Type 2 Diabetes
Insulin is a hormone that the body needs to convert sugars into energy. In type 2 diabetes, the body is unable to make enough insulin or is unable to effectively use insulin. Despite high levels of glucose in the blood, the body's cells are starved for energy.
The American Diabetes Association estimates 16 million Americans have type 2 diabetes. It's the most common form of the disease (type 1, caused when the body inappropriately destroys its insulin-producing cells, affects 5 to 10 percent of diabetics). Type 2 is most commonly diagnosed in overweight, sedentary adults. However, with increasing rates of obesity among youth, doctors are finding more cases of type 2 in children.
Over time, patients with diabetes are at risk for development of complications. Risk for stroke is two to four times higher than that of non-diabetics. Patients are at a much higher risk of death from heart disease. Damage to the blood vessels in the eyes can lead to diabetic retinopathy and, eventually, blindness. Some other potential complications of diabetes include: kidney disease, nerve disease, gum disease and, for women, problems during pregnancy.
Neuropathy in Type 2 Diabetes
Neuropathy, or nerve damage, affects as many as 70 percent of diabetics to some degree. While some patients experience no symptoms at all, for others, symptoms can be quite severe. Signs include: numbness or loss of ability to feel pain or temperature, tingling or burning, pain or cramps, sensitivity to touch and loss of balance, slowed digestion, erectile dysfunction, bladder problems, diarrhea or constipation and weakness.
Foot problems are common manifestations of peripheral neuropathy in patients with diabetes. Because of an inability to feel pain, tiny sores or blisters may develop on the feet. The injury may go unnoticed until infection develops. Many patients with diabetes also have impaired circulation, which reduces the ability of the body to fight the infection. In some cases, doctors need to amputate part of the limb to prevent the infection from spreading. More than 60 percent of all non-traumatic lower-limb amputations are performed on patients with diabetes.
Some patients with neuropathy experience a significant amount of sharp or burning pain. Pain medicines may be helpful for mild to moderate symptoms. If the pain is overwhelming, doctors may recommend other treatments.
Researchers are testing the use of a drug, called TOPAMAX® (topiramate), for diabetic neuropathy. TOPAMAX is an anti-seizure medication that's sometimes used for epilepsy. Investigators say it may be beneficial for other conditions. In a small study, doctors tested nerve pain and nerve density of 11 patients with type 2 diabetes. Once patients were stabilized with conventional diabetic therapy and weaned from traditional pain medications, they were given low doses (25 mg) of TOPAMAX. Over the next few weeks, the dose of TOPAMAX was gradually increased, reaching 100 mg/day by the 42nd day. The 100 mg dose/day was maintained for 84 more days.
By the end of the trial, pain levels and numbness decreased. More importantly, researchers found some of the nerve fibers had grown back. The study also uncovered some other unexpected benefits. On average, patient cholesterol levels decreased by 10 percent, diastolic blood pressure dropped about 10 points and blood sugar control improved. Patients also lost several pounds (although not a significant weight loss).
To verify the findings, doctors need to perform large-scale studies of TOPAMAX in patients with diabetic neuropathy. Researchers caution TOPAMAX is only approved for epilepsy and was used "off-label" for the study. Doctors must also be careful to start out with low doses because higher doses can cause side effects, such as sleepiness, loss of coordination, dizziness, vision or speech problems, impaired coordination, memory problems, confusion and/or changes in perception.
Type 2 Diabetes