Poor Circulation and/or Neuropathy

Patient

Q: Hello,

I am a 28 year old type 1 diabetic, diagnosed at age 9 . In early February (2015) I had a urinary tract infection which was cured through antibiotics. Suspecting a possible link to the care of my diabetes (or lack thereof), I fully committed to the care and control of my blood sugar. The month following, I started getting cold toes and hands. I went in for a blood test and my A1c was 7.1 and there was no detection of "plasma." Few weeks followed and I continue to get cold toes and now feet, especially when I am sitting. Once I move around or even when I lie down, the temperature appears to return to normal after a while. Please note that the feet are cold to the touch by others and I've noticed all my hair on both my toes are gone. I have been quite inactive for the past year given my profession requires me to sit in front of the computer for 8 hours.

I went to the podiatrist mid march and he says there are no real signs of neuropathy, as there is no numbness at all. However, earlier this month I started getting slightly prickly feet every so often, especially after having the blood return to my feet. My GP scheduled me for an appointment for neuropathy testing.

My question is this, is there a link between poor circulation to the foot and toes and neuropathy? What is the potential of neuropathy given the symptoms described? Could it possibly be the change of blood sugar control that is causing the symptoms to appear and if so, would the symptoms only be temporary?

It seems like a minefield when researching the subject online so I am really worried and clueless as to what exactly is going on.


Thank you for your time.

Symptoms:  Cold toes, cold feet, prickly feet, cold hands
Doctor

A:   Hi.
Thanks for your query and an elucidate history.
To recapitulate: Male 28 / DM Type I - cured UTI Feb 2015 - committed to the care and control of sugar - cold toes and hand - HbA1c 7.1 - no detection of plasma - cold toes and now cold feet ''especially when sitting - job of 8 hours on computer - temperature returns to normal if you lie down or move around - hair on toes gone and feet are cold on touch by others too - to Podiatrist Mid- March - says no signs of neuropathy as there is no numbness - now prickly feet, this month - especially when the blood returns to the feet - appointment for neuropathy testing -
Question:
-Is there a link between poor circulation to the foot and toes and neuropathy?
-Potential of neuropathy
-Could it possibly be the change of blood sugar control that is causing the symptoms to appear and if so, would the symptoms only be temporary?

My thoughts:
Either of it, the problems is due to the DM Type 1
Loss of hair is a classical sign of low / poor circulation.
*Poor circulation can add on neuropathy (nerves too need blood supply)
*Potential of Neuropathy- although less, is still there as a secondary effect of DMT1 as well as poor circulation (which itself may be due to DM).

*Could it possibly be the change of blood sugar control that is causing the symptoms to appear and if so, would the symptoms only be temporary?
I think the symptoms may not be due to change of blood sugar control as this is a gradual process going on since inception and incidentally noted by you with the way you changed the control your sugar.

Color Doppler for vascular study of the lower limbs is also required along with Neurologists's opinion

I hope these answer your queries; please feel free to discuss further if you need to or if you feel that there is a gap of communication.

Comments / Follow Ups

Patient: Thank you for the followup.

Would it be then that the neuropathy caused the poor circulation or the other way around?

What would then be the prognosis? Is it possible to stop the poor circulation with better control and medication?

It seems like a vicious cycle where the possible nerve damage affects the blood vessels which in turn affect the nerves.

Thank you.
Doctor: Hi.
It is really difficult to say what comes first.
Irrespective of which occurred first, the management remains the same.

I would also suggest you some non-conventional techniques which helps: Yoga, Acupressure- you can learn too.

Prognosis is not poor, as the problems have just started, and I am sure that with the help your Doctors you will have a great control.
Perseverance is the key to success, you have to be consistent.
Keep away the stress and anxiety and you need to have a bit disciplined life-style.

Finding the ways is more important than finding the causes.

I hope this answer helps you. Please feel free to ask for further relevant queries, I shall be really happy to assist you more.
Patient: To follow up on my symptoms. As discussed, there were zero symptoms prior to strict control. I would say I went 5-10 years or relatively poor control. When I went for my A1C, it read in the 7's, but that was after a month of decent control, which i wound assume meant that it would have been hovering around the 11-9 mark prior. Is there a risk gaining string control and have your a1c drop from 11-9 to roughly 5.4 in the span of 3 months? I feel that the symptoms appeared after gaining control and are increasing by the day. I have read articles on insulin neuritis or treatment induced diabetic neuropathy which i would find common. I was considering easing my restrictions and aiming for a 7.0 rather than 5.4 a1c for the first three months and then gradually tighten it thereafter.

Thoughts?
Doctor: Though about your thinking. Somehow doesn't go any books. You will have to follow your Diabetologist. Internet can never give you the details a specialist can give, and trying something on your own can cause irreparable damage.
I would never suggest you do try something which had no scientific basis.
You may please discuss with your treating Doctor before you want to change anything about your disease.

Follow the norms.
You have a long way to go.

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