Diabetic Neuropathy after only 2 years and despite good control?

Hey everybody,

I went to my quarterly routine check up at my endo the other day, where they performed a foot check for neuropathy. The nurse did the thing where they hold a tuning fork to your foot and see how long you can feel it. Afterwards she said that my ability to feel the vibration of the fork was slightly compromised. (Apparently instead of sensing it for 8/8 units (?) of time I could only feel it 7/8 units.
I also told her that within the last 3 months or so I sometimes when inactive can feel a strange "vibration" / buzzing feeling in both my feet, mainly when lying in bed or sitting on the couch. Not unlike the sensation the tuning fork produced. She asked if it was only during inactivity and occurred in both feet which it does. She said that this was in fact a typical early sign of diabetic neuropathy in the feet but said when looking at my A1cs it would be highly unusual to already have developed neuropathy. The endo seconded that and said I shouldnt worry...Easy for him to say – especially BECAUSE my control is good that worries me: what if I have a propensity to develop DN even after a minimum of high blood sugars?
I was diagnosed 2 yrs ago, slow onset, so I thought maybe I have just been running around with high BS for a long while before DX, but then I was diagnosed with quite a "low" Hba1c: 7,5. and ever since diagnosis I have not have a single A1c over 6.0.

It would be great to get some opinions of others to how likely they think this could be neuropathy? Any of you have developed it unusually early? And any ideas if in fact is is neuropathy, how can I hault its progression if good control doesnt do it?
Would be grateful for any feedback – thank you!

Ps: And here I was thinking I am doing just great :(

Had they ever done a previous tuning-fork test, for reference? I've had probably a hundred tuning fork tests done over my decades... as well as monofilament tests... and also the double-pokey-thing-test (not sure what that one is called). I think the prefered method as of past few years is tuning fork.

I think 8 seconds is the "threshold score"... which would be the 8 in "7 out of 8" or the "8 out of 8" she might have been talking about.

According to http://guidelines.diabetes.ca/Browse/Appendices/Appendix8 , "threshold scores do not exist to indicate the risk of future onset of neuropathy."

I wouldn't worry too much. Only a few years in, without a past reference test, I think the "7 out of 8" means keep a watch on it, not that anything has set in yet.

yes I ve had these tuning fork tests a number of times before. The previous ones were always "fine" ( 8 out of 8).

I still wouldn’t worry too much… I am sure the scoring of that test must be somewhat subjective and I wouldn’t be too concerned unless there was a more significant change.

I'd say watch out, make sure you're vigilant about checking your feet. Don't see this as neuropathy yet though just as a warning sign?

I agree with Tim. I've had the tuning fork held to my feet, but never tested for duration (do you feel it or not was the extent of the test). There are, in my opinion, WAY too many uncontrolled variables in the test to begin with - how hard is the tuning fork struck, where is it held, how hard is it pressed, how active was the patient before the test, etc. The difference between 7 and 8 secs. is therefore insignificant.

I would be skeptical that you have neuropathy because you don't have any of the risk factors. Besides very short duration of diabetes, excellent control since diagnosis, and relatively good A1c at time of diagnosis, you (I assume) don't have the other risk factors: "apart from the glycaemic control was related to potentially modifiable cardiovascular risk factors including raised serum triglyceride, body mass index, smoking, and hypertension". STUDY

If you still concerned, though, you can press to have quantitative tests which are needed for a real diagnosis. One of the most common and least invasive test is called R-R interval test (measuring heart rate while breathing), but there are others.

There are various nutritional supplements (ARIs, alpha lipoic acid) that have some indications of improving neuropathy but you'de have to look at the studies and consider whether you really want to add a daily supplement. Good review is HERE

As to the "buzzing" in your feet, do you notice it only when BG is relatively high? Or associated with something more prosaic like having spent the whole day on your feet, or in high-heels, etc.?

All of the foot-sensation tests have some amount of variability depending on the guy doing it, never mind when I announce the vibration has stopped or whether I feel anything or not!

Lately I notice that my docs strongly prefer the tuning fork test over the monofilament (Fishing line) and sparkies (that's where they jab you twice at variable distance and ask you if it feels like one or two) tests. They tell me that of all the tests the tuning fork one has the least variability and is the most sensitive.

The tuning fork test has evolved over the 30+ years I've been having the tests... at first it was just "do you feel it or not" but now they always do the count-the-seconds thing. I have been told a non-diabetic person would be expected to feel the vibration for much more than 8 seconds, more like 12 or 14 seconds.

Oh... maybe the official name for "sparkies" is "two point discriminator".

julez, you're getting sound advice from the community. The "decline" is so marginal that it may not be there next time you are examined.

Also, there are other sources of peripheral neuropathy. Among the most common causes is diabetes, so when a diabetic presents with neuropathy -- especially peripheral neuropathy -- the first place a doctors looks is diabetes.

For this reason, if it gets worse, make sure your doc considers other possibilities and tests for them. Your current history present a weak case for diabetic peripheral neuropathy, although it's certainly not impossible.

Also, something you can do (if you don't already) is do some BG testing 1, 2, and 4 hours post prandial. Don't need to be maniacal about it (like, every meal!), but maybe do it after one meal a day each day for a week, to get some data. Keep careful records of carb, protein, and fat content in those meals.

If you're hanging out above 140 for hours after eating, then getting back under 100 eventually so you spend about an equal amount of time down there, you can wind up with a good a1c that isn't telling the whole story.

An a1c of 6% translates to an average BG over the last 3 months (weighted more heavily to that last 4-6 weeks) of 126 mg/dl. If you're spending half your time, during fasting, around 100, then you're spending the other half of the time, on average, around 152.

Of course, it doesn't really work this way, but it gives you an idea of what's going on. Those 1/2/4 hour postprandial numbers, a long with your a1c, tell a much more detailed story that you can then draw some conclusions from.

Finally, some words of encouragement: I've been a type 2 diabetic for 15 years. I allowed my diabetes to get out of control, and started to develop peripheral neuropathy in hands and feet. I went on insulin therapy last June, and it took awhile, but today it's all cleared up!

So, your overall control is good, but you may be experiencing large excursions after you eat, which can lead to neuropathy, even if overall control is good. The postprandial testing will uncover that.

I was going to say the same thing about B12. Maybe give it a try?

I wouldn't worry to much about it. You may have just "moments" when you may have some very slight symptoms, diabetes is very is mysterious in many ways..who knows how it exactly affects your system. Most likely your symptoms will never get worse, sure and occasional feeling here and there but nothing of any concern. I have had this since 2008 and DN..my BS's numbers were in the 400's when I found out. My DN is perm, but has not become worse. Please don't worry, you're fine. Doctors, as you well know, say a lot of things..and they are are as stumped as the patients on many issue. Hang in there! August