Most American investigations suggest the best thing a person with diabetes can do to prevent or lessen neuropathy, regardless of age or length of time he or she has had diabetes, is to strictly control the level of blood sugar. Results from an important clinical study which included 1,441 insulin-dependent volunteers (known as the Diabetes Control and Complications Trial) indicated that over 60% of those participants who were on an intensively managed control program for blood sugar for five years showed a lesser progression of nerve damage.

Although only Type I diabetics were included in the study, researchers believe that Type 2 diabetics would benefit from rigorous blood sugar management as well. Even though other studies have also reported that strict control of blood sugar reduces pain and improves nerve conduction, no one is sure exactly why. It is thought by many that glucose probably does not damage nerve cells directly but rather may affect other body systems which in turn affect the nerves. One possibility, for example, is that high glucose levels may impair blood vessels, thereby preventing oxygen and various nutrients from getting to nerve cells (the condition called ischemia as noted).

Dr. David S. H. Bell, a professor of medicine at the University of Alabama at Birmingham, had a somewhat different explanation which appeared in the June 1995 issue of Diabetes Forecast. He pointed out that although insulin helps glucose enter muscle and fat cells, nerve cells don't require insulin to take up glucose. Therefore when there's too much glucose in the blood some of the excess inevitably ends up in these cells. Once inside, the excess forms sugar alcohols such as sorbitol. The build up of these alcohols, he believes, in turn affects the production of other nutrients which the nerve cells need to function properly. After years of having to deal with this situation the nerves suffer permanent damage, according to Dr. Bell. (Aldose reductase inhibitors which help limit the overproduction of sorbitol. This sugar form, if not moderated, is believed to cause problems in nerve cells by upsetting their chemical balances.)

Some researchers have also focused on the effects of excessive glucose on nitric oxide in nerves. They point out that low levels of nitric oxide in diabetics may lead to a constriction of blood vessels supplying the nerve, thereby contributing to nerve damage.

The connection between diabetic neuropathy and nerve myoinositol was noted earlier. Decreased levels of inositol are frequently found in nerve cells of diabetics due to the build up of sorbitol in these cells caused by high blood sugar levels.

As a result of innovations such as electronic glucose monitoring and insulin pumps, blood sugar control is easier to achieve today than in the past. The ADA publishes its Buyers Guide to Diabetes Supplies in Diabetes Forecast Magazine every October, which lists products to assist the individual with diabetes in this regard (for more information call 1-800-232-6733.

Information from the book Numb Toes and Aching Soles: Coping With Peripheral Neuropathy written by John A Senneff and available from the www.medpress.com.