Christopher A. Trower, DO
Resident
Eastern Virginia Medical School, Department of Physical Medicine and Rehabilitation
Norfolk, Virginia, United States
James Lau, MD
Resident
University of North Carolina, Department of Physical Medicine and Rehabilitation
Chapel Hil, North Carolina, United States
Edmond Benedetti, MD
Resident
Eastern Virginia Medical School, Department of Physical Medicine and Rehabilitation
Norfolk, Virginia, United States
Amara A. Chike, BS
Medical Student
Howard University College of Medicine
Washington, District of Columbia, United States
Jason Fung, MD
Doctor
N/A
Toronto, Ontario, Canada
Steve Gershon, MD
Doctor
Gershon Pain Specialists
Virginia Beach, Virginia, United States
A 62-year-old male with a medical history of long-standing Type 2 diabetes mellitus (T2DM) was diagnosed with distal symmetric polyneuropathy (DSPN). A 62-year-old male with T2DM (HgbA1c 8.3) presented for electrodiagnostic studies (EMG/NCS) to assess for DSPN. EMG/NCS identified abnormalities of the fibular motor/sensory, sural sensory, and tibial motor responses. The patient was diagnosed with DSPN and was subsequently started on an intermittent fasting (IF) protocol, which consisted of a combination of 16-hour and 24-hour fasts, in conjunction with vitamin supplementation and exercise. Repeat studies one year later revealed some mild interval improvement on the EMG/NCS. The patient’s HgbA1c was 8.2. Three years later, marked improvement was noted, with the sural nerves demonstrating normal conduction, and the tibial motor amplitude increased by >50%; the HgbA1c decreased to 7.4.
Case Description:
Discussions:
DSPN is believed to be an irreversible complication of T2DM. Treatment focuses on prevention and progression through lifestyle changes, medication, and occasionally interventional treatments. Some diabetic patients have successfully transitioned off insulin and metformin with therapeutic IF, suggesting it as a viable non-medical option. However, the patient’s recovery may also be influenced by co-implemented vitamin supplementation and exercise, which could contribute to improved neuropathic outcomes.
Conclusions:
DSPN is often seen as an irreversible condition. However, the nerve conduction studies revealed marked improvement during the 3-year time period of IF, vitamin supplementation, and exercise. While this drop in HgbA1c is significant, it’s still abnormal which indicates that reversal of the polyneuropathy might not solely be due to targeting a specific glucose level (e.g., < 7%). Given the fact that most treatments for DSPN target symptoms as opposed to reversing the underlying condition, IF may play a key role in treating and reversing this previously thought irreversible condition.
