When we think of diabetic neuropathy, we generally think about the painful condition that affects the bottom surfaces of the feet. This can become debilitating and drastically lower the quality of life for patients suffering with this condition. However, there are other nerve conditions that are affected by diabetes. One particular condition can cause pain that is located over the side and front of the thigh.
Meralgia paresthetica is one of my favorite diagnosis. Not because it responds well and that patients are happy to have a simple answer to their problems. No–I just happen to like the ring of it. Kind of makes me sound like I know what I’m talking about in front of patients. Sometimes I just throw it out there even though it has nothing to do with a new patient’s complaints–again just merely to sound important. Maybe this is a cheesy reason, but this is why I like meralgia paresthetica so much (there–just used it again!!).
You can see from this diagram the distribution of this particular nerve. Pain is usually superficial and can present as a numbness or, later on, as a burning pain. Most often, this condition responds very well to stretching and soft tissue work over the front and side of the hip. However, MP can be associated with a much more ominous condition.
Finding out that diabetes is associated with another nerve condition besides pain across the bottoms of the feet is not a big shocker. Diabetes has already been strongly linked to other neurological conditions like tinnitus, Alzheimer’s and Parkinsons, so to add MP to the list is a pretty comfortable feeling. The next step is a big one.
I can honestly say that I have not viewed this association in reverse. I’ve never looked at a healthy patient who has MP and suggest that they are at increased risk of diabetes. But maybe I should. This particular study found that, in those who were diagnosed with MP, the risk of developing diabetes in the future was doubled. Pretty high odds.
Why is this? Is it possible that, like tinnitus, MP is merely a very early warning sign that the nerves aren’t happy? That, because of a prediabetic state, the nerve cell cannot quite get the energy it needs from sugar to generate the ATP requirements of the cell and the nerve function begins to fail in subtle ways?
We don’t exactly know yet, but the above hypothesis seems to fit well (ok–so maybe it is because I came up with it, but it sounds good to me…). Either way, I know that in my office, I will now view any MP patients with a much broader eye and try to connect any poor lifestyle choices to their current condition and their risk of diabetes in the future.