Part 1: Diabetes
According to the National Diabetes Statistics Report for 2020 put out by the CDC 34.2 million people in the USA have diabetes. That’s 10.5% of the population. In 2018, 1.5 million new cases of diabetes were diagnosed and that includes 210,000 children and adolescents under 20 years of age. According to the World Health Organization, 422 million people worldwide have diabetes. In 2016, an estimated 1.6 million deaths were directly attributed to diabetes and nearly half of the deaths were in individuals younger than 70.
Cause of Diabetes
Diabetes is, in short, is caused by persistent high blood sugar. Most of the food we eat is converted into sugar and we depend on insulin, a hormone produced by the pancreas, to deliver the sugar into our cells as an energy source. However, if we do not produce enough insulin, or the insulin secreted is ineffective, then our blood sugar remains elevated, putting us at risk or leaving us with diabetes. Although diabetes is first a blood sugar problem, one significant consequence of this is that our blood vessels have an increased risk and occurrence of vascular disease.
TWO VARIANTS:
Diabetes has two variants: Type 1 and Type 2
Diabetes Type 1:
- Autoimmune disease
- People do not make insulin
- Quick Onset
- Any age (usually children)
- No known risk factors
Diabetes Type 2:
- Low level of insulin or body has become resistant to it
- Insulin produced is not enough or ineffective
- Gradual onset
- Typically older (usually adults)
- Directly related to lifestyle choices
Diabetes can cause major complications and adversely affect…
- Heart Disease
- Stroke
- Kidney
- Eyes
- Nerves
SYMPTOMS:
- Frequent urination
- Increased thirst
- Hungry despite eating
- Fatigue
- Blurry vision
- Poor healing
- Weight loss (especially Type 1)
- Tingling of hands and feet (especially Type 2)
- Problems with joints, tendons, muscles, and bones.
Today, let’s focus on the “arthritic” problems that diabetes can produce.
COMMON RHEUMATIC COMPLICATIONS OF DIABETES:
Diabetic stiff hand syndrome:
- This is known as diabetic cheiroarthropathy in the medical world
- Can occur with Type 1 or Type 2 . . . 10-20% of the time
- Correlates with the duration of diabetes, blood sugar control, and the amount of microvascular disease
- In short, it produces flexion contractures of the fingers. In other words, peeps are unable to place their hands together, like in the praying position, and have the fingers on the left hand touch the fingers on the right hand (i.e. “prayer sign”)
- There is no treatment other than physical therapy and better blood sugar control
Neuropathic Arthropathy (Charcot joint):
- In short, this is when a joint (typically those of a foot or the ankle) will slowly develop painless swelling and deformity.
- Xray will show the destruction of the joint, increased density of the bone, disorganization of the joint and dislocation of the joint
- It is thought to be due to the neuropathy associated with diabetes
- It can be seen in Type 1 or Type 2
- Typically with a longstanding history of diabetes (>10years) and poorly controlled blood sugars that are complicated with diabetic neuropathy (abnormal nerve function that leads to numbness and tingling of hands and feet).
- Treatment is to protect weight-bearing, good shoes, soft casts, and prevention of skin ulcers.
- If progressive, the only surgical procedure recommended is amputation
Diabetic Amyotrophy (Amy – o – trophy):
- Severe pain described as itchy, burning that most commonly affects the upper thighs and pelvis (can affect the shoulder muscle as well).
- Typically, starts on one side but can spread to the other side as well.
- Can see weight loss, poor balance with walking due to muscle weakness and wasting.
- Can be seen in individuals with well-controlled diabetes
- Dx with lumbar puncture and EMG/Nerve conduction study
- Cause is unknown
- Treatment includes pain management and physical therapy
- 50% of people will recover in 3-18 months although recovery is not completely back to normal
- Relapses can occur.
Frozen Shoulder / Adhesive Capsulitis:
- Also known as Diabetic periarthritis of the shoulder
- 10-33% of diabetics
- More common in women, in those with Type 2
- Diffuse soreness and loss of motion of the shoulder joint
- Can be bilateral (approx 50% of the time)
- Typically, nondominant shoulder more severely affected
- Lab and X-ray of the shoulder are usually normal
- Treatment includes anti-inflammatories, shoulder injection, physical therapy
Flexor Tenosynovitis (teno – sin – o – vitis):
- Women more commonly affected than men
- Achy pain and stiffness in the palm of a hand
- Worse in the morning.
- Often associated with a “trigger finger”—inability to fully extend a finger after making a closed fist.
- Trigger finger is due to an inflammatory nodule on a tendon
- Treatment for Dupuytren’s and Trigger finger includes anti-inflammatories, local steroid injections, and occasionally surgery.
Dupuytren’s Contracture:
- More common in Type 1 (30-60% of those with Type 1)
- Thinking of tissue known as ‘fascia’ in the palm of the hand
- Usually long-standing diabetes
- Causes a flexion of the pinky finger and the one next to it
- Treatment includes anti-inflammatories, steroid, and collagenous injections, and occasionally surgical release.
DISH (Diffuse Idiopathic Hyperostosis):
- Seen in 20% of the people with Type 2 Diabetes
- Typically in those who are significantly overweight and older than 50
- Neck and back stiffness with limited range of motion
- X-ray of the neck will show a fusion of at least 4 vertebrae (bones that make up the spine)
- Treatment is anti-inflammatories and physical therapy
DIABETIC MEDS AND POTENTIAL RHEUMATIC PROBLEMS:
- Increased fracture risk and thinning of bones:
- Rosiglitazone
- Pioglitazone
- Canagliflozin
- Dapagliflozin
- Empagliflozin
- Severe Joint and Muscle Pain
- Sitagliptin
- Saxagliptin
- Linagliptin
- Alogliptin
As you see, although diabetes is well known for heart, kidney, eye, nerve, and vascular problems, it doesn’t spare the muscles, tendons, or joints.
Like all ‘disease processes’ or imbalances with our minds and bodies, diabetes and the complications from it CAN be improved with making a few different choices. We can improve our blood sugars through #LiveYourValue by choosing to be mindful of the choices we are making regarding our . . .
Dietary choices
Beverage choices
Weight loss effort
Physical activity effort
Use of tobacco products
Coming up later this week, my in-house Functional Nutritional Therapist, Karey Thomas will be addressing Diabetes and Nutrition.
Remember, today and every day, reduce your sugar and increase your contentment by living your value one choice at a time.
For new peeps, welcome, I’m Dr. Drew Huffman.
As an arthritis doc, and through my own personal experiences, I’ve learned that if we truly want to become healthier and more content individuals, physically and emotionally, learning how to live our value one choice at a time is a crucial step.
I hope you find my page and website informative, inspiring, and occasionally, entertaining. Welcome to the journey
