Diabetes control may stave off nerve damage

Dear Dr. Roach: What are the treatment options for diabetic neuropathy? What is likely to happen over time to someone with this condition? M.P.

Diabetic neuropathy is a condition of nerve damage associated with diabetes, both Type 1 and Type 2. It affects the long nerves of the body earliest, especially those to the feet, causing numbness and sometimes pain. The hands also may be affected. Usually, both sides are affected the same way. Numbness usually is the first sign, followed by pain, often described as burning or tingling. The nerves to the gut can be affected, leading to constipation and bloating.

The best way of dealing with diabetic neuropathy is to not get it in the first place. Excellent control of diabetes, with nearnormal sugar levels, was shown to reduce the incidence of people with diabetes developing the condition. In people who already have diabetic neuropathy, good control of blood sugar can improve symptoms and slow progression, but the condition usually is not reversible in people who have established symptoms. However, the pain sometimes can go away mysteriously.

Numbness to the feet puts individuals at risk for injury, as the affected person does not realize he or she is beginning to develop a problem, such as a sore or abrasion. People with diabetic neuropathy need to inspect their feet daily for warning signs, such as dry, cracking skin, redness or drainage, especially between the toes and around the nails. This should be combined with regular professional foot care by a diabetes doctor or foot specialist.

For people with pain due to diabetic neuropathy, there are several treatment options. Medication treatments include anti-epilepsy drugs, such as gabapentin (Neurontin) and pregabalin (Lyrica); antidepressant drugs, including amitriptyline or venlafaxine (Effexor); anesthetic agents, such as lidocaine; and topical agents, such as capsaicin.

I have been asked recently on my Facebook page (facebook.com/keithroachmd) about using cannibinoids (marijuana extracts) as a topical treatment for painful neuropathy. I found one paper in German that showed promise, and have heard several anecdotal stories of success, but it is too early for me to recommend it for clinical use.

Dear Dr. Roach: I was diagnosed with celiac disease eight years ago, after a camera study showed that my small intestine was abnormal. It was confirmed by a blood test for antibodies. Can you get over celiac disease after a period of time? A.M.

Celiac disease is caused by a sensitivity to gliadin, a protein found in gluten, which is a component in wheat, rye and barley. The primary affected organ is the small intestine, and the villi (microscopic projections greatly increasing the absorptive area of the intestine, whose job is to absorb nutrients) become flattened, leading to inability to absorb food properly. This can lead to weight loss, diarrhea and other symptoms.

People who are meticulous about following a gluten-free diet can have complete resolution of all of their symptoms, and the small intestine will look and act as it should. Even the blood antibody tests usually become normal. However, the sensitivity to gluten remains, and if people resume eating gluten, the symptoms of the condition will rapidly return.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@ med.cornell.edu