Life

Ask the GP: How to stop diabetes from making your fingers numb

I have type 2 diabetes and I’ve lost feeling in the tips of my fingers
Dr Martin Scurr

Q: FOR a long time I've had no feeling in my feet, but recently I've lost feeling in the tips of my fingers, too. I have type 2 diabetes which is diet-controlled, and my GP says I have a very good blood sugar level, but this numbness distresses me.

TM

A: These symptoms must be giving you considerable anxiety – especially without a diagnosis. What you describe sounds like polyneuropathy or peripheral neuropathy: damage to the nerves at the greatest distance from the brain and spinal cord. This is why your feet have long had no feeling, and why your fingertips have recently become affected.

The most common causes are diabetes and excessive alcohol intake. Alcohol can cause nerve damage, partly because alcohol is a solvent and nerves are mostly made of fat.

Even though your diabetes is mild – it is controlled by diet instead of requiring medication – it can still become a source of worrying complications, and your nerve damage is one major example.

Blood sugar damages the nerves in a number of ways, including by harming the blood vessels supplying them with oxygen.

More than 25 per cent of people diagnosed with type 2 diabetes already have evidence of nerve damage, so you are not alone.

Being overweight; having raised blood pressure; and being a smoker all increase the risk of peripheral neuropathy. They also make it advance faster, because they reduce blood flow to the peripheral nerves – so if any of these factors apply, you must address them.

The most important treatment is to control blood sugar levels, and the progression of your symptoms suggests your control is not as good as your GP thinks. It may be that you need to go on medication or control your diet more rigorously.

The best way to judge whether your blood sugar is really under control is with a blood test called the glycosylated haemoglobin level, or the HbA1C test, which shows the average blood sugar level over the previous three months. A ‘healthy' reading is between four and 5.6; above 6.5 confirms diabetes. Your results should always be seven or less.

Maintaining a low carbohydrate, sugar-free diet (the body breaks carbohydrates down into sugar) is essential to keeping your blood sugar down, and this applies even if you're not overweight.

Alcohol is a carbohydrate, so limit your intake to two units a week or even zero. It might help you to see a dietitian about the best strategy – your GP can refer you.

Unfortunately, even with the greatest success in blood sugar control, you are unlikely to see an improvement in the neuropathy – but with effort you will be able to prevent further progression.

Q: IN 2015 I had a mastectomy and started a 10-year course of tamoxifen. Hair loss is a side-effect, for which I take Florisene – but I read it's for women up to 50 years old. I am 62, and still shedding hair.

DM

A: In many cases, breast cancer cells are stimulated by oestrogen. Drugs such as tamoxifen block the effects of this hormone, which is why it was prescribed after your mastectomy, to stop oestrogen acting on any residual cancer cells.

Hair follicles are sensitive to hormone levels, and a lack of oestrogen means there is a higher ratio of testosterone, which can result in hair loss.

At the time of your diagnosis and treatment, you were likely post-menopausal, with lower oestrogen levels than in your younger years. With the added effect of tamoxifen, hair loss is not surprising.

Florisene contains no hormones but provides nutrients for hair follicles, including iron, selenium, lysine, vitamin C, and vitamin B12. Regardless of your age, this can improve hair health, though it will not fix the main cause of the loss.

You could consider taking another preparation at the same time. Regaine For Women contains the drug minoxidil and is applied to the scalp as a liquid or a foam, once a day. It speeds up your hair's growth cycle and will complement the benefits of Florisene.

Over a number of months you may see great improvements, though it might be unrealistic to expect your hair to grow back as thick as it was pre-menopause. Do discuss the use of this with your doctor, though no prescription is needed and it is safe to use with tamoxifen.

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