By: Scott M. King
The big news of the day for me is that carpal tunnel syndrome (CTS) is one of a group of muscular-skeletal manifestations common to diabetes. Most people know about retinopathy [eyes], nephropathy [kidneys], and neuropathy [nerves]. But many are not aware of this whole other group of degenerative problems that relate to the joints.
In March 1995, Todd Kaye, MD published an excellent article about this group of muscular-skeletal problems in Practical Diabetology. He explained that CTS is grouped in with trigger finger, frozen shoulder, charcot foot, and osteoporosis. Also in the group is a condition called diabetic hand syndrome which affects 30% to 40% of people with diabetes. If you can’t hold your hands in a “prayer position” you may be one of those with this problem.
Diabetic hand syndrome has been consistently associated with retinopathy, and may precede it by up to five years. When I think of these disorders, I am reminded of the method coal miners once used to detect deadly gas within the mines-they’d bring a canary down with them, and if the bird died, the miners knew there was trouble and evacuated. Dr. Kaye’s article didn’t mention blood sugar control, but we learned from the DCCT that high blood sugar increases the rate of complications from diabetes. CTS, for me, is a canary in my coalmine. Are my BGs too high? This thought was already on my mind when I got a phone call that rocked my socks.
Richard K. Bernstein, MD, is on the DIABETES HEALTH medical advisory board and has had diabetes himself for 50 years. He has authored two books on diabetes and is known for his belief that a high-protein, low-carbohydrate diet is the key to good glucose control-he has maintained this philosophy through the ever-changing “fashions” in diabetes management. When I interviewed Richard on my radio show four years ago he told me he hadn’t eaten a slice of bread in 20 years. At the time, I thought he was a nut. Now I would call him a visionary.
He asked me about my A1c-it’s generally about 7.4%, which corresponds with an average BG of 180 mg/dl. Richard says my A1c should be 5.2%, which indicates an average BG of 90 mg/dl.
Richard says that good glucose control could alleviate carpal tunnel syndrome. When BG levels are too high, the proteins in the tendon around the carpal tunnel nerve are glycosylated, causing the tendon to become inflamed and stiff. He also said that losing weight can help, and that reducing salt intake is important since sodium causes fluid retention, which in turn causes the tendons to swell further.
I talked to some friends who agree with Richard. Evelyn Narad has normalized her BGs and lost 75 pounds thanks to his “method”-see DIABETES HEALTH, July 1995, page 18. Well-known diabetes writers Barbara Toohey and June Biermann are also doing well on Richard’s recommended diet-Barbara lost six pounds in six weeks, and June’s blood glucose levels have stabilized around the 100 mg/dl mark since they started limiting carbs. Richard recommends that people with diabetes eat no more than six grams of carbs for breakfast, and no more than twelve for lunch and dinner.
DIABETES HEALTH reader Bob called to say that people with diabetes get CTS more frequently because of fluctuating blood glucose levels. “Every time our blood sugar shifts it causes osmotic pressure changes in the tendon sheath.”
Michael Brownlee, MD, of the Albert Einstein College of Medicine in New York City says that in people with diabetes, proteins can attach to glucose molecules, forming what he calls “biological superglue.” The sticky molecules become a constant irritation to the body, which can lead to problems like CTS. (see the article “Antioxidants” in the January 1996 issue of DIABETES HEALTH, page one.)
I take vitamins faithfully, including inositol. Inositol is a member of the vitamin B family. Reader Gordon says that he took inositol once a day for five months-after two weeks the CTS “started to go away.” Paul Schickling, a pharmacist who writes for DIABETES HEALTH, recommends 500 mg of inositol twice per day. As I mentioned in the last issue, I take it along with vitamins C, B complex, B6, and zinc.
I would like to follow Richard’s diet regimen, although I realize it will entail a major lifestyle change. Since I cook for my kids, my new diet will mean preparing different meals. I want that 5.2% A1c, but I wonder if I can achieve it without major changes in my diet. A low-carb mealplan was one of my New Year’s resolutions-in my the next issue I’ll let you know if I can stick to it.
I am coming to terms with my problem as I gain more knowledge about what I can do for myself. I feel that my CTS has gotten somewhat better-the pain is gone and I no longer need to wear the wrist splints every night. In a way, CTS is a blessing. Like the canary in the coalmine, CTS’s appearance showed me that it’s time to take better care of myself.