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Suggest treatment for nerve pain and stiffness in feet

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Posted on Tue, 7 Jul 2015
Question: over weight diabetic on levmir high sugars even when I don't eat feet feel like it's pass nerve pain
gone to stiffing freezing up can't leave my feet in shoes due to burning or foot in one spot
and pain increases need to exercise but yes i'm tired all the time witts end XXXXXXX wi. has no diabetic doctor
doctor
Answered by Dr. Abhay A Mali (27 minutes later)
Brief Answer:
Need further evaluation.

Detailed Answer:
Hi,

Thanks for your question.

After going through your question, I can understand your concern.

For better opinion your need further evaluation.

In your case there is need for:

1) Detailed Clinical examination including BMI calculation, neuropathy screening, foot examination.
2) Blood test like
Complete blood count
Renal function test.
Liver function test.
Urine examination.
Blood sugar level: fasting and postprandial.
HbA1c.
Lipid profile.
Serum B12 level.
Serum Vitamin D3 level.
Thyroid function test.
Base line EKG
Depending upon your clinical evaluation and above test results there may be need for ultrasound of abdomen and pelvis, lower limb arterial doppler and 2DEcho of heart.

For your diabetes control and weight loss certain medicines can be used like GLP1 receptor agonists if not contraindicated.
Also for neuropathic pain different medicines can be tried after primary evaluation.

As you have mentioned there is no diabetologist available, you should at least consult general physician and neurologist, they can guide you further.

Hope I have answered your question.
I will be happy to answer your follow up questions if any.
Otherwise you can close the question and rate the answer.

Regards,
Dr. Abhay Mali.
Diabetologist.

Above answer was peer-reviewed by : Dr. Vaishalee Punj
doctor
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Follow up: Dr. Abhay A Mali (3 hours later)
1. Why are glucose normal range 116 at night, and high 166 in the morning? Dinner the night before was salad, cottage cheese, meat and cucumbers? Glucose was 200 in the am.
2. How do I lower blood sugars in the daytime?
3. What do I eat when blood glucose is high and I am hungry?
4. Mobility is limited because of pain from neuropathy, what do I do? Siatica, prevents me from standing and exercising for short periods of time.
5. Whole wheat products are they good for me?
6. I am trying to go low carb/ no carb. is this good?
7. How about losing weight with B12 and liponox shots weekly. How do they help and is this good for diabetics?

Ps. How do I overcome emotional eating that may cause my sugars to go up.?

Pss. Another question. If I don’t eat for 6 hours or more. My glucose is in the normal range. Then when I eat its up in the 200-300 range. Then its hard to get it under control. What do I do?
From: XXXX
doctor
Answered by Dr. Abhay A Mali (13 hours later)
Brief Answer:
You should consult nearby diabetologist.

Detailed Answer:
Hi,

Thanks for your follow up questions.

I am here with giving answers to your questions-

1) During fasting state as in night our liver produces glucose to fulfil body requirement. This production is under insulin control though. In diabetes due to insulin resistance liver produces glucose irrespective of body requirement and that’s why fasting blood glucose level goes high.
2) I think you need to take short acting insulin before each meal according to level of blood sugar level.
3) When you are hungry, I suggest you eat calories restricted diet with high fibres and with appropriate antidiabetic medicine and/or insulin.
4) It may be worthwhile to consult an orthopedician and get sciatica sorted. There are some useful measures to treat it. An orthopedician or spine surgeon will be able to discuss on those.
5) You can take whole wheat products. Furthermore it is better to consult dietician for proper diet plan according to your weight and medical concerns.
6) Low carbohydrates with consultation with dietician and diabetologist.
7) I had no experience with use of Liponox therefore I am unable to make a comment. Vitamin B12 supplementation has no direct relation to weight loss.

At this point of time, you may also contact a dietician and see if it helps control emotional eating.

For blood sugar rise after eating you need appropriate medicines like short acting insulin or incretin therapy after proper evaluation and consultation with your local diabetologist or physician.

In short I will advise you aggressive weight reduction either with bariatric surgery or with GLP1 agonist after consultation with nearby diabetologist/ endocrinologist.

Hope I have answered your all questions.
If so close the question and rate the answer.

Regards,
Dr. Abhay Mali.
Diabetologist.

Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Abhay A Mali

Diabetologist

Practicing since :2006

Answered : 807 Questions

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Suggest treatment for nerve pain and stiffness in feet

Brief Answer: Need further evaluation. Detailed Answer: Hi, Thanks for your question. After going through your question, I can understand your concern. For better opinion your need further evaluation. In your case there is need for: 1) Detailed Clinical examination including BMI calculation, neuropathy screening, foot examination. 2) Blood test like Complete blood count Renal function test. Liver function test. Urine examination. Blood sugar level: fasting and postprandial. HbA1c. Lipid profile. Serum B12 level. Serum Vitamin D3 level. Thyroid function test. Base line EKG Depending upon your clinical evaluation and above test results there may be need for ultrasound of abdomen and pelvis, lower limb arterial doppler and 2DEcho of heart. For your diabetes control and weight loss certain medicines can be used like GLP1 receptor agonists if not contraindicated. Also for neuropathic pain different medicines can be tried after primary evaluation. As you have mentioned there is no diabetologist available, you should at least consult general physician and neurologist, they can guide you further. Hope I have answered your question. I will be happy to answer your follow up questions if any. Otherwise you can close the question and rate the answer. Regards, Dr. Abhay Mali. Diabetologist.