Did you know that more than 37 million Americans have diabetes, which means 1 in every 10 people gets the disease? Of those 37 million individuals, approximately 90%-95% have type 2 diabetes. Why are chiropractors talking about diabetes if they are not the primary care provider treating it? With diabetes comes many risk factors, especially if they are not managed or properly regulated. One extremely common risk factor of diabetes is neuropathy, which chiropractors can treat. In this week’s blog, we will discuss what diabetes is, what diabetic neuropathy is, how it typically is managed, and how our facility manages it. 

What is Diabetes?

Before we discuss what diabetic neuropathy is, it’s a good idea to get a basic understanding of what diabetes is. First, let’s define some key terms that are involved in a diabetes diagnosis. 

  1. Glucose- a simple sugar which is an important energy source in living organisms and is a component of many carbohydrates. In easier terms, whenever humans eat, food is broken down and turned into blood sugar (glucose) for energy. 
  2. Insulin- a hormone produced by the pancreas that helps regulate blood sugar (glucose) levels. Insulin also signals the liver to store blood sugar for later use. Blood sugar enters cells, and levels in the bloodstream decrease, signaling insulin to decrease too.
  3. Pancreas-The pancreas is an organ located in the abdomen. It plays an essential role in converting the food we eat into fuel for the body’s cells. The pancreas has two main functions: an exocrine function that helps in digestion and an endocrine function that regulates blood sugar. We will be focusing on the endocrine function.

The endocrine component of the pancreas consists of islet cells (islets of Langerhans) that create and release important hormones directly into the bloodstream. Two of the main pancreatic hormones are insulin, which acts to lower blood sugar, and glucagon, which acts to raise blood sugar. Maintaining proper blood sugar levels is crucial to the functioning of key organs including the brain, liver, and kidneys. 

Knowing these key terms is essential to understanding what diabetes is and how you can get it. Diabetes occurs when the pancreas does not produce enough insulin in the body to lower blood sugar levels. When this happens, glucagon keeps secreting, drastically increasing blood sugar levels. There are three different types of diabetes that we will briefly discuss. Each are different and are caused by different risk factors.

Type I Diabetes

Type I Diabetes makes up 5%-10% of the American diabetes population. It is an autoimmune disorder which means the body attacks itself. Someone who has Type I Diabetes produces little to no insulin and needs to have an insulin pump or take injections daily to regulate blood sugar levels. Type I Diabetics can live a completely normal life without complications as long as they monitor their blood sugar levels, eat healthy, create a regular physical activity routine, and take their insulin when needed.

Type II Diabetes

Type II Diabetes makes up the other 90%-95% of the American Diabetes population. Unlike Type I Diabetes, Type II Diabetes is not autoimmune, but rather, caused by lifestyle factors. In other words, Type II Diabetes is preventable where Type I is not. Typically, Type II Diabetes is caused by poor diet, overweight/obesity, and physical inactivity. Just like Type I, Type II individuals can live a completely normal life; however, Type II tends to be harder to manage as many find it difficult to change their lifestyle factors. Type I individuals typically get it very young in life and learn a proper regimen from the get-go, where Type II individuals develop the disease on average in their 30s or 40s and thus must change lifestyles that they’ve lived the majority of their lives making it very difficult to do. 

That being said, it is possible for Type II Diabetics to live completely normal lives with improved lifestyle changes. Just like Type I, Type II individuals can achieve this goal if they monitor their blood sugar levels, eat healthy, and create a regular physical activity routine. Typically, Type II Diabetics produce enough insulin that they do not need to take insulin injections or need to be on a pump; however, if they don’t change their lifestyle factors, they can completely destroy the pancreas which will no longer be able to produce insulin and require them to be on an insulin pump.   

Gestational Diabetes

Gestational Diabetes is the least common form of diabetes and is diagnosed when a woman is pregnant. This form of diabetes tends to go away after pregnancy, but this could cause complications to the mom and/or baby later in life. Complications to the mom includes an increased likelihood of getting Type II Diabetes later in life. Complications to the baby are far worse including excessive birth weight, premature birth, serious breathing difficulties, low blood sugar, obesity and Type II Diabetes later in life, and possibly stillbirth. There is no true cause for why pregnant women get gestational diabetes, but doctors say that risk factors such as being overweight, poor lifestyle choices and pre-diabetes could play a role. The best thing to do is monitor blood sugar levels and do everything to keep both mom and baby healthy. 

How is Diabetes Diagnosed

Diabetes is very easy to diagnose as blood work will give an accurate diagnosis. However, it is still very important to take a good case history on the patient to give the doctor a reason to order blood work. The most common symptoms of diabetes are feeling more thirsty than usual, urinating often, losing weight without trying, feeling tired and weak, feeling irritable or having other mood changes, experiencing blurry vision, having slow-healing sores, as well as frequent infections, such as gum, skin and vaginal infections.

There are several tests on a diabetic panel but when bloodwork comes back, two very important tests that confirm a diabetic diagnosis are the Hemoglobin A1C test and a fasting blood sugar test. Below are the average ranges for each test. Tests should be performed twice to confirm a diabetes diagnosis.

Hemoglobin A1C

Normal:  0%-5.6%

Prediabetes: 5.7%-6.4%

Diabetes: 6.5%-higher

NOTE: A Hemoglobin A1C test of 9% or higher is considered dangerous, thereby increasing the risk of long-term diabetes complications like blindness, nerve damage, and kidney failure.

Fasting Blood Sugar

Normal: 0-99 mg/dl

Prediabetes: 100-125 mg/dl

Diabetes:  126 mg/dl

How is Diabetes Managed?

When people are diagnosed with diabetes, they are stuck with it; there is no cure. Regardless of which type of diabetes people have, if they take control, they can live completely normal lives without anyone ever knowing it. A simple exercise plan and proper diet routine are all it takes to regulate the disease. Reduce intake on junk food, sweets, sugary drinks, and foods high in fat and carbohydrates.

Let’s briefly talk about carbohydrates and how diabetics should be careful. When carbohydrates are broken down in the digestive system, they become sugars thereby increasing blood sugar levels and stimulating the pancreas to get to work. Many doctors tell patients to stay away from carbs and eat a diet high in protein and good healthy fats. While we agree with this for the most part, realize that carbohydrates are extremely important for brain function and should make up 35%-65% of the human diet. 

Yes, too many carbs are bad, especially for diabetics, but carbs should not be completely eliminated. Realize that insulin plays a key role in helping sugar, a major source of energy for muscles and other tissues entering cells in the body. Without enough insulin, the body begins to break down fat as fuel. This causes a buildup of acids in the bloodstream called ketones. If it’s left untreated, the buildup can lead to a life-threatening condition known as diabetic ketoacidosis.

What is Diabetic Neuropathy?

With diabetes comes a great deal of risk factors and complications including vision problems, kidney failure, gum disease, heart attack, stroke and nerve damage resulting in amputation of extremities. One of the most common complications of diabetes is neuropathy and is simply called “diabetic neuropathy.” There is absolutely no difference between peripheral neuropathy and diabetic neuropathy. Peripheral neuropathy is just simply called diabetic neuropathy when someone has a diabetes diagnosis. 

When we first began our blogs, we discussed neuropathy in great detail, and we would like to reiterate the big points of what it is and how it can be managed. Neuropathy is a nerve disease that gets progressively worse. A more blunt but accurate description of neuropathy is the failure and potential death of nerves culminating in a loss of entire function of a single nerve or multiple nerves.

Mononeuropathy is when one nerve is affected. Polyneuropathy is when multiple nerves are affected. In the majority of neuropathy cases, multiple nerves are affected. Whether one nerve is affected or multiple nerves are affected, it’s still considered neuropathy and still presents a major issue to the body and one’s health. 

Affecting mainly the Peripheral Nervous System and Autonomic Nervous System, the most common symptoms of neuropathy include loss of feeling in the arms/legs, muscle weakness, widespread sharp pains, loss of coordination, heat intolerance, bowel/bladder incontinence, digestive problems and irregular heart rate and blood pressure fluctuations.

How Do Medical Doctors Manage Neuropathy Patients?

I think we all know the answer to this question. If you guessed medication, you answered correctly. There are several different medications that doctors have prescribed to patients over the years with the most common used include amitriptyline, duloxetine, pregabalin and gabapentin. Just like any drug used for pain, it’s only numbing the pain, not fixing the problem. Neuropathy patients can also get steroid injections or nerve blocks to help with pain, but again, its only numbing the pain, not fixing the problem. In addition to prescription drugs and injections, doctors may also give information on regular exercise and dietary recommendations which is something we absolutely recommend. Many patients ask, is there a better way to manage neuropathy?

How Does Our Facility Manage Neuropathy Patients?

Did you know that there is another solution for neuropathy management that is both painless and effective? Using state of the art equipment, our facility has been successfully managing patients with neuropathy using Horizontal Therapy (HT) for years.

These next few sentences maybe very confusing, but there is no better way to explain horizontal therapy. Based of the Hakomed Therapy manual, HT is a simultaneous combination of the biochemical and bioelectrical effects of current on the human body. It is based on the premise that bioelectrical changes in living tissues are closely linked with biochemical changes, and vice-versa. By applying one form of therapy having both effects, one obtains a synergistic effect via improved communication between the cells.

From the functional standpoint, the effects induced by HT in relation to symptomatic components of pathology are the reduction of pain, excess muscular recruitment, and improvements in range of motion (ROM) as an indirect effect of rigidity outside the joints and improves deficiency in motor functional activity as the result. HT has demonstrated the ability to increase ATP production within cells. This means increased energy production. Recent research has also shown that HT increases production of catalase, gluthathione and reactivation of Super Oxidase Dismutase which works to reduce dangerous free radicals resulting from cellular oxidation. Additionally, HT has shown to increase protein synthesis, tissue regeneration, bacterial destruction and improved immunomodulation.  

In sum, horizontal therapy changes cell structure which will stimulate the body’s fighting response and increase the healing process to allow regeneration. Now think about nerves and the nervous system. Just like the rest of the body, nerves contain cells which allow horizontal therapy to come in, restructure nerve cells and regenerate failing nerves. This process helps our neuropathy patients to get back on their feet and to live normal healthy lives. 

Just like our decompression program featured in a previous blog. our neuropathy patients also go through a vigorous program to get them better. Just like any patient who walks into our facility, a consultation will be performed to learn about the patient’s case followed by a series of x-rays and thorough neurological examination in the region of complaint.

One way a neuropathy examination differs from either a chiropractic or decompression examination is that the doctors must dig a little deeper and perform a set of tests designed specifically for neuropathy to determine the severity of the condition.

Once the examination process is complete, a treatment plan is designed for each patient. No patient has the same treatment plan as another neuropathy patient would. It all depends on the case severity of each neuropathy patient. Some patients may only need 10-15 treatments, where others may need 40 treatments. Once a treatment plan has been completed, patients are then placed on a maintenance program that we will discuss in a future blog.

We covered a lot of ground in such a short period of time. We hope that you learned something about neuropathy. Realize that diabetes is no joking matter and should be monitored regularly and lifestyle factors implemented. If there is one thing we want you to remember about this week’s blog, don’t take diabetic neuropathy lightly and get it managed before it gets progressively worse. Realize that there is an alternative solution to drugs and injections. We are the only facility in the Pittsburgh tri-state area that has this state-of-the-art equipment for neuropathy management.  If you or someone you know is tired of living in pain and have tried just about anything to do just that, please consider our neuropathy management program. It could be your saving grace. If you have any questions about neuropathy, please feel free to call us at (724) 547-3377 and checkout our website at www.drlarrywilkinsspinalcare.com for more content on neuropathy.

Yours In Health,

Larry E. Wilkins, DC

Brian M. Steinert, DC