About 60 percent of people with diabetes have some degree of peripheral neuropathy, or peripheral nerve damage. Traditionally, high levels of glucose and/or poor control over glucose levels have been thought to increase risk for nerve damage but researchers have found high levels of triglycerides may play a role in the development of the condition.

Diabetes and Neuropathy
Diabetes is a condition that occurs when the body doesn’t produce enough insulin, a hormone needed by cells to use glucose (sugar) for fuel. The Centers for Disease Control and Prevention estimates about 24 million people in the U.S. have diabetes. There are two main types. In type 1, the body’s immune system destroys the insulin-producing cells in the pancreas. Patients need regular injections of glucose to stay alive. Type 1 accounts for about 5 to 10 percent of all cases of diabetes.

In type 2 diabetes, insulin production is decreased. In addition, the body is unable to effectively use insulin to get glucose into the cells. Type 2 diabetes is the most common form of the disease, accounting for 90 to 95 percent of cases.

Over time, diabetes can lead to the development of many different kinds of health complications. In peripheral neuropathy, damage occurs to nerves in the limbs, most commonly, those in the feet and legs. Researchers estimate about 60 percent of people with diabetes have some degree of peripheral neuropathy. The longer the duration of diabetes, the greater the likelihood of having peripheral neuropathy.

A serious consequence of peripheral neuropathy is the loss of sensation in the affected limb. A foot wound may go undetected and become severely infected. Eventually, all or a part of the foot may need to be amputated to prevent the infection from spreading further up the limb. The National Institute of Diabetes and Digestive and Kidney Diseases estimates about 60 percent of non-traumatic (not due to accident) lower-limb amputations are performed on patients with diabetes.

The Role of Triglycerides
Triglycerides are a form of fat. Eva Feldman, M.D., Neurologist with the University of Michigan Health System, explains that excess body fat is stored in the form of triglycerides. Researchers have been looking at various factors which may contribute to nerve damage in people with diabetes. High levels of glucose and/or poor control over glucose levels have long been thought to contribute to an increased risk for peripheral neuropathy. Now, investigators say triglycerides may also play a role.

Researchers took biopsies of the sural nerve (a nerve in the ankle) of one leg in volunteers with diabetes. A biopsy of the sural nerve from the other leg was taken one year later. Tests of blood sugar, triglycerides and cholesterol were taken at the start and the end of the study. Doctors also measured the degree of sensitivity, pain, numbness and weakness in the lower limbs at each point in the study.

The researchers compared the differences in nerve health at the end of one year with the results from the blood tests and symptom scale. Surprisingly, a decline in nerve health and function wasn’t associated with blood sugar levels. But it was correlated with elevated triglyceride levels.

Feldman says researchers don’t know why higher triglyceride levels are associated with diabetic nerve damage. One thought is that when triglyceride levels are high, the nerve cells use the fat as an extra source of fuel (in addition to glucose). The cells take in too much fuel, producing high levels of waste products. These waste products may damage the peripheral nerves. Two other possible reasons for the association may be (1) triglycerides cause inflammation, leading the body’s own cells to attack the nerves, or (2) hormones produced by fat cells may damage the nerves.

Further research needs to be done to understand the interaction between triglycerides and nerve damage. In the meantime, Feldman says the research suggests patients with diabetes need to pay attention to their triglyceride levels in addition to glucose levels.

AUDIENCE INQUIRY
For general information on diabetes and diabetic neuropathy:
American Diabetes Association, http://www.diabetes.org
Centers for Disease Control and Prevention, http://www.cdc.gov/diabetes
National Institute of Diabetes and Digestive and Kidney Diseases, http://diabetes.niddk.nih.gov

Research compiled and edited by Barbara J. Fister

© 2009 Medstar Television, Inc. All Rights Reserved

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