder. They can be effective in reducing neuropathic pain and, as a bonus, may improve mood and other quality of life factors.
  • Tricyclic antidepressants (TCAs), such as amitriptyline, nortriptyline, and imipramine. TCAs are also anti-depressants, and have been used for decades. TCAs are considered “effective” in the treatment of neuropathic pain, but are associated with side effects, including weight gain.
  • Sodium channel blockers (such as carbamazepine, oxcarbazepine, lamotrigine, valproic acid, lacosamide). Like gabapentinoids (including gabapentin and pregabalin), these drugs are used to prevent seizures. Sodium channel blockers are not often prescribed, perhaps due to the likelihood of side effects, but the AAN has concluded that they have a similar ability to reduce pain as the preceding drugs.

The AAN believes that the drugs named above are of roughly similar effectiveness, and that doctors should therefore make their recommendations based on “potential adverse effects, patient comorbidities, cost, and patient preference.”

The other important thing to note here is that none of these drugs is perfectly effective, and that doctors are completely unable to predict which drugs will work for which patients. Diabetic neuropathy is a mysterious condition, and experts don’t completely understand why drugs do and don’t work to reduce pain. It may take many months of experimentation with a series of pharmaceuticals to find a pill and a dose that works for you.

Finally, a word about opioids. These powerful painkillers are, in fact, the most commonly-prescribed treatment in the United States for diabetic neuropathy. However, they are not popular in the Diabetes Daily community. That may be for the best: experts from the AAN believe that the drugs should not be prescribed for this type of chronic pain. It seems that most doctors are unaware of that recommendation; a distressing 2020 study in the journal Pain found that most patients are prescribed opioids “before trying even one guideline-recommended medication for peripheral neuropathy,” and that far too many patients end up on chronic opioid therapy. The dreadful impact of opioid addiction is by now very well-known.

Mental Health and Sleep

It may sound surprising, but the American Academy of Neurology actually recommends that people with pain from diabetic neuropathy should seek treatment for sleep and mood disorders first, before they explore pain-relieving medication.

While mood or sleep improvements do not actually address the root cause of painful diabetic neuropathy, they do significantly alter our perception of pain.

It stands to reason that a well-rested and happy person is better equipped to deal with chronic pain. If that sounds too obvious, consider that people with diabetes suffer from both depression (and related mental health issues) and sleep disorders far more frequently than average, and that these conditions far too commonly go unrecognized and untreated.

The next time you see your healthcare provider, consider whether you should be discussing your sleep and mental health, in addition to your neuropathy pain and discomfort.

Topical Treatments

There is a bewildering variety of over-the-counter creams and sprays available for neuropathy pain. Experts are optimistic about the use of topical treatments, but scientific proof of their efficacy is a bit murky.

In the AAN guidance, four topical treatments were rated as “possibly more likely than placebo to improve pain.” Those treatments are:

  • Capsaicin
  • Nitrosense patches
  • Citrullus colocynthis
  • Glyceryl trinitrate spray

A different recent review identified many more chemicals that may be helpful, including even botox injections. This second review highlighted lidocaine and capsaicin patches as two therapies with particularly good data supporting their efficacy.

One brand that our community likes is Biofreeze, which uses menthol as its active ingredient. Biofreeze is available in many different application forms, including sprays, gels, patches, and wipes.

But to put it simply, nobody really knows which topical treatments work best, and what works for you may not work for someone else. It will probably take trial and error to find a product you like. We encourage you to work with your doctor to find good options.

Exercise

Exercise is a tricky subject for some people with neuropathic pain, because a workout itself may trigger that pain. There is also the fear that exercise is likely to cause problems for people with sensitive feet.

However, there is evidence that exercise is healthful for those damaged nerves. A 2014 review concluded that “it is critical to understand that routine exercise may not only help prevent some of those causes [of neuropathic pain], but that it has also proven to be an effective means of alleviating some of the condition’s most distressing symptoms.” And experts have argued that the benefits of exercise outweigh the risk of foot injuries.

Exercise can also be an important part of a holistic treatment plan for diabetic neuropathy. Even low-intensity exercise is known to help lower both blood sugar and cholesterol, prevent weight gain, and improve both mood and sleep, all of which means it will help combat both the root causes of neuropathic pain and your ability to tolerate pain.

Cannabis and CBD

When polling the Diabetes Daily community, perhaps the biggest surprise was how enthusiastically so many of our readers endorsed cannabis for neuropathic pain relief. Many have ranked it as their favorite way to alleviate or cope with the pain and discomfort.

Indeed, there is some evidence that cannabis can be effective. A small 2015 study found that “inhaled cannabis demonstrated a dose-dependent reduction in diabetic peripheral neuropathy pain.” A follow-up by the same team found a similar result.

Generally speaking, experts are somewhat hesitant. In 2021, the International Association for the Study of Pain announced that, due to a lack of good scientific evidence, it could not endorse the use of cannabis for pain relief. The organization also noted that there are important research gaps and much work to be done.

If medicinal-use cannabinoid products are allowed in your area, your doctor may be happy to write you a prescription. If adult-use cannabis is allowed, you don’t need a prescription. Nevertheless, please be aware that the legal status of cannabis use remains confusing in the United States. It is illegal at the federal level, but a gray area is increasingly emerging, for both medicinal and recreational use, as more and more states pass new legislature.

To learn more about cannabis and diabetes—including blood sugar effects and a special warning for patients with type 1 diabetes—please read our article, Marijuana and Diabetes, What You Need to Know.

Some of our community members also recommend CBD oil, either consumed or applied directly to the skin. Most medical authorities believe that the evidence in favor of CBD oil is extremely thin, and caution patients to be wary of anecdotes and marketing claims. Is CBD oil just snake oil? It’s impossible to say. Some of our community members believe it works, and there is some evidence that CBD oil can reduce neuropathic pain.

Elevating Feet

It is the feet, more than any other body part, that suffer most from peripheral neuropathy. Diabetes can lower the blood flow to the feet, which leads to all manner of issues, including slower wound healing and increased risk of infection.

Inadequate blood flow may contribute to nerve damage and pain in the feet. Elevating your feet may bring some pain relief.

When practical, put your feet up while sitting. Be sure to stand up, stretch your legs, and wiggle your feet and toes every once in a while. If the tingling, burning, and pain are at their worst when you’re in bed, experiment with elevating your feet by resting them on a pillow, even while you sleep.

Soaking Feet

Many people with diabetic neuropathy find fast relief from a good bath. Some go a step further, and include Epsom salts in their soaking ritual.

A 2020 study found that an electrical foot bath filled with saltwater offered significant pain reduction. (The warm water bath without salt had no effect).

But it is important to know that major diabetes authorities disagree with this advice, in part because a long soak may not be great for patients with vulnerable feet. The American Diabetes Association very plainly states: “don’t soak your feet.” If your feet are prone to slow-healing wounds, it may be wise to be careful with this remedy.

Compression Socks

Opinions differ on the wisdom of wearing compression socks. Some sources claim that these socks, which gently squeeze the lower legs, promote healthy blood flow. Others claim the exact opposite and say that compression socks restrict blood flow.

Compressions socks are most popular among people with diabetes that have foot and leg swelling issues. Studies have found that compression socks are effective in treating lower leg edema (swelling) without compromising circulation. We were not, however, able to find any published studies evaluating compression socks and pain from diabetic neuropathy.

Some of our community members find them useful for the treatment of neuropathic pain, but many experts think they’re a bad idea for people with diabetes. The National Institutes of Health tells people with diabetes foot issues: “do not wear tight socks.”

Alpha Lipoic Acid

Alpha lipoic acid (ALA) is a fatty acid and antioxidant that is found both in the human body and in many foods. It’s been proposed as an alternative treatment for many conditions, including neuropathic pain.

Several of our community members take ALA supplements (they should be easy to find in most pharmacies). ALA is theorized to improve “nerve blood flow, nerve conduction velocity, and several other measures of nerve function.” And there is some scientific evidence that ALA really does help to relieve neuropathic pain.

B Vitamins

B vitamins have a complex relationship with the human nervous system; too little or too much of certain B vitamins can directly cause nerve damage.

Some Diabetes Daily readers take a B vitamin supplement, and believe that it helps with their neuropathic pain. The science, though, is unclear. A review of 13 studies concluded that “the evidence is insufficient to determine whether vitamin B is beneficial or harmful,” but that the supplements were “generally well-tolerated.” There is some weak evidence that vitamin B12 may be helpful.

Massage

Whether they do it themselves, persuade a loved one, or hire a professional, several of our community members find relief from massage. Although the science on this isn’t exactly settled, a quick google search will show that there are many protocols out there for massage for pain relief from neuropathy.

We identified two studies that found significant pain reduction from aromatherapy massage, although it’s unclear if the aromatic oil or the massage was the critical element, or if they’re both necessary for relief. A 2016 study found that “Thai foot massage” achieved significant results, and a large 2019 meta-analysis found that Chinese acupressure massage, when combined with a Chinese medicinal footbath, also offered improvement.

Of course, you don’t really need a randomized controlled trial to know if a little foot rub feels good. This can be considered a nonpharmaceutical therapy with few downsides, one that is well worth a try.

When Nothing Works

Unfortunately, some of our community members have never found anything that helps relieve their pain. If that’s the case, we encourage you to re-prioritize blood sugar control and consider lifestyle changes that can promote stress reduction and good mental health.

There are also many resources out there for people that deal with chronic pain, such as the U.S. Pain Foundation, which has a wealth of information on coping mechanisms and self-management techniques. As the American Psychological Association states, “Mental and emotional wellness is equally important—psychological techniques and therapy help build resilience and teach the necessary skills for management of chronic pain.”

Takeaways

There are no easy answers for pain from diabetic neuropathy. Patients that do find some relief often use a combination of prescription medication, over-the-counter treatments, and non-medicinal techniques such as massage or foot elevation. Good blood sugar management is the only therapy that addresses the root cause.

If you have neuropathic pain, please seek treatment from a medical professional soon. The problem is better addressed sooner than later, and it may take some experimentation to find what works for you.

Read more about chronic pain, complications, foot pain, neuropathy, peripheral neuropathy.

Pain from Diabetic Neuropathy? Experts Now Say to Try This First

Posted by

0


A new expert guidance states that people with pain from diabetic neuropathy should seek treatment for sleep and mood disorders first, before they explore pain-relieving medication.

The new advice comes from The American Academy of Neurology (AAN), the leading professional society of neurologists and neuroscientists.

In treating patients with [painful diabetic neuropathy], it is important to assess other factors that may also affect pain perception and quality of life… Mood and sleep can both influence pain perception. Therefore, treating concurrent mood and sleep disorders may help reduce pain and improve quality of life, apart from any direct treatment of the painful neuropathy.

An accompanying press release stated, “a doctor should first determine if a person also has mood or sleep problems since treatment for these conditions is also important.”

Diabetic neuropathy is a type of nerve damage common in people with diabetes. Neuropathy can affect many parts of the body, including the digestive system, the heart, the eyes, the bladder, the sweat glands, and sexual organs.

The nerve damage that mostly affects the feet, hands, legs, and arms is referred to as peripheral neuropathy. This condition is often very uncomfortable, with patients feeling pain, tingling, burning, prickling, numbness, and complete loss of feeling in the extremities. Pain may be worse at night. These symptoms are generally noticed first in the feet.

To support the new recommendation, the guidance cites two studies: one showed that chronic back pain is significantly resolved by improved mood; the other that fragmented sleep significantly reduces pain tolerance. (There are many other studies in the scientific literature that offer similar conclusions.)

To put it simply, while mood or sleep do not actually address the root cause of painful diabetic neuropathy, they do significantly alter our perception of pain.

It stands to reason that a well-rested and happy person is better equipped to deal with chronic pain. If that sounds too obvious, consider that people with diabetes suffer from both depression (and related mental health issues) and sleep disorders far more frequently than average, and that these conditions far too commonly go unrecognized and untreated.

Disordered sleep is itself a complication of diabetes, and is actually a risk factor for cardiovascular disease. Likewise, depression is a huge problem in the diabetes community. Scientists have estimated that roughly 20-25% of people with diabetes experience depression. The prevalence of diabetes distress – a lower level of anguish tied specifically to the stress involved in managing this chronic condition – is even higher.

Not only do disordered sleep and mental health issues have a direct negative effect on pain tolerance and overall health, but they also negatively impact glycemic control. Because diabetic neuropathy is ultimately caused by high blood sugars, addressing sleep and mood problems can create a virtuous cycle of improvement.

For patients that require pharmaceutical relief, there are many options available. The new guidance directs doctors to offer one or more of the following prescription medications:

Some of these drugs also have benefits for mood and sleep, which may partially explain how they work.

There are also many topical treatments for peripheral neuropathy, although the scientific proof of their efficacy is a bit murky. In the new AAN guidance,  four treatments were rated as “possibly more likely than placebo to improve pain.” Those treatments are:

  • Capsaicin
  • Nitrosense patches
  • Citrullus colocynthis
  • Glyceryl trinitrate spray

Another treatment people have found effective is exercise. A 2014 review concluded that “it is critical to understand that routine exercise may not only help prevent some of those causes [of neuropathic pain], but that it has also proven to be an effective means of alleviating some of the condition’s most distressing symptoms.” As a bonus, exercise is known to improve both mood and sleep, which means it should also help reduce the perception of pain, as explained above.

Like other complications, nerve damage is ultimately caused by chronic high blood sugar. About half of people with diabetes develop nerve damage. It can happen at any time but chances of developing nerve damage go up with age and the longer a person has diabetes. It is also more common in patients with obesity, high cholesterol, and high blood pressure. But it is never too late to improve blood sugar control.

The next time you see your healthcare provider, consider whether you should be discussing your sleep and mental health, in addition to your neuropathy pain and discomfort.

Taking Your Type 2 Diabetes Diagnosis Seriously

Posted by

0


making food choices

People sometimes ask me, “What’s the most important thing to do if you’re diagnosed with type 2 diabetes?’

My answer: “TAKE THIS DISEASE SERIOUSLY.”

Well, actually, I don’t usually shout, but I sometimes want to. If you’re reading this, then I think you’re taking this disease seriously, trying to learn as much as you can about it so you can control it.

But too many people don’t. They want the doctor to give them a pill so they can go on exactly as they have in the past, eating too much, especially foods that make their blood glucose (BG) go up, and getting no exercise.

One problem in type 2 control is that the results of not controlling well aren’t immediate. You won’t break out in blue spots if you eat a big piece of chocolate cake with ice cream. Your hair won’t turn pink if you eat a huge pile of mashed potatoes and gravy with Texas toast on the side. Some people feel bad when they have high BG levels. Others don’t.

I was diagnosed with fasting levels in the 300s, and I went into the 400s after meals. But I felt fine.

No, the effects of high BG levels are insidious. The glucose gloms on to various substances in your body and eventually causes complications. The damage from the glucose can result in cataracts, retinopathy that can lead to blindness, neuropathy that can make your feet hurt all the time, vascular problems that lead to heart attacks, amputations, impotence, kidney disease, and more.

None of these complications are pleasant. But if you take this disease seriously and control your BG to normal or near-normal levels, the chances that you’ll get complications are low.

It’s not easy. Watching your friends pig out at an ice cream stand while you drink a cup of black coffee, no sugar, isn’t fun. Different people have different ways of dealing with this. Some can eat just a couple of spoonfuls of some treat and leave the rest. Others find it works best to avoid the treats altogether. I’m in the latter group. If I ate a couple of spoonfuls of some treat, I’d crave it all. When I haven’t eaten bread, cake, and ice cream for years, I no longer want them, even if all around me are eating them.

This situation of not wanting the treats isn’t instantaneous. It takes a while before you can deal with these situations easily. But persistence pays off.

Well, I’d rant on and on, but right now I’m craving a lamb chop with broccoli and butter, so I’d better go.

 , , , , , , , .

Why Don’t People Take Diabetes Seriously?

Posted by

0


 

When we hear that a loved one or friend has a serious illness it can evoke in us strong emotions of fear, worry, sadness and compassion. “I’m so sorry” and “How can I help?” are commonly offered sentiments in these difficult situations. Hearing the news that someone has diabetes does not often herald the same degree of concern.

Why is this? I believe that the reasons are multifactorial.

Broad Terms Contribute to Confusion

If we consider the word “cancer” people typically have an immediate reaction of alarm. However, cancer is a large umbrella representing over 100 distinct diseases depending on the organ or system affected. Prognoses for cancer are widely variable and many cancers are curable with early diagnosis and treatment.

These important distinctions reflective of cancer’s diverse landscape are often lost on the public’s perception. Thus, people may endure unnecessary anxiety, dread and anguish. Society’s increased understanding of the medical and scientific advances in cancer treatments would alleviate a lot of suffering and fear and replace it with hope and optimism. Even those who can’t be cured are often able to have significantly lengthened periods of disease-free survival and enhanced quality of life due to new treatments.

While the term diabetes is not as deceptively broad as cancer it does represent over seven distinct conditions each with its own pathophysiology. If you consider that diabetes may occur as a result of another disease or condition like cystic fibrosis, hemochromatosis or chronic pancreatitis, just to name a few, there are even more types of diabetes.

Unless you’ve personally known someone with diabetes and seen firsthand either a complication of the disease or its daily, labor-intensive management you may not grasp the seriousness of the diagnosis. Perhaps we’ve heard the word so much that we are desensitized to it. This is unfortunate since diabetes has become one of the fastest growing risks to human health throughout the world.

Since my own child was diagnosed with type one diabetes in 2013 I’ve become very attuned to how diabetes is perceived both in personal encounters and in the media. In our circle of family, friends and teachers, the reactions to my son’s diagnosis were a mix of bewilderment, sadness and nonchalance. Most people simply didn’t know what it was.

The knowledge gap with T1D may partially be attributed to its name. For clarity, I tell people that it was previously called Juvenile Diabetes. That charged term usually captures attention. Putting “juvenile” in front of any word will often do that (e.g., juvenile delinquency, juvenile detention center, etc.)

In my experience people generally assumed that my son would now need some sort of low-level lifestyle tweaks. The word sugar was always coming up. Should we get some sugar-free foods for him? Can he have cake? Wouldn’t some exercise, a “balanced diet” and a Crystal Light or two keep this thing in “control?”

Someone once told me to ditch my son’s insulin and go macrobiotic. Although disturbing, at least one of my son’s classmates understood that diabetes was serious. Lacking a filter he felt compelled to share that he had a relative who had his leg amputated. My husband who is an ICU physician had to reassure my son that these complications are very rare.

Pre-Diabetes

With so many different types of diabetes it’s no wonder that such a knowledge deficit exists. Take prediabetes as a perfect example.

According to the American Diabetes Association, in 2015 an astonishing 84.1 million Americans or more than 1 out of 3 adults had pre-diabetes. A person may leave an annual doctor’s visit with this news and a general recommendation to lose weight and exercise more. He may compare notes with his friends and discover that some of his buddies are in the same boat. With the tendency to feel like there is safety in numbers one might be inclined to either ignore the diagnosis or just try a few lifestyle tweaks like joining a gym or eating brown rice instead or white.

Unlike those with type 1, those with pre-diabetes don’t leave the doctor’s office with an abrupt and permanent new way of life requiring 24/7 insulin. Perhaps this is another factor that contributes to a lack of urgency to reverse pre-diabetes. Some will gamble that they can coast along with no lifestyle changes without converting to type 2 diabetes. They might be right but they need to know the real risks of this strategy.

Pre-diabetes means that something is wrong with a fundamentally important body function: glucose metabolism. Even if an individual does not ultimately receive a type 2 diagnosis he is still at risk for serious complications like retinopathy and neuropathy. So, feeling “fine” with this relatively silent condition is, indeed, a false sense of security.

Inspiration from a Type 2

Before my own child was diagnosed with type one I had a grim, skewed perception that diabetes was either coping with spirit crushing food restrictions or trying to persevere through difficult complications. Two relatives with type 2 succumbed to those complications. I just didn’t understand the other perfectly viable scenario of a healthy life filled with abundance.

One type 2 thriver who has intruigued me so much is the acclaimed English actor, Robin Ellis. In the 1970s he was the heartthrob leading man, Captain Ross Poldark, of the beloved BBC and Masterpiece Theatre series, Poldark.

A remake of it is currently thrilling millions on Masterpiece Theatre.

A huge fan of the original, I was fascinated to discover that Mr. Ellis is an inspiring type 2 diabetic. He has contributed to the diabetes community by being very transparent about his condition and his successful journey adapting to it.

An accomplished chef, Mr. Ellis’s lushly photographed and delectable diabetic-friendly cookbooks are a wonderful resource. Anyone with diabetes perusing these books may begin to feel that there is, indeed, another way to not just live with diabetes, but flourish as a result of it.

His latest, Mediterranean Cooking for Diabetics: Delicious Dishes to Control or Avoid Diabetes, is a go-to book in my cookbook collection. My type one son is a big fan of Mr. Ellis’s lower carb recipes and it makes me feel good to cook his healthy and flavorful dishes for my entire family.

So why do some people with diabetes like Robin Ellis become converts to a new way of living with diabetes? Growing up with a mother with type 1 diabetes who passed away from a heart attack due to her condition, Robin was cognizant of the dangers of diabetes as a result of this terrible loss.

However, I believe his motivation for a lifestyle change was not simply motivated by fear. Living in the French countryside with his supportive wife, Meredith, Mr. Ellis embraced the healthy culinary treasures of this region. He used his diagnosis as a springboard to explore new possibilities in food, exercise and wellbeing.

As the mighty Theodore Roosevelt used to say, “get action.” Take diabetes seriously no matter what type you have. Don’t let denial put your health at risk. You can shift from a place of worrisome vulnerability to one of hopeful optimism and fortitude if you are open to change.

There is a full life of abundance waiting for you.

Can Diabetes Cause Muscle Cramps?

Posted by

0


cramps in people with diabetes

A recent study looked at links between muscle cramp frequency and severity and nerve fiber measures in patients with type 1 and type 2 diabetes.

Persons with type 1 and 2 diabetes as well as healthy controls were given an evaluation and their large and small nerve fibers were assessed. Details about their muscle cramps were noted. There were 37 control subjects, 51 patients with type 1 diabetes and 69 with type 2 diabetes.

Muscle Cramps a Diabetes Complication?

The researchers state in their study paper that “Muscle cramps were the most frequent symptom captured by the Toronto Clinical Neuropathy Score (TCNS) in all groups, up to 78% in patients with [type 2 diabetes].” They also explained that in only those with type 1 diabetes, muscle cramp frequency and severity was tied to clinical, large, and small nerve fiber measures.

They concluded that muscle cramps are common diabetes and are associated with clinical and both small and large nerve fiber measures in type 1 diabetes, “suggesting that their origin and propagation might extend beyond the motor nerve,” wrote the study authors.

For the study, those with type 2 diabetes were older and had more muscle cramps, more severe cramps, and worse clinical and small and large nerve fiber measures when compared with those with type 1 diabetes. They also had worse nerve function, but this could have been due to the patients with type 1 diabetes being younger than those with type 2 in the study.

Researchers added that “These findings are in line with previous studies, describing muscle cramps in a large spectrum of polyneuropathies, including sensory and small fiber polyneuropathies (Lopate et al., 2013; Maxwell et al., 2014; Abraham et al., 2016), suggesting that the cause of muscle cramps may extend beyond the motor nerve.”