Diabetic Peripheral Neuropathy
Attending a weeklong family practice course at the University of Oregon last year, I was instructed to reach for two medications when approaching the new diabetic patient – metformin for basic glucose control and a “statin” drug to reduce elevated cholesterol. The thinking was that most diabetic patients need an effective drug to control sugar immediately, effectively, and with minimum adverse effects; and metformin fit that role. However, most endocrinologists have agreed with cardiologists that heart disease is often the big danger for the diabetic. Hence, controlling lipids in the diabetic has been pushed to the foreground in medical strategy. For the diabetic, controlling lipids requires a greater level of reduction than the nondiabetic population: while cardiologists want most patients to have an LDL cholesterol of 100 mg%, diabetics are expected to drop their LDL levels to 70 mg%. The reasoning for tougher cholesterol standards for diabetics is based on the peculiar progression of coronary artery disease for these patients; plaque forms in the diabetic patient with a high cholesterol level at two to three times the rate as for a nondiabetic. It is difficult to argue against these drug standards, given the increased rate of disease progression in the diabetic.
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