Diabetes, not me

Larra

Well-Known Member
A very positive report! Elevated BUN with normal Cr does sound like dehydration. Could be because he had to fast for blood tests, could be from his diuretics for his liver health. And I'm very glad he's taking care of his feet - wish everyone with diabetes would!
 

DianaCox

Bad Cop
He said he had a half glass of water before going to the lab, but he pees all night.

It’s sort of interesting (!!) that the liver doc says low salt and to restrict fluid intake and take diuretics to prevent ascites, while the endo and PCP say to push fluids to lower blood glucose and help his kidneys, and to take salt tablets to get his sodium and chloride values up. ‍♀
 

southernlady

Administrator
Staff member
He said he had a half glass of water before going to the lab, but he pees all night.

It’s sort of interesting (!!) that the liver doc says low salt and to restrict fluid intake and take diuretics to prevent ascites, while the endo and PCP say to push fluids to lower blood glucose and help his kidneys, and to take salt tablets to get his sodium and chloride values up. ‍♀
I average 12-20 oz before I get to the lab.
 

Georgepds

Well-Known Member
Re
"(drumroll) A1C is 5.6!!!

...plus he’s getting special shoes for mild neuropathy - he put the fear of foot amputation into Charles."

FWIIW...good news.. my experience is diabetic foot neuropathy progression stops once blood glucose is under control. It even gets a little better.

At one point the weight bed sheets on my feet would cause pain... can't remember the last time that happened. These days numbness is the problem

Any pain, or more like discomfort, is taken care of by generic lisinopril, which works well for me. The experience is like getting over hiccups... which are just annoying. Once they're gone you don't notice it, unless you concentrate, then you remember the irritant is gone

I didn't notice lisinopril among rhe list of meds.

Good luck..
 

DianaCox

Bad Cop
Charles was on lisinopril for years, when his BP was high, but now it’s low, so he stopped taking it. His neuropathy was and is mild - just numbness. He had that for many years, and attributed it to having thick calluses, which are being treated by the podiatrist.
 

southernlady

Administrator
Staff member
FWIIW...good news.. my experience is diabetic foot neuropathy progression stops once blood glucose is under control. It even gets a little better.
Mine too, I’ve had years of getting better, so much so that 1) no meds needed for the discomfort and 2) no need for special shoes. At one point, tied athletic shoes were terribly uncomfortable, now, no problem.

I saw my neurologist this past week along with my PCP. Now when you see a new doctor, the medical history is one you give them. They have no previous doctors notes for the most part, altho in our case because we are connected with MyChart, they had our previous PCP. I asked nicely if we could disconnect the diabetes and peripheral neuropathy diagnosis from each other. This got into a “I’m the doctor with Yada, yada years of med school” versus my lifetime of living with the damned diseases. I didn’t want them removed, just not listed as the same diagnosis. I honestly feel that my close to 20 years of tight control has mitigated the damage diabetes has done. However, now, the damage is more spinal in nature. She tried to tell me there was only one cause of small fiber neuropath, there are several listed by the NIH. She also referred to my DS as a gastric bypass (couldn’t even call it it’s true name, the RNY), I corrected her twice, tell her it was a BPD/DS and they are not the same even tried to explain the difference when she interrupted and said, “I went to med school”. Her ONLY acceptable excuse is hormone brain due to being 8 months pregnant. But I left there fuming.

When I saw my PCP two days later, I was telling her about it, asked her if they could be disconnected, she said, sure and did it. I wasn’t asking to remove either, just not assume the neuropathy was caused by diabetes right off the bat. It helps that the dry needling being done in my PT sessions on my lower back are helping the tingling in my feet.
 

JackieOnLine

Moderator
Staff member
I corrected her twice, tell her it was a BPD/DS and they are not the same even tried to explain the difference when she interrupted and said, “I went to med school”. Her ONLY acceptable excuse is hormone brain due to being 8 months pregnant. But I left there fuming.
I don't blame you! Med school should also teach them to be grownups and realize they don't know everything and should be open to learning, but no!

:mad:


It helps that the dry needling being done in my PT sessions on my lower back are helping the tingling in my feet.
so interesting! I knew a PT who did dry needling and it makes perfect sense why it would help and why accupuncture can also help people even though some of it is woo, the actual application of needles can cause tiny injuries that then increase the circulation as your body moves in to heal them.

whatever helps!
 

Georgepds

Well-Known Member
Re ". I asked nicely if we could disconnect the diabetes and peripheral neuropathy diagnosis from each other. "

Any particular advantage to that separation? Why did you ask for it? My understanding is diabetes is the root cause of neuropathy, even if BG later is controlled, the neuropathy remains, or possibly lessens, but rarely goes into complete remission if you reached the bed sheet foot pain stage before controlling BG.

Re "She tried to tell me there was only one cause of small fiber neuropath, there are several listed by the NIH."

SFAIK, neuropathy, no matter what the cause, is mostly treated by mitigation measures, there is no cure

I didn't look up the NIH causes, but I know of three:

T2 Diabetes ( don't know if it affects T1 diabetics)
MGUS (b cell blood disease, precursor to myeloma)
PAD ( peripheral artery disease)

What are the others?
 

Larra

Well-Known Member
Actually, the correct name for the gastric bypass that is done in the USA would be "RNY gastric bypass", to differentiate it from the so-called (and poorly named) "mini gastric bypass", which is gastric bypass with a loop configuration rather than the RNY configuration. RNY configuration is part of other intestinal operations that have nothing to do with bariatric surgery.
But either way, that MD was wrong, clearly didn't know that there is more than one bariatric surgery available, and did not listen to the patient, which is crucial to providing good medical care, not to mention to the doctor-patient relationship. Hopefully there is another neurologist available.
 

southernlady

Administrator
Staff member
Re ". I asked nicely if we could disconnect the diabetes and peripheral neuropathy diagnosis from each other. "

Any particular advantage to that separation? Why did you ask for it? My understanding is diabetes is the root cause of neuropathy, even if BG later is controlled, the neuropathy remains, or possibly lessens, but rarely goes into complete remission if you reached the bed sheet foot pain stage before controlling BG.

Re "She tried to tell me there was only one cause of small fiber neuropath, there are several listed by the NIH."

SFAIK, neuropathy, no matter what the cause, is mostly treated by mitigation measures, there is no cure

I didn't look up the NIH causes, but I know of three:

T2 Diabetes ( don't know if it affects T1 diabetics)
MGUS (b cell blood disease, precursor to myeloma)
PAD ( peripheral artery disease)

What are the others?
Actually there are 100 causes for peripheral neuropathy, three of the most common are diabetes, alcoholism, and idiopathic. Two are vitamin related, low B12 and high B6. But those are likely also related to alcohol as most alcoholics drink their food, not eat it.

As for disconnecting them, other doctors might not be so quick to assume my neuropathy is caused by diabetes.
 

southernlady

Administrator
Staff member
Unfortunately, she’s my second one. I‘m just hoping by the time I see her again in 6 months, her pregnancy brain will return to normal and since my PCP took care of my request, the only issue I now have is to educate her on my surgery. I see lots of printouts in her future.
 
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