Need help navigating life with diabetes? You can always Ask D'Mine... Welcome back to our weekly Q&A column, hosted by veteran type 1 and diabetes author Wil Dubois.

Today, Wil's responding to a question about pain in the knees and how that may (or may not) be related to diabetes. Read on for more, and not just a "knee-jerk" response, but an always-insightful column from Wil.

{Got your own questions? Email us at AskDMine@diabetesmine.com }

 

Joe, type 1 from Vermont, writes:  I have pain in my knees on and off, sometimes intense. Is this associated with diabetes? And can you recommend a good vitamin to take for a knee pain? I am talking calcium but it doesn’t seem to work. Thanks.

Wil@Ask D’Mine answers: I’m sorry to report that the knee pain you’re suffering from could well be associated with your diabetes. What a pain in the backside. And while I’m sure that regular readers—and diabetes vets in general—won’t be surprised to learn that there’s yet one more way diabetes can mess with our bodies, I confess to having a morbid fascination with all the myriad ways one hiccup in the genome can lead to such widespread chaos.

The most common diabetes-triggered joint chaos is called neuropathic arthropathy, and if you’ll pardon the pun, it’s one of those the shin-bone-is-connected-to-the-knee-bone kinda syndromes. Here’s how it works: uncontrolled diabetes causes high blood sugar > high blood sugar causes neuropathy > neuropathy causes loss of sensation > loss of sensation can result in unnoticed joint injury > un-noticed joint injury leads to people using a damaged joint unawares > using a damaged joint unawares leads to further damage. In the case of neuropathic arthropathy, PWDs (people with diabetes) suffering this malady can completely wear down the cushioning cartilage in a joint resulting in physical friction bone damage. Ick. Oh, and just so my fellow PWDs don’t feel too put upon, neuropathic arthropathy is not exclusive to diabetes. You can also get it from syphilis, leprosy, and chronic alcoholism -- among other conditions and diseases. 

Neuropathic arthropathy most commonly affects the feet and ankles—in fact, its common name is Charcot’s foot—but it is seen in the knee as well, especially in type 1s, and sometimes in patients who are quite young. 

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Due to the fact that neuropathy is part of the recipe here, the first thing to do when considering if your knee pain could be the result of Charcot’s (named after the pioneering French neurologist Jean-Martin Charcot) is to be honest with yourself about the quality of your diabetes control. And I don’t just mean the quality of your current control, but the quality of your control, overall, since diagnosis. Complications, such as neuropathy, can come home to roost years, or even decades, after the damage was first inflicted. Of course, that’s not to say you shouldn’t strive for the best control possible for your diabetes, but if you had a long spell of poor control in your youth, you’re at higher risk of neuropathy, and hence Charcot’s.

It’s also interesting to note that neuropathy aside, apparently glucose has a negative impact on collagen, the stuff the cushioning cartridge is made of. Just the way blood cells glycate when exposed to glucose, so too does collagen tissue, which can cause the cartilage to stiffen. Meanwhile, research by Dr. Tord Kjellström (who gets this month’s award for the coolest name), showed that collagen from type 1s responds very differently than collagen from type 2s when exposed to glucose.

If you suspect Charcot’s, somewhat paradoxically, your first stop to get your knee treated is at podiatrist’s office, rather than an orthoptist’s. As Charcot’s most often affects the feet, podiatrists are the most familiar with the condition.

Moving on to the next way the big-D takes a toll on our joints, the number two slot is taken by osteoarthritis. In this case, the diabetes isn’t at fault so much as the excessive body mass we historically see in type 2s, and increasingly see in type 1s. To be blunt, if you are a fat type 1, you could be suffering from osteoarthritis, which can be either triggered or exacerbated by weight. If this is the case, skip the foot doc and visit a rheumatologist. And a dietitian.

Somewhat related, is a grimmer form of arthritis called Rheumatoid Arthritis, which is an autoimmune disease commonly linked to type 1 diabetes. Apparently, diagnosing RA is no simple matter as there’s not a single test for it; rather a number of lab tests and imaging studies are needed to ferret it out. The labs can include an ESR, a C-reactive protein, and something called anti-cyclic citrullinated peptide antibodies. Imaging runs the gauntlet from X-ray to MRI with ultrasound in-between. I hope you have good health insurance.

Meanwhile, on to your question about vitamins for knee pain. While not actually a vitamin, many patients suffering knee pain for a wide range of conditions find that taking the cartilage component glucosamine helps. It’s generally considered safe, although science on its effectiveness—as with most supplements—is controversial. That said, years ago my wife and I had an old dog that had a lot of knee problems, and our hippie vet put Canine Kody on glucosamine, and damn if it didn’t help. I’m not saying you’re an old dog, but what works for one mammal might work for another. But that’s not to say you should avoid getting some professional medical advice on you knee. And no, my hippie vet doesn’t count when it comes to professional medical advice. 

Other over the counter compounds that people report success with are:

  • Chondroitin, a chemical found in joint cartilage, which is thought to inhibit the activity of substances that break down collagen in joints.
  • Ginger, which as well as being a spice has a long-standing place in folk medicine, and is believed by some to have both anti-inflammatory and antioxidant properties.
  • MSM, which is slang for methylsulfonylmethane, a sulfur-containing compound that helps some people suffering from joint degeneration, mostly likely serving in an anti-inflammatory fashion. 

And finally, the only actual vitamin I could find for you that some people take for knee pain is vitamin D, which functions in a roundabout way. As it turns out, one of the symptoms of vitamin D deficiency is joint pain. So you might want to have your vitamin D levels checked. It would be ironic if your knee pain was from this little-d rather than from the big-D we all worry about.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. Bottom line: you still need the guidance and care of a licensed medical professional.