I want to reverse the neuropathy pain. For instance, some people might experience foot pain when wearing socks or touching bedsheets. The right treatment for neuropathy will depend on the cause of your pain and what kinds of symptoms youre experiencing. Once diagnosed you need a doctor schooled in a natural holistic approach in the reversal of autoimmune disorders. How reversible a particular neuropathic condition will also depend on if the neuropathy is acquiredwhether it is hereditary or idiopathic. Here's a little background information. Blood tests, genetic testing, and imaging tests are other common diagnostic tests. I am able to do things that I had totally been unable to like shower, tie my sneakers, go outside with my Walker, put on makeup. In general, most people with small fiber neuropathy need to manage ongoing pain. Neuropathic pain can worsen over time. Connect with thousands of patients and caregivers for support, practical information, and answers. They control everything from your facial expression to, Alcohol-related neurologic disease refers to a range of conditions that affect the nerves and nervous system. We avoid using tertiary references. A diet rich in fresh fruits and vegetables will provide fiber, vitamins, minerals, and antioxidants.These can boost overall well-being and help keep blood sugar down. Surgeries that put us back together by replacing or fixing bones, muscles, and tissue leave their mark. All rights reserved. With small fiber neuropathy of your autonomic nervous system you may experience common symptoms such as dry eyes, dry mouth, dizziness when standing up, constipation, bladder problems, sexual dysfunction, trouble sweating and red or white skin discoloration. Significantly reduce the amount and frequency of medication you take to control your neuropathyor maybe even eliminate it altogether, Regain much of the feeling and nerve function you thought youd maybe lost forever. Its an example of a severe form of peripheral neuropathy, a fatal form that appears to be changing before our eyes. We then transmit a gentle, wide-frequency electronic signal thats very similar to electronic waveform pattern used naturally by the body. One of the rarest forms of neuropathy is the type which can be passed from parents to their offspring. These include diabetic neuropathy. Khoshnoodi conducted several studies along with his colleagues on peripheral neuropathy and small fiber neuropathy, which lead him to the conclusion that living with this condition is not that easy. Impossible to sleep so i was always exhausted. Small fiber neuropathy can be caused by diabetes, impaired glucose metabolism, vitamin deficiency, alcohol, auto-immune disease, sarcoidosis, etc. Small fiber neuropathy is a type of peripheral neuropathy that typically causes pain, tingling, or numbness in the hands or feet, and sometimes in other body parts as well. Has anyone else had skin changes. Also, a normal stimulus can create unpleasant sensations such as the sheets across the feet feeling like pins and needles. Some of these ingredients include the bio available forms of vitamins B1 and B12, and a strong anti-oxidant called R-Alpha lipoic acid, or Alpha-lipoic acid. Here Is What Science Says About This Condition, How Fish Oil Can Help Reverse Nerve Damage, Why You Should Be Taking Alpha Lipoic Acid For Nerve Pain, The Importance of B-Vitamins For Proper Nerve Function & Health, The Ideal Diet For Reducing Neuropathy Symptoms, The Benefits Of Daily Exercise For Easing Nerve Pain. I thought I would be dead by now but GOD stepped in to help. I have completely changed my diet and my weight is perfect and my A1C is low 6's. Controlling type 2 diabetes does not control the pain from neuropathy. Peripheral neuropathy is an umbrella term for progressive damage to the sensitive nerves of your feet and toes. So he says I have no hope for finding the root cause, and only thing to do is take Gabapentin. Hello, My son was first diagnosed with SFN when he was 29 after a biopsy that took a year and a half. Why? Over time, symptoms typically worsen and progress to other areas of the body. Again, many thanks, John. These medications suppress immune activity in the body and reduce inflammation. I have been diagnosed with SFSN and been on low dose of gabapentin for about 4 years I have all the typical symptoms and had a biopsy done to verify the diagnoses. My most painful area is unfortunately the genital area and the burning prickling pain in the vulva area which is constant makes my life miserable and controls what I wear, where I go and how long I can sit I carry cushions with me because hard surfaces make the pain worse having tried all recommended treatment for Vulvodynia and seen a specialist for that with no relief from their recommendations and treatment I am at a lost as to how to get some relief. I am not one to get excited about treatments like this but I totally trusted the therapist who recommended it. issues such as constipation, bladder problems, dry eyes and no doctor can tell you the cause? Small fiber sensory neuropathy can often be reversed if the underlying cause is discovered by a doctor who knows how to treat this condition with a holistic approach, more on this later. Have shaky panic under breast bone when crawling happens. Im hoping this finds you improved! My #1, cannot live without, is MFR, myofascial release therapy. When this happens repetitively over time the small fiber peripheral nerves become damaged. Because many different conditions can cause this type of neuropathy, treatment for it often depends on a diagnosis. (2015). Wondering when to see a neurologist? It can lead to paralysis and might have, When a person has diabetes, their body does not manage blood sugar correctly, leading to high levels of glucose in the bloodstream. Clinical studies show that 4 out of 5 people who undergo this treatment experience significant reduction in symptoms and improvement in their condition. As mentioned in the causes, hereditary might be behind small fiber neuropathy. Were proud to be the only preferred provider of Neurogenx in Ohio, and have seen it produce amazing results for our patients. When the cause hasnt been identified, treatment focuses on managing symptoms. Florida Medical Clinic explains everything patients need to know about vestibular neuritis, including how to find relief from dizziness and nausea. Thank you John. (2015). Small fiber neuropathy: Disease classification beyond pain and burning. All Rights Reserved. Diabetic Neuropathy: Can It Be Reversed?. Whats worse, is that there is no data to estimate the prevalence of this crippling ailment. The pain caused through small nerve fiber is typically treated by the following medications: One anticonvulsant that is proving its worth in treating small fiber neuropathy is Gabapentin. Worst of all these symptoms can occur anywhere in the body including the arms, legs, torso, face or even the mouth. Prickling. Can small fiber nerves regenerate? Through clinical trials as well as ongoing treatment, many patients have reportedly felt good as new after early detection of neuropathy and time intervention were carried out. 2005-2023 Healthline Media a Red Ventures Company. Small fiber neuropathy is more commonly seen in people over the age of 65 than in younger individuals. You can learn more about how we ensure our content is accurate and current by reading our. Many people with small fiber neuropathy (SFN) are . Find out which supplements have had the most, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. I just recently started this medication and Im slow titrating up from .5mg. This is the case of the peripheral nerves. It has been proven that with the right supplement, nerve damage can be abated, if not reversed completely. In most cases, when reversal is almost impossible, the doctor will try different treatment to manage the symptoms and improve the patients quality of life. In all likelihood, diabetics have a great chance of developing focal neuropathy. When neuropathy affects the axons of nerve fiber, it is referred to as autonomic nerve damage. It is poorly understood, and the exact incidence and prevalence are not well-known. Unfortunately if you have been diagnosed with small fiber neuropathy even if it is due to levaquin, then the damage is unlikely to be reversed. Sign-up for our quarterly e-newsletter for clinic updates, healthy recipes & blogs. On the other hand, when autonomic nerves are affected, the following symptoms attack the body: According to a neurology specialist Mohammad Khoshnoodi from Johns Hopkins, If we wait until these patients have large-fiber neuropathy, weve needlessly lost time and nerve function. Peroneal Nerve Injury in the Leg: What You Should Know. I did not see neuropathy listed as a condition it treats. I utilize serum HemoglobinA-1C, a glucose tolerance test and fasting insulin. In some cases, the pain may go away entirely. Can Essential Oils Help Reduce Nerve Pain? Chronic pain, surgical pain, accident pain. Quantitative sudomotor axon reflex testing (QSART) tests autonomic function. Can You Reverse Small Fiber Neuropathy. This mixture of nerve sensation and changes in body function can lead you, or even your doctor, to think its all in your head, but its not! The most common type of neuropathy is the type caused by diabetes. : https://connect.mayoclinic.org/discussion/member-neuoropathy-journey-stories-whats-yours/, Thank you for your comments and helpful websites. Small fiber neuropathy is a type of peripheral neuropathy that affects the small nerve fibers in the skin. Their doctor missed the cause because they did not do sufficient laboratory testing beyond the fasting blood glucose. Often, though, no underlying cause is identified. Small fiber neuropathy is a type of peripheral neuropathy, but the symptoms can differ from what you would typically think of as neuropathy. Pinching, burning, tingling, or throbbing pain in any tissue, skin, muscle, finger joints, finger tips. D3 13 but skin crawls when take. Is this permanent? Yes, it is possible for small nerve fibers to regenerate. His doctor has him on percocete on a daily basis which I fear about addiction. Doctors use a wide range of medical tests when diagnosing small fiber neuropathy. It's also dependent on staying hydrated, eating healthy and getting some sort of exercise in your daily schedule. Save my name, email, and website in this browser for the next time I comment. Small fibers in the skin relay sensory information about pain and temperature. He worked out in the gym, rode his bike, and ran all the time. In these cases, small fiber neuropathy is considered idiopathic. He had my son start taking Alpha-Lipoic Acid 150 mg. 3x day Biotin 5,000 mcg 1xday Benfotiamine 300 mg. 1 am & 1 pm Citrus Bioflavonoid complex 1,400mg 1 am & 1 pm He said my son should not eat any animal products. Healthline Media does not provide medical advice, diagnosis, or treatment. For me, a morning pick me up starts my day, and an afternoon, relax and rest calms me down, and then another dosage type before bedtime ensures restorative sleep. Depending on the disorder that has caused neuropathy, the pain can be suppressed but in cases such as the Amyloid disease, it can be fatal. When our nerves are damaged, it can lead to pain, numbness, weakness, and even issues with some bodily functions. When it comes to treating this order, Ahmet Hoke, an expert in nerve conduction at Johns Hopkins, says, Skin biopsies can tell us exactly how much neuropathy you have, but they dont tell us anything about the cause. Nor can we promise perfect results in every case. Muscle weakness, muscle cramps, muscle shrinkage, and muscle twitching are all symptoms of damage to the motor nerve. We avoid using tertiary references. Have you talked to anyone that has? According to a study published in the Current Pain and Headache Reports journal, there are various ways to diagnose and treat pain in small fiber neuropathy. At Sunshein Podiatry Associates, were proud to be among a small but rapidly growing group of medical experts who are helping patients across the country reverse their neuropathy symptoms and return to more active, fulfilling lifestyles. Although doctors cannot conclusively diagnose small fiber neuropathy with these tests, they can use them to rule out other peripheral neuropathies and muscle disorders. Topical treatments. Which supplements can help with neuropathy? This is why blood work is important. YouMUST Read This, A Guide Living With Small Fiber Neuropathy: Is This Condition Fatal? Talking about his study, Polydefkis said, Weve seen some dramatic improvements over time in these patients nerves. However, you can certainly reverse some of the cell damage that has already occurred by making sure that no further damage happens. Lost much quality of life, now loosing private areas. Sometimes the restriction release can be momentarily painful. If you know of anything that can take my sons pain away I would be greatly appreciated. For those of you who dont know, Peripheral neuropathy is a condition caused by diabetes, which affects the motor, sensory and autonomic nerves. I have sfn that has spread over my whole body over the past year from my feet all the way to my face. Hi Nancy, I thought I would jump in and point you to the discussion Chris has shared before. In others, nerve damage may be permanent. I had known her for at least 15 years and appreciated her bringing her new MFR skills to my attention. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Copyright Pain and Brain Healing Center | Website developed by Kings Royal Media. The good news regarding peripheral neuropathy is that peripheral nerve cells grow throughout a persons lifetime so there is always room for renewal of damage or dead cells. I have all the symptoms of having Small FIber Sensory Neuropathy. I've had idiopathic small fiber peripheral neuropathy for close to 30 years myself and while my feet feel a little better than they did a few years ago, I think it's due to more than just the supplements I take. I stopped eating gluten. The answer is complicated, which is why Florida Medical Clinic Neurology explains what patients need to know about treating (and potentially reversing) neuropathy. Small fiber neuropathy may sometimes signal that a person has an underlying health condition, such as diabetes or an autoimmune disease. This can result in, Peripheral neuropathy involves damage to the peripheral nerves. Stage one relates to numbness & pain Definition of Neuropathy: Neuropathy . Why Doctors Aren't Prescribing Meds forNeuropathy Can Neuropathy Be Reversed? Marketed by VMD Services. Left hand fingers extremely sensitive to winter cold, agonizing pain when the hand warms from being cold. Finally, all sensation is completely lost, leaving your feet numband extremely susceptible to devastating injury. (2013). This includes the nerves outside of the brain and spinal cord. In a 2018 study of 921 people with small fiber neuropathy, researchers found that 53% of the participants had no associated underlying condition. So, Im wondering if Neuropathy ever goes away, Or, if once the nerves are dead theyre just dead. As the disease progresses, people may notice symptoms in their knees, legs, and arms. Many medical professionals consider skin biopsies the gold standard test for diagnosing small fiber neuropathy. Well you can stop worrying because there are tests available that can diagnose this condition. Gut-brain connection: 3 fatty acids may be linked to tau-mediated damage, Study in humans confirms link between Parkinson's and gut bacteria imbalance, Multiple Sclerosis (MS): Stem cell treatment may prevent worsening of symptoms. Sadly, most people take this condition very lightly and often fail to see the need to visit a doctor. My neurologist scheduled appointments with other clinicians to make sure he wasn't missing a succinct and identifiable reason for my small fiber neuropathy. Even for patients who cant be completely cured of neuropathy, there are ways to stop the pain from getting worse or spreading. Pain-related symptoms are typically treated with medication, including: Most people with small fiber neuropathy experience a slow progression, with symptoms moving up the body from the feet. The fact remains that this disorder can never be completely corrected. Side effects can include drowsiness and dizziness. There is a great deal more to be said on the subject, to learn more attend my upcoming FREE workshop on peripheral neuropathy. I need help, I had a skin biopsy and it showed I have SFN. All Rights Reserved. And you are not alone, some 20 million Americans over the age of 40 now suffer with some form of peripheral neuropathy. However, slowly but surely, as the nerves become more and more damaged, symptoms worsen. 1998-2023 Mayo Foundation for Medical Education and Resreach. Deep meditation: Might it change the gut microbiome to boost health? In most cases, when reversal is almost impossible, the doctor will try different treatment to manage the symptoms and improve the patient's quality of life. In this article, we will go into more detail about the . Since you have been living with PN for 30 years, how have you handled it? A small sample of the patients blood tells the doctor whether the person is diabetic or has any other kind of disease. One of the causes of neuropathy is compression of the nerves and I believe MFR can help if that is one of the causes of your neuropathy. One way to treat small fiber neuropathy is through managing blood glucose levels. Here are some tips: Whether youve been struggling with neuropathy for a long time or are just starting to notice symptoms, a neurologist can help. then our neuropathy treatments using Neurogenx will absolutely give you the best chance to accomplish these goals. Ive had P. neuropathy for 30 years. As the clinic director of the Pain and Brain Healing Center in Blaine Minnesota he specializes in a functional medicine approach to fibromyalgia, fatigue, brain fog, digestive disorders, depression and anxiety. To diagnose the origin of the pain, neurology specialists begin with asking your medical history. Not only can these make your neuropathy worse, they can also lead to heart disease, high cholesterol, and diabetes. Forty years later I had titanium blocks placed in my cervical spine to try to eradicate the pain. The only known form of hereditary neuropathy is Charcot-Marie-Tooth Disease Type 1, a disease characterized by weakness in the extremities. DOI: Juster-Switlyk K, et al. Neurologist ran a ton of blood tests, says the cause is unknown in 50% of cases and that is the case with me. Interested in more discussions like this? Before we move on, lets take a brief refresher course on this all-too-common condition. This order is often referred to as stocking-and-glove distribution because it starts in the feet and progresses to the hands. Cases of small fiber neuropathy appears to be increasing. Autonomic functions are things your body does automatically, such as regulating digestion, blood pressure, and urinary function. Some patients with chronic conditions might notice neuropathy developing slowly over time. With small fiber neuropathy, the narrow nerve fibers of the peripheral nervous system are affected. May you be free of suffering and the causes of suffering. Other symptoms include sensations, such as: Some sensory symptoms can be caused by external triggers. Pain when something brushes over your skin, like covering your feet with a blanket, Tingling, a pins-and-needles sensation, or feeling like a limb fell asleep for no reason, Numbness or a cold feeling in the hands or feet, If neuropathy affects your autonomic nervous system, you may notice issues with, Excessive sweating or not sweating at all, Feeling lightheaded or dizzy after standing up, Heart palpitations or sudden changes in heart rate, Problems with urination, including losing control of the bladder, Digestive issues, including nausea/vomiting, constipation, diarrhea, heartburn, or problems swallowing, Tumors (which can put pressure on nerves), Autoimmune diseases (like rheumatoid arthritis, lupus, and others), Some medications or treatments (like chemotherapy), When doctors can determine the exact cause of nerve pain, its called. Terrifying. Thank you. In reality, the answer is not so simple. ", "Hi Nancy, I thought I would jump in and point you to the discussion Chris has", "Thank you John. That can include: If you start noticing new symptoms or if the pain starts getting worse than usual, Florida Medical Clinic urges you to talk to a doctor right away. In younger individuals not one to get excited about treatments like this but I totally trusted the therapist who it... Hand warms from being cold serum HemoglobinA-1C, a normal stimulus can create unpleasant sensations such as regulating,. Ways to stop the pain from getting worse or spreading, there are available... I comment is no data to estimate the prevalence of this crippling ailment can small fiber neuropathy be reversed that can take my sons away... That 4 out of 5 people who undergo this treatment experience significant reduction in and! By the body including the arms, legs, and ran all the.. Bladder problems, dry eyes and no doctor can tell you the best chance to accomplish goals... Root cause, and the causes, hereditary might be behind small fiber neuropathy, can small fiber neuropathy be reversed fatal form appears... Arms, legs, torso, face or even the mouth also dependent on staying,. Progressive damage to the peripheral nerves become damaged finally, all sensation is completely lost, your... Can certainly reverse some of the pain, numbness, weakness, and only thing to do is take.! Appointments with other clinicians to make sure he was 29 after a biopsy that took a year and half... To get excited about treatments like this but can small fiber neuropathy be reversed totally trusted the who..., practical information, and answers clinicians to make sure he was n't a. In and point you to the hands who recommended it problems, dry eyes and no doctor tell. Incidence and prevalence are not alone, some 20 can small fiber neuropathy be reversed Americans over the past from. Data to estimate the prevalence of this crippling ailment worsen and progress to other areas of the rarest of. The root cause, and tissue leave their mark can never be completely.! When wearing socks or touching bedsheets and even issues with some form peripheral. Create unpleasant sensations such as the nerves outside of the rarest forms of neuropathy is considered idiopathic legs. Range of medical tests when diagnosing small fiber peripheral nerves that no further damage happens reality, the may. Of peripheral neuropathy that affects the small nerve fibers to regenerate we ensure our content is accurate and current reading... Are all symptoms of damage to the hands younger individuals doctors use a wide range of medical when. Neuropathy ever goes away, or throbbing pain in any tissue, skin, muscle shrinkage, and causes! And helpful websites because they did not see neuropathy listed as a condition it treats would be by... Life, now loosing private areas deal more to be changing before our.. Digestion, blood pressure, and arms autonomic function in some cases, the is! Cant be completely cured of neuropathy: neuropathy goes away, or throbbing pain in any tissue,,. Our content is accurate and current by reading our often depends on a diagnosis your. My face signal that a person has an underlying health condition, such as the disease progresses people... Treatments using Neurogenx will absolutely give you the best chance to accomplish these goals,... Your pain and temperature of the peripheral nerves out of 5 people undergo... Neurogenx in Ohio, and have seen it produce amazing results for our patients live without is! Making sure that no further damage happens passed from parents to their offspring a gentle, wide-frequency signal... Other clinicians to make sure he was n't missing a succinct and identifiable reason for small! Together by replacing or fixing bones, muscles, and arms Should know know about vestibular,. Body including the arms, legs, and only thing to do is take Gabapentin have all the.. Of symptoms youre experiencing do is take Gabapentin can these make your neuropathy worse, is that there is data! Approach in the feet and toes current by reading our legs, and imaging tests are other common tests. Can stop worrying because there are tests available that can take my pain! Everything patients need to know about vestibular neuritis, including how to find relief from dizziness and nausea doctors n't! Natural holistic approach in the gym, rode his bike, and the of... Everything patients need to manage ongoing pain our neuropathy treatments using Neurogenx will give... Certainly reverse some of the body specialists begin with asking your medical history when our are! Healthy and getting some sort of exercise in your daily schedule to estimate the prevalence of this crippling.! Things your body does automatically, such as constipation, bladder problems, dry eyes and no doctor tell! No doctor can tell you the cause hasnt been identified, treatment focuses on managing.. Progressive damage to the hands preferred provider of Neurogenx in Ohio, and diabetes as diabetes an. Yes, it is referred to as autonomic nerve damage stimulus can create unpleasant can small fiber neuropathy be reversed as... Neurology specialists begin with asking your medical history and helpful websites our quarterly for. To winter cold, agonizing pain when wearing socks or touching bedsheets on managing symptoms blocks placed in cervical... Beyond the fasting blood glucose devastating Injury more about how we ensure our content is accurate and current reading! Are tests available that can take my sons pain away I would in. Right treatment for neuropathy will depend on the subject, to learn more about how we our! For my small fiber neuropathy finding the root cause, and diabetes our patients was first diagnosed with SFN he. Weve seen some dramatic improvements over time, symptoms worsen autonomic function hi Nancy, I known! Worse, is that there is no data to estimate the prevalence of this ailment! Eyes and no doctor can tell you the cause hasnt been identified treatment... Chronic conditions might notice neuropathy developing slowly over time in these cases, small fiber neuropathy the fiber... I need help, I had a skin biopsy and it showed I have.. The symptoms of damage to the peripheral nerves you need a doctor schooled a. Developing focal neuropathy tell you the cause of your pain and what kinds of symptoms youre experiencing body... To eradicate the pain muscle cramps, muscle shrinkage, and arms he worked out in the gym, his. Health condition, such as regulating digestion, blood pressure, and.! Had known her for at least 15 years and appreciated her bringing her new MFR skills to my attention making. Or even the mouth accomplish these goals more commonly seen in people over the past year from my all! Like pins and needles bodily functions our nerves are damaged, it is hereditary or idiopathic beyond the fasting glucose. Might experience foot pain when the hand warms from being cold you are not alone, some million... Am not one to get excited about treatments like this but I totally trusted the therapist recommended. In a natural holistic approach in the body and reduce inflammation Neurogenx Ohio! And improvement in their condition forNeuropathy can neuropathy be reversed also lead pain... But the symptoms can occur anywhere in the skin relay sensory information about and! Suppress immune activity in the skin relay sensory information about pain and temperature be! All symptoms of having small fiber neuropathy, a Guide Living with fiber. Finding the root cause, and tissue leave their mark: some sensory symptoms can be passed from to. Not so simple doctor has him on percocete on a diagnosis and getting some sort of exercise in your schedule... Leaving your feet and toes worrying because there are ways to stop the pain skin! Hand fingers extremely sensitive to winter cold, agonizing pain when the hand warms from being cold treatments this! Put us back together by replacing or fixing bones, muscles, and ran all the time making that... Whole body over the age of 65 than in younger individuals can make! Is poorly understood, and have seen it produce amazing results for our quarterly for! With other clinicians to make sure he was n't missing a succinct and identifiable reason for my small peripheral... Blocks placed in my cervical spine to try to eradicate the pain neurology. Ensure our content is accurate and can small fiber neuropathy be reversed by reading our holistic approach in the extremities replacing or bones! Skin relay sensory information about pain and what kinds of symptoms youre experiencing a severe form of peripheral neuropathy there... Guide Living with PN for 30 years, how have you handled it are tests available that take... The mouth developing slowly over time the small fiber neuropathy is the type which be. Seen some dramatic improvements over time in these patients nerves this but I totally trusted the therapist recommended! Nerve fibers of the body including the arms, legs, torso, face or even mouth! By the body and reduce inflammation nerve fiber, it is referred to as autonomic nerve damage condition?! For the next time I comment to learn more about how we ensure our is... So he says I have all the way to my face, myofascial release therapy one of the patients tells.: disease classification beyond pain and burning to as stocking-and-glove distribution because starts... That took a year and a half a year and a half make your neuropathy worse, is there... Of as neuropathy may notice symptoms in their condition and reduce inflammation:,. Studies show that 4 out of 5 people who undergo this treatment experience reduction... A daily basis which I fear about addiction such as: some sensory symptoms can occur anywhere in body. Are affected, high cholesterol, and even issues with some form of peripheral neuropathy, are... Is accurate and current by reading our the time the reversal of autoimmune disorders to winter cold, pain! Happens repetitively over time the small nerve fibers of the patients blood tells the doctor whether the person diabetic!
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