Diabetic Neuropathy: YOU ARE NOT PREPARED!

For those unfamiliar with the line, "YOU ARE NOT PREPARED!", you should watch the trailer for World of Warcraft: Burning Crusade. The way Illidan shouts the line at the end is exactly how I'd say it when warning diabetics about diabetic neuropathy. There's no way I can explain this complication of diabetes and discuss my experiences with it in one post. This condition, which is permanent nerve damage, has been the bane of my existence for almost 25 years, and can be YOURS for the low, low price of neglecting your diabetes!

Do you know what causes diabetic neuropathy? "You just said it, Rob. Neglecting my diabetes." Yeah, okay. I get that. But do you know its specific pathogenesis? "It's patho-hoozi-whatsis?" The specific physiological changes that cause disease. For example, when I discussed diabetic retinopathy - diabetic eye disease - I talked about vascular damage and neovascularization. So I'll ask again: Do you know what causes diabetic neuropathy? "No, Rob. I do not. But you're going to tell us, right?"

Ummm... No, I'm not. Because the reality is that no one can. There are a great many working theories about what causes it, but no one really KNOWS. Here's one of them. 

Take notes. There'll be a test later.

Through the scientific processes of voodoo and mysticism, the body converts glucose (regular old sugar) into fructose (sugar from fruits), which it then converts into sorbitol (sugar alcohol). Why does the body do all of that? Well, I'll tell you... 

...that I'm STILL not a doctor, so I'm explaining this the best a layman can!

Somehow, some way, the sorbitol winds up in the nervous system. The sorbitol and the neurochemicals that make your nervous system function are just about the same size, so only one can squeeze through the neuropathways. Think "Three Stooges Syndrome" from The Simpsons. When the proper chemicals go through, all is well. When sorbitol goes through, it damages the nerves.

I guess I should toss the other theories at you while I'm here. Telling you to research it on your own might be pushing it. I mean, somehow you wound up here, reading this blog, and that was a miracle unto itself. Left to your own devices, you might decide neuropathy is caused by Bill Gates and 5G network towers.

Before you jump off that ideological bridge, diabetic neuropathy has been around a lot longer than Bill Gates and 5G.

Okay, the next theory is the typical microvascular disease. High blood sugars alter the shape of the smallest blood vessels, causing them to narrow. Inadequate blood flow starves the nerves of oxygen. (To starve a body part of oxygen is medically known as hypoxia.) Oxygen-deprived nerves break down and never properly recover because the blood vessels feeding it oxygen are permanently damaged.

The last theory I have to share is very similar. High blood sugars alter the structure of the nerves themselves, causing them to malfunction.

"Hang on, Rob. Theories two and three are the same thing, aren't they?" Yes and no. Theory two involves sugar damaging the blood vessels. Theory three involves sugar damaging the nerves directly. The problem is that science has yet to figure out a way to see these events as they're happening. By the time researchers are able to examine ruined blood vessels and nerves, it's after the fact.

Try to imagine a house that's been burned to the ground. The fire marshal says that the fire started in the garage, where there was the following: a natural gas leak, a stove turned all the way up with a pan of oil on it, and a faulty electrical outlet. So what started the fire? Did a spark from the outlet ignite the natural gas? Did the oil in the pan get hot enough to combust? Did that outlet release a spark inside the walls, which in turn started burning? Here's a brain twister: What if all three happened simultaneously?

It's very similar to diabetic neuropathy. Scientists know it exists, they just don't know what "started the fire."

"Ummm... Rob? Why was there a stove in the garage?" Really? That was your takeaway from that example? 🤨

This is the part where I rail against the way diabetics are taught about its complications. It's always the same simplistic warning: "You could lose a foot." The problem is that they never explain HOW it can happen. Well, dear reader, you'll be unhappy to know that I'm going to tell you.

It starts with pain. Diabetic neuropathy provides two exciting types. One is a burning sensation in the skin. The other is what's been described as a sudden sharp electric pain. The best part is that you'll experience both, sometimes simultaneously. Now you might be thinking, That's not so bad. I've had little burns and sharp pains before. I'll live. Oh, no doubt that you'll live. Except that these pains are your nerves screaming at you that they're not functioning properly. And here's some bonuses... The burning sensation can be so bad that silk touching your skin could cause you extreme pain. That sharp electric pain...? Yeah, I had one of those last for a week; just one specific spot feeling like someone has jammed a sewing needle into me.

By the way, for the sharp pains, I once referred to them as "pain seizures" and a pain specialist REALLY liked the phrase. And one of the reasons he probably liked it so much is because diabetic neuropathy is often treated with anti-seizure medications. I have a story about that one, but it'll have to wait. Let's focus on one thing at a time.

So there's pain. It tends to start in the extremities. For a majority of people, that means the feet and lower legs. Once neuropathy has advanced enough, you'll start experiencing numbness the the affected areas. That's not good news. It means the nerve endings have died. You could smash your foot into the leg of a table and the only way you'd know is that the impact registered with nerves that are still active deeper inside you.

This it where the loss of a foot can happen. Let's say you DO smash your foot into something and the skin gets broken. You have no idea how bad the damage is until later, when you decide to take off your socks. Surprise! The sock is soaked in blood! As you peel it off, you feel nothing as the scab, still clinging to the sock, gets ripped away. Around the now-freshly bleeding would is skin that's an angry red and warm to the touch. Congratulations. It's infected.

If you're one of those diabetics who hates doctors and think you can treat such a wound on their own, you might well be on the path to amputation. Cleaning the wound and using topical antibiotics probably aren't enough. The infection can go deep! Deep into other tissues, like muscles, bones, and tendons. That's when you'll feel it, when it reaches those still-functioning nerves. Such serious infections could lead to septicemia - blood poisoning - and gangrene - tissue death. It's at this point that amputation becomes a requirement because a part of your body has already died! There's no saving it.

I think it's time to bring this post to a close. I still have a lot more to say about diabetic neuropathy, but I've been so serious and, if I'm honest, angry, for a while. I'm angry because I know the end stages of diabetic neuropathy can be avoided, but almost no one listens. "Experience is the best teacher." Not in this case. By the time you're experiencing an amputation, you've got an entirely new set of lessons to learn... like how reliant you were on having two feet until you lost one.

Okay, let's decompress. Let's all relax and look at the beautiful... No, wait. Every time I promise to show you the woman, something else appears. So this time I'll promise something diabetes-related and maybe we'll get lucky.

Diabetes Fight Club.

Perfect. And with kids, no less!

Never was the cry of "phrasing!" more appropriate.