Diabetes Forecast

Stop Nerve Damage Now

Tips for stopping—or stalling—diabetic neuropathy

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Unlike in type 1, tight blood glucose control may not have an effect on neuropathy in people with type 2, studies show. That’s where healthy eating and exercise come in—they can help prevent it or delay its progress. “We need to educate people to do at least moderate exercise—30 to 40 minutes, five days a week,” says Munmun Chattopadhyay, PhD, a researcher at Texas Tech University Health Sciences Center.

But for people with painful neuropathy, or people worried about foot injuries, “that is easier said than done,” says Brian Callaghan, MD, a neurologist at the University of Michigan in Ann Arbor. “We have to be more creative with exercise recommendations for people with diabetic neuropathy.” Some ideas might be to exercise in water or simply start a slow and careful walking workout.

Another benefit of exercise is weight loss, which is also a good way to slow or prevent neuropathy.

To test the idea that weight loss could have an impact on neuropathy, Osama Hamdy, MD, PhD, director of the Joslin Diabetes Center’s Obesity Program, worked with 50 people between the ages of 18 and 75, all of whom had obesity and type 2 diabetes for about a decade and had average A1Cs over 7 percent; none had severe neuropathy. Half of the participants were enrolled in an intensive, 12-week weight-loss program developed at Joslin called Why Wait, and the other half were given standard medical care but no special counseling.

The Why Wait group maintained a 10-pound weight loss at the one-year mark. Their blood glucose levels dropped initially but didn’t change significantly over that time, hovering around an average A1C of 7.3 percent. The control group didn’t lose weight and finished the study with an average A1C of 7.6.

In the group that lost weight, one thing was very different: Their nerve function was significantly better than the group that didn’t lose weight. When researchers looked closer, they found that losing weight didn’t seem to stop the death of the nerves, even though it did improve their function. “Diabetes is gradually killing the nerves, but weight loss helps the surviving nerves work better,” Hamdy explains.

Exercise, too, has positive effects on the growth and survival of nerve cells. In 2014, Gordon Smith, MD, FAAN, a neurologist at the University of Utah, published a study looking at the nerves of two groups of people with type 2 diabetes. One group got counseling and regular exercise sessions, while the other received standard medical care. Results showed that after a year of regular exercise, the nerve fiber density near the skin increased.

Hamdy says there’s something else to keep in mind: “People with very, very high A1Cs who drop down to a normal A1C too fast can develop very painful neuropathy,” Hamdy cautions. “You have to be careful.”

But lowering high blood glucose is important. And while the data is not definitive when it comes to glucose control for neuropathy prevention in people with type 2, trends show good diabetes management may be helpful for everyone with diabetes.

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