Rapid correction of A1C and neuropathy
I was diagnosed with T2 in Feb of 23. My A1C was 13.3 and I began taking Metformin. By May, I had corrected that to an A1C of 6.3. I began experiencing nervy pain and numbness in my feet and lower legs later that same month. By July, the burning, the pain, and the numbness in my feet prevented me from walking my dog in the yard. My balance was horrible and I had to eyeball distances- from the door to the tree, from the tree to the deck, in order to keep myself from falling. By August my A1C was 5.3.
After I couldn't attend a concert by my favorite artist in mid-July because I was worried I couldn't walk the distance to the venue or that I might fall on someone and hurt them or myself, I made an appt with the PA of my PCP and she got me in quickly. She ordered an emg and I began taking gabapentin, but I couldn't get in to see the neurologist until Oct 19th, 2023, (three months later), by which time the neuropathy became almost unbearable and simply walking through the house was a challenge. The neurologist told me I had neuropathy, to wear boots that support my ankles and to use hiking sticks to keep my balance. He wrote in his summary of my condition that it was possibly due to rapid correction of my A1C. I researched it, and it is indeed a "thing".
Why wouldn't my pcp warn me about something as devastating and life changing as neuropathy caused by the rapid correction of my A1C? I'm angry, so angry that I wasn't warned about this possiblity. I can't sleep and my blood sugar actually rose to 158 after cleaning the oven to release some of that anger. Now I'm up in the middle of the night and I don't know what to do with this rage and pain. I realize I did all of this to myself, but has anyone else experienced exponential neuropathy like I have during or after arapid correction of your A1C, were you warned, and what did you do about it?
I'm so discouraged and disgusted with myself and my doctor. She tells me that I should stop testing my blood sugar levels and let her worry about those instead, but what kind of sense does that make? This is my first post, and I apologize for the hostile tone, but that's what I'm feeling right now. Even more than hostility, it's rage, and I don't know how to handle that either. So beyond frustrated and unable to sleep or walk normally anymore. Thank you for reading my post.
Welcome to the community,
. I am glad you found us and please don't feel the need to apologize. This is exactly what we are here for - to provide support and give you a safe place to vent. You have every right to be angry. Neuropathy can be debiliating, especially in the feet and legs, and I am sure it's hard to accept that treatment for one condition caused another, especially since you were never informed of the possible outcome. I wish your doctor had referred you to an endocrinologist given that your A1C was so high, but that is 20/20 hindsight. We can't change that now. Neuropathy due to rapid correction of A1C usually occurs in people with Type 1 diabetes, so it is possible your doctor was unaware that this might happen. The good news is that it can improve over time. Here is a study from the National Institutes of Health: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8315201/#:~:text=Rapid%20correction%20of%20glycemic%20control,worsening%20of%20retinopathy%20and%20microalbuminuria . The artcle shows that patients with well-managed glucose improved over several years and that some even recovered fully. You have a long road ahead and there are no guarentees, but it would be wise to continue focusing on keeping those blood sugar levels under control. You might also want to ask for a referral to an endocrinologist. If there is any hope of recovery from your neuropathy, you need the best possible care. I hope this helps and that you get some good input from other members. Keep us posted if you don't mind. I will be thinking of you. Gentle hugs. - Lori (Team Member) Thank you Lori, I appreciate your reply, despite reading information that was far worse than I expected. Years to heal "if there is any hope of recovery"... I used my new boots and hiking poles like the neurologist suggested to get my old horse and blanket her for the snowfall we're expecting this afternoon and into the night. She was so good. She didn't knock me over; I fell down all by myself.
My rage has subsided, into what, I'm not sure. Maybe a deeper hopelessness than I've known before. I wrote to my doctor and asked her why she didn't refer me to an endocrinologist when my initial A1C was so high, or at either of the two following appointments as my A1C continued to drop, with a lot of hard work changing my diet, losing weight, controlling my blood sugar levels, and doing my best to exercise and gain muscle. I guess she didn't know, because she told me I was doing a very good job and that my condition was "fixable".
Thank you for the link. It was enlightening, to say the least. I shared it with my doctor, told her the gabapentin is not working, that the pain is overwhelming and that I'm feeling hopeless and afraid. I can't even imagine losing my sight, especially in my current physical state. I had never heard of gastroparesis or the other conditions mentioned in the NIH link you shared with me. I'm glad to know the truth regarding what I might be facing in the future, however grim that may be.
I hope my experience may help other "new" diabetics and their doctors to understand what the potential of a too-rapid correction of A1C levels can lead to. I had no idea. Again, thank you for your reply to my post.Oh,
. Please don't worry that you will develop all those problems the people in that study developed. Those patients were chosen for the study because their cases were highly abnormal, not the norm. I was hoping only to direct you to the part about recovery from neuropathy, specifically this statement: "All 19 patients who maintained stable, adequate glycemic control (HbA1c between 6% and 8.5%) after the development of symptoms of treatment-induced neuropathy of diabetes had gradual improvement in their neuropathic symptoms over several years, with near-complete functional recovery, which suggests that the syndrome is reversible to some degree."
There are plenty of reasons for hope even if it takes a few years.
I very much understand your rage and that feeling of hopelessness, though on a smaller scale. A doctor sewed through a nerve in my foot during surgery a few years ago, causing severe damage that she wouldn't even acknowledge until a year had passed and a huge neuroma had developed. I couldn't wear my post-surgery boot and I was limited to flip flops. No socks. No sleeping on my right side and no blankets or sheets touching my foot. The pain was unbearable at times. After surgery for the neuroma, my doctor thought it would improve, but it didn't. My doctor pretty much threw her hands up and said the pain might improve during first year after the second surgery, but that it would never get better after that. I was horribly depressed. But it did little by very little over the past four years. I still can't sleep on that side due to pain that goes all the way up my leg, but I can now wear a shoe for decent periods of time and socks when I need to. For the past two years, I have been able to hike and even run a bit. I didn't think any of that would ever be possible again, not without a great deal of pain. Despite all the knowledge we have, nerves are still a mystery. Focus on your blood sugar management and keep that hope alive. All 19 of those patients recovered nearly fully. That might be you as well. Sending lots and lots and lots of healing vibes your way. - Lori (Team Member)
