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Can Nerve Tests Distinguish Between Diabetic Neuropathies And Other Neuropathies?
Question: I am a67 y.o male . I recently was diagnosed with a herniated disc touching on a nerve . 3 epidurals later and p.t. I am doing better. However , between my first and second epidural, I developed numbness , not pain on the pads of my toes on both feet. My last blood work with my p.c.p showed a fasting glucose under 100, but my a1c result was 6.2. That occurred after a few scripts of methylprednisilone, so my dr. attributed the elevated a1c rate to it. I had an emg and ncv nerve test today to determine the cause of the numbness in my toes. It was done by a physical medicine dr. The results he said indicated my numbness is caused by diabetic neuropathy. I told him that my last a1c was 6.2. His response was that 6.2 is diabetes. My question , is that true? And are these nerve tests able to distinguish between diabetic neuropathies and other neuropathies? So can his diagnosis be accurate for diabetes? I currently am asymptomatic for diabetes, but my glucose levels haven't been checked since late Sept.
Brief Answer:
Not diabetes, could be compressive neuropathy,
Detailed Answer:
Thank you for asking!
I understand your concern. Age of 67 is a geriatric limited age with articular degenerations as an inevitable process. Numbness between epidural steroid injections inducing paresthesias in toes of both feet is less likely to be connected to diabetes as you don't have one. Fasting less than hundred and HBAc1 is still good at 6.2. slightly raised but still in normal range and that is due to steroids injections you took.
Nerve conduction studies may just correlate the neuropathies and sorting out the etiology to be demyelinating or diabetic neuropathy is not possible with just a conduction study. That further is evaluated with further work up. How ever, diabetic neuropathies are usually to the end arteries or vasa nervorum which are arteries supplying to the vessels. And that is a long term chronic process, meaning to get those symptoms, you need to be a long term diabetic and that too with no compliance and uncontrolled glucose levels.
HErniated disc itself and the age related articular degeneration of discs and demylination of nerves may be causing it more likely. Also the disc might be recurring and compressing the nerve leading to this pain. Only a detailed clinical correlation will sort out.
Let your doctors be the judge of that. I hope it helps. Take good care of yourself and dont forget to close the discussion please.
may the odds be ever in our favour.
Regards
Khan
Not diabetes, could be compressive neuropathy,
Detailed Answer:
Thank you for asking!
I understand your concern. Age of 67 is a geriatric limited age with articular degenerations as an inevitable process. Numbness between epidural steroid injections inducing paresthesias in toes of both feet is less likely to be connected to diabetes as you don't have one. Fasting less than hundred and HBAc1 is still good at 6.2. slightly raised but still in normal range and that is due to steroids injections you took.
Nerve conduction studies may just correlate the neuropathies and sorting out the etiology to be demyelinating or diabetic neuropathy is not possible with just a conduction study. That further is evaluated with further work up. How ever, diabetic neuropathies are usually to the end arteries or vasa nervorum which are arteries supplying to the vessels. And that is a long term chronic process, meaning to get those symptoms, you need to be a long term diabetic and that too with no compliance and uncontrolled glucose levels.
HErniated disc itself and the age related articular degeneration of discs and demylination of nerves may be causing it more likely. Also the disc might be recurring and compressing the nerve leading to this pain. Only a detailed clinical correlation will sort out.
Let your doctors be the judge of that. I hope it helps. Take good care of yourself and dont forget to close the discussion please.
may the odds be ever in our favour.
Regards
Khan
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
I don't have any pain in my toes, just a mild numbness that is not debilitating. I understand your answer, but can an emg, ncv test result be specific for diabetes or can it only be specific for generalized neuropathy. The Dr. taking the exam said that the results indicated that I HAD diabetes. Thank you for your time and knowledge in this area, as it made me feel a little better about the situation.
Brief Answer:
Follow your doctor's advice.
Detailed Answer:
Thank you for getting back!
I understand the concern. Diabetes may be diagnosed with conduction studies for nerves and that is quite a tough job using different DSPN scorings and people with score 5N. But who would do that when a simple fasting glucose levels can fix that for you . Yo got my point? Your glucose level tests are fine and in normal range. I wonder why did doctor correlated it that way. he might have a reason for that.
Polyneuropathy is a symptom and there are thousands of etiologies behind it. Just the test can never help you diagnose it. Its the correlation clinically done to sort it out what is behind it.
But as your doctor has examined you and he has correlated all that clinically, i am sure he has valid reasons for your diagnosis. So i would strongly recommended to prefer his advice and do as directed by him .
I hope it helps.
take care.
Khan
Follow your doctor's advice.
Detailed Answer:
Thank you for getting back!
I understand the concern. Diabetes may be diagnosed with conduction studies for nerves and that is quite a tough job using different DSPN scorings and people with score 5N. But who would do that when a simple fasting glucose levels can fix that for you . Yo got my point? Your glucose level tests are fine and in normal range. I wonder why did doctor correlated it that way. he might have a reason for that.
Polyneuropathy is a symptom and there are thousands of etiologies behind it. Just the test can never help you diagnose it. Its the correlation clinically done to sort it out what is behind it.
But as your doctor has examined you and he has correlated all that clinically, i am sure he has valid reasons for your diagnosis. So i would strongly recommended to prefer his advice and do as directed by him .
I hope it helps.
take care.
Khan
Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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