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Can peripheral nephropathy of the feet start before a person…

Can peripheral nephropathy of...

Can peripheral nephropathy of the feet start before a person is diagnosed as diabetic.

Doctor's Assistant: Have you seen a doctor about this yet? What medications are you taking?

I am seeing a doctor at the VA and for about 2 years my glucose numbers and A 1C numbers bounced around so they wouldn't say I was diabetic but I have had numbness of the feet for about 5 years and now they are numb and burning on the bottom constantly. I am taking saxagliptin for the diabetes and losartan for blood preasure and Gabapentin for the pain in my feet but only if it is real bad and only at night because it puts me to sleep.

Doctor's Assistant: How long have you been dealing with the burning? Are you experiencing any other discomfort?

A couple of years and yes I am getting red bumps on my legs and arms that get scabs on them and take weeks to go away and the palms of my hands are starting to get numb.

Doctor's Assistant: Anything else in your medical history you think the doctor should know?

I served in Vietnam in of the heavily sprayed areas of Agent Orange and have been diagnosed as type 2 diabetic.

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Answered in 20 hours by:
1/14/2018
Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,415
Experience: American Board Certified Neurologist, Internal Medicine
Verified

Hi, I am an American Board Certified Neurologist with vast experience in diagnosing & treating all neurological as well as all other health/medical conditions, and I am very glad to help you with your health concerns.

I am sorry to hear about your health as you have described above. And you have inquired – “can peripheral neuropathy of the feet start before a person is diagnosed as diabetic?” As a Neurologist I frequently diagnose & treat this type of health situation and I can certainly help you in this regard.

To your main question whether neuropathy condition can precede the diagnosis of diabetes, yes it is possible

Most often diabetic neuropathy follows diabetes diagnosis, in fact many years after the diagnosis of diabetes the neuropathy symptoms start and neuropathy gets diagnosed

But on rare occasions neuropathy symptoms may start before the diabetes gets diagnosed

Diabetic neuropathy can occur during prediabetes stage too, so before diabetes diagnosis is made neuropathy may get diagnosed in some individuals

However when this situation arises, where neuropathy is diagnosed before the diagnosis of diabetes is made we need to explore other possibilities that may be associated with neuropathy, and there are myriad non-diabetic causes for neuropathy and the examples include the following;

Prediabetes (mentioned earlier above)

Vitamin deficiencies

Thyroid diseases (usually hypothyroidism)

Autoimmune connective tissue disorders

Heavy metal toxicity

Exposure to other toxins (agent orange etc)

Inflammatory neuropathies

Chronic infections

Kidney diseases

Alcohol (if used chronically but not otherwise)

Medication side effects (certain types of medications too can cause neuropathy)

Amyloidosis

Porphyria

Genetic causes

Idiopathic causes (cause is not found even after thorough and extensive workup)

Not all these above causes may be applicable in your case; I am providing you with a list like this so that you are familiar with the different possibilities.

A nerve test by name EMG/Nerve conduction test can help in confirming the diagnosis of neuropathy. So if this has not already been done then your neurologist needs to arrange for this test. If neuropathy diagnosis has already been confirmed with EMG/Nerve conduction test then there is no need to repeat this test.

Once neuropathy is clinically suspected and/or confirmed with the above mentioned nerve test then the next step is finding what is causing the neuropathy (the various causes as mentioned in the list above). So if you have not been worked-up so far to find out the cause for neuropathy then you will also need to undergo certain additional investigations to find out the precise cause for the neuropathy, and the following investigations are generally required to find out the cause for neuropathy;

CMP (comprehensive metabolic panel)

Vitamin B12, Folic acid, B6 (vitamin deficiency tests)

TSH, T3, T4 (thyroid tests)

ESR, CRP, ANA, Rheumatoid factor, SS-A, SS-B, serum complements etc (autoimmune connective tissue disorders tests)

Serum total protein & globulin – tests related to immunity

SPEP (Serum Protein Electrophoresis) – test related to immunity

IPEP (Immuno Protein Electrophoresis) – test related to immunity

Urine for BJP (Bence Jones Protein) – test related to immunity

Heavy meal screening

Chronic infection tests

Anti ganglioside antibodies etc

If any of the above investigations/blood tests have already been accomplished then no need to repeat them.

Sometimes for the final confirmation of the exact type of neuropathy a nerve biopsy and/or a genetic test may also be required too.

If any obvious cause for the neuropathy is identified it will be treated appropriately.

As we discussed above diabetes or prediabetes conditions can cause neuropathy and there are many other conditions too can cause neuropathy, but to your main question – yes, while it is rare but diabetic neuropathy can start manifesting before a person gets diagnosed with diabetes, so it is possible.

Coming to the treatment aspects of neuropathy; as pointed above the primary treatment for the neuropathy condition is finding the cause for the neuropathy and treating it, and in the meantime certain symptomatic treatments that can help in getting relief from the neuropathy symptoms too can be tried to get relief from the symptoms such as the following;

A) Over the counter OR Non-prescription OR Home remedies to control neuropathic pain;

Capsaicin pain relief skin cream

Penetrex Neuropathic Pain Relief Cream

Nervex neuropathic pain relief cream

Arnicare pain relief skin cream

Cannabinoid CBD Hemp oil

Evening Primrose oil (for external application)

Neuroveen (for external application)

Lidocaine anesthetic pain relieving skin patches (Aspercreme skin patches) – Non-prescription type

Lidocaine anesthetic skin cream

Therapeutic Neuropathy and Arthritis Pain Relief Healing Balm with Organic Essential Oils

Neuropathy homeopathic Rubbing Oil

Massage therapy etc

B) Prescription pills (Nerve-pain pills) & other preparations to control neuropathic pain;

Gabapentin (you are already on this pill)

Pregabalin

Duloxetine

Milnacipran

Amitriptyline

Nortriptyline

Imopramine

Desipramine

Venlafaxine

Lidocaine anesthetic pain relieving skin patches (prescription strength)

Vicodin

Percocet

Botox injections etc

C) Medical devices to control neuropathic pain;

TENS (Transcutaneous Electrical Nerve Stimulation)

Laser therapy (Cold laser therapy)

Ultrasound therapy

Stimpod NMS460 neuromodulation device

Calmare Scrambler Pain therapy etc

D) Complementary or Alternative medicine treatment options to control neuropathic pain;

Acupuncture

Biofeedback

Hypnotherapy etc

The above are the various treatment options to consider, but please see not all these above mentioned treatments may be required in your case; I am trying to provide a list of the various treatment options like this so that you are familiar with several treatments that are available for helping with your health condition symptomatically and you may try to use them as necessary. If you see any of the above treatments you have already tried please disregard them and you may explore the treatment options which you may have not yet tried.

E) The following are the various nutritional supplements that can be used to treat neuropathy condition;

Methyl Guard Plus (This is combination pill containing active forms of vitamin B12, Vitamin B9/Folic acid, Vitamin B6, and Vitamin B2)

Or using another special vitamin combination pill called as “RHP Extra Strength Nerve Support Formula” which contains Benfotiamine, Methylcobalamin, Vitamin D, Vitamin B1, B2, B6 etc and serves as a nutritional support for neuropathy & nerve pain relief

Alpha Lipoic Acid

Coenzyme Q 10

Calcium & Magnesium

Omega 3 fatty acids or Fish oil

Evening Primrose Oil Oral

Neuroveen Oral

Acetyl L Carnitine

Glutathione

Glutamine etc

The above mentioned nutritional supplements are also called as nerve repair supplements because they may help with nerve repair & nerve regeneration and this can additionally help in the relief from the pain, burning sensation & numbness etc, and also promote faster recovery from nerve damage. These are considered as safe nutritional supplements and are not expected to cause any major or serious side effects, or interactions among themselves or with any other medications, so if you wish you may take all of the above, or you may try only some of the above too.

Once again to your main question, yes it is possible to get diagnosed with peripheral neuropathy before getting diagnosed with diabetes, it is rare though but it is possible as mentioned earlier above, but if other causes for neuropathy have not been already explored then a thorough neurological evaluation including the EMG/Nerve conduction test followed by certain investigations as mentioned earlier above can help us to find out the precise cause for the peripheral neuropathy and then treated appropriately for the best results and best outcome.

Wishing you the best health!

All the very best!

Please let me know if you have any additional questions or if you want to discuss this further. And please take a moment and kindly click a positive rating (preferably 5 Star/Excellent) to credit for the time & effort put by me in answering your health question, and this is the only way I will be credited for my service to you. Rating me now does not close your question and if you have follow-up or additional questions you can ask them after the rating too!

Assuring you the best services!

Best Regards!

Dr Subbanna MD

Dr Subbanna MD
Dr Subbanna MD, Neurologist (MD)
Category: Neurology
Satisfied Customers: 6,415
Experience: American Board Certified Neurologist, Internal Medicine
Verified
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