David Mendosa's Articles

Until recently most treatments for diabetic neuropathy have been painkillers that helped some people but not others. Even if they helped control the pain, they did nothing to reverse the neuropathy. My web page on “Diabetic Neuropathy” describes many of these treatments.

About half of us have some degree of neuropathy. It is probably the most common complication of diabetes.

We now have better ways to deal with neuropathy than these palliative measures that relieve or sooth the symptoms of neuropathy without effecting a cure. Some are drugs that are in development and are pending approval by the Food and Drug Administration.

But the most interesting treatments to prevent or reverse neuropathy are what we can broadly call gadgets. Most of these devices give earlier and better diagnoses, but at least one of them may at least temporarily reverse the symptoms.

This is the Anodyne Therapy System. It not only reduces pain but also improves circulation and increases feeling. The FDA has cleared it, and it is likely that your insurance will cover it.

More than 3,000 centers and hospitals now offer this treatment. A physical therapist places four or more pads on your feet. These pads give off infrared light that releases nitric oxide in your feet. This is especially important for people with diabetes, who often have low levels of nitric oxide, which can lead to poor circulation, pain, and numbness.

It is the only photo energy therapy with clinical studies published in peer-reviewed medical journals. I have read a lot of these reports and am impressed.

The most impressive of these reports is a recent double-blind, randomized, placebo-controlled study in a peer-reviewed journal, Diabetes Care. The study concluded that Anodyne Therapy treatments “improve sensation in the feet of subjects with DPN [diabetic peripheral neuropathy], improve balance, and reduce pain.” Two other gadgets can help you prevent the complications of diabetic neuropathy. One of them is free and the other costs $150. The free gadget is a disposable probe or monofilament to test our feet at home. It is equivalent to the Semmes-Weinstein 5.07/10 gram monofilament that your doctor uses.

The disposable probes don’t hurt, don’t require a prescription, and are quick and easy to use. You can get a package of 10 at no cost by calling the U.S. Bureau of Primary Health Care at 1 (888) 275-4772. While you are at it, it can be quite useful to make another call for a related government freebie. You can order a copy of the booklet, “Feet Can Last a Lifetime,” by calling the National Diabetes Information Clearinghouse at 1 (800) 860-8747. This booklet, of about 50 pages, shows where, why, and how to test your feet.

If you can’t feel the probe, trouble is brewing. You need to hightail it to a doctor.

If one foot is several degrees warmer than the other, even more serious trouble is in the offing. An ulcer could be brewing.

The FDA has just approved the TempTouch, a device that makes it fast and easy to check the skin temperature on the bottom of our feet every day. If one foot is 4 degrees warmer than the other, you have an early warning sign that an ulcer is developing. With that knowledge you can take action to prevent ulcers and therefore prevent an amputation. Xilas Medical in San Antonio, Texas, sells the TempTouch for $150.

There is also a newly developed screening system that measures how well oxygen is getting to the skin. I’m not surprised that people who have diabetic neuropathy not only have less nitric oxide (which the Anodyne Therapy may reverse) but also less oxygen.

Researchers at Beth Israel Deaconess Medical Center and Harvard Medical School writing in a recent issue of The Lancet, perhaps the world’s leading medical journal, found that people with diabetic neuropathy have less oxygen available to their skin.

They use a camera to capture images of the feet at different wave lengths. They call their screening method “medical hyperspectral imaging.”

If you have a low oxygen level in your feet, you need to pay special attention to them. Of course, all of us need to check our feet every day.

This gadget to measure the amount of oxygen in your feet isn’t on the market yet. But these four gadgets, all developed quite recently, show that we have come a long way toward preventing and perhaps even reversing diabetic neuropathy.

These gadgets are great. But you are even better.

The best way to prevent neuropathy, of course, is to keep your blood glucose levels as close to normal as possible. You can do it.

When it comes to blood glucose testing, with only a little simplification there are three types of people in the world – those who use insulin, those who control their diabetes without insulin, and those who don’t yet have diabetes.

People with type 1 diabetes and pregnant women who take insulin need to test at least three times a day, according to The American Diabetes Association’s Position Statement on Standards of Medical Care in Diabetes. But the recommendations are murky for people with type 2 diabetes who use insulin and anyone changing therapy and are especially murky for people who control their diabetes on diet alone. The statement doesn’t even consider people who control their diabetes with pills or with exercise.

Technically, self-monitoring of blood glucose (SMBG) is what we call blood glucose. The position statement says, “The role of SMBG in stable diet-treated patients with type 2 diabetes is not known.” Until now I never could understanding why they said that.

Now, a huge debate has broken out in the ADA’s professional journal, Diabetes Care. This debate explains why the professionals don’t know how often type 2s who don’t use insulin should test.

For people who use insulin the benefits of testing are obvious and well documented. If your levels are too low or too high, you can correct them immediately.

But what about those of us who don’t use insulin? Of course, we can exercise or not eat if our level is too high, or we can take a glucose tab if it’s too low.

Mayer Davidson, an M.D. who is a past president of the ADA, shocked me with his editorial that it is “a waste of money” for type 2s not using insulin to test. He does believe that if they test the best time is before and one or two hours after a meal.

Rather than checking fasting levels, in the last five years or so testing after meals has become the preferred time for those who have good blood glucose control. More on this later in a separate article.

Why does the ADA say the benefits of testing for non-insulin users is unknown? Because until quite recently there have been few well-designed studies. Few studies – but not no studies.

This year a team of Dutch doctors systematically reviewed these studies and found that six of them were randomized controlled trials. Their article, Self-Monitoring of Blood Glucose in Patients With Type 2 Diabetes Who Are Not Using Insulin, is available in full online. Those who tested were able to decrease their A1C level by 0.4 percent – statistically significant and clinically relevant. A decrease of that magnitude reduces the risk of eye, kidney, and nerve disease by 14 percent, according to the huge U.K. Prospective Diabetes Study.

Two more studies are so new that they haven’t even been published yet, but were presented at the ADA’s Scientific Sessions in June and are abstracted online.

A group of doctors in Atlanta presented their study of 552 people not on insulin. Those who tested at least once a day had an average A1C of 6.9 percent, but those who never tested had an average of 7.8 percent. But the A1C hardly changed if they tested more than once.

Doctors in Germany and Switzerland reported on their 10-year study of 3,268 people with type 2. Those who tested their blood glucose levels – whether or not they were taking insulin – were 33 percent less likely to develop complications of diabetes or to die than those who didn’t test.

The evidence is clear. All of us who have diabetes need to test our blood glucose levels. Others can wait.