Happy Saturday! Welcome back to Ask D'Mine, our weekly advice column hosted by veteran type 1 and diabetes author Wil Dubois.

This week, Wil tackles a question about a diabetes complication that isn't always discussed or seen as "serious," but can be frustrating all the same -- cramps. Here's what Wil has to say about that...

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

 

Mia, type 2 from Ireland, asks: Do you have any remedies for toe, foot and calf cramps? 

Wil@Ask D’Mine answers: Thanks for writing from the Emerald Isle! We love hearing from our overseas diabetes brothers, sisters, and cousins. But before I get to your question, I need to clarify something, because while diabetes is universal, language is not. And even though you and I speak English (although, ironically, neither of us live in England), I suspect that we don’t really speak the same language. Heck, even from state to state here in the good ol’ US of A, we don’t speak the same English. 

What on earth is he getting at? Many confused readers may wonder this morning, as you check to make sure you didn’t put decaf in your coffee machines by mistake. Isn’t this supposed to be a diabetes column?

Yes, yes it is. But it’s written by a writer who moonlights as an adult education Language Arts teacher, so words are sacred to me and I’m highly alert to their subtle and varied meanings. And today my highly developed antenna for language makes me suspect that you and I just hit a linguistic speed bump going a little bit too fast, so I need to make sure we’re all on the same page, so to speak.

Excuse me a moment while I put on my scholarly robes. (Actually, I normally teach wearing an Eddie Bauer Travex shirt with the sleeves rolled up. I was just being metaphorical.) But here we go: One of the things I teach my students is that words have both denotation and connotation. Now, despite how that first word sounds, denotation has nothing to do with blowing things up, which always disappoints my students, most of whom are borderline delinquents. Instead, denotation is the literal definition of a word. It’s what you find when you look a word up in the dictionary.

Speaking of how words sound, however, that’s not far off the mark of connotation. At least for how things sound inside our heads. The connotation of a word is what it means to the people who hear it, including, in many cases, a lot of emotional baggage. The classic example is the word “cheap.” If we blow cheap up, the denotation is simply something that doesn’t cost much; but on the other hand, the connotation of “cheap” is something that’s poorly made. At least it is to those of us here in the USA.

In fact, word connotations tend to be specific to geographical areas and subcultures, making it easy for one group of people who speak a certain language to misinterpret other folks who seem to speak the same language. It’s that damn Tower of Babble all over again. Only subtler, because we don’t realize in many cases that were not understanding each other.

Simply put: Your English Language May Vary.

Anyhoo, you asked if I had a remedy for cramps. When I hear the word "remedy," it carries the connotation of “cure” for me. So no, I don’t have a remedy for cramps.

I do, however, have several “treatments,” which to me are something altogether different. My connotation of treatment is: A medication, substance, or action that will relieve the symptoms of a medical condition, while not necessarily addressing the underlying cause.

Cramps are nothing more than super-tight contractions of muscle groups. That sounds harmless until you have one, because a good cramp can put Spanish Inquisition torture to shame. WTF causes these super-tight contractions? 

To shed some light on that, consider what’s needed for normal muscle action. For muscles to do their normal thing of contracting when you want and need them to, and relaxing when you don’t need them contracting, they need glucose. Ah-hah, you say, I see where this might be going. But they also need a proper electrolyte balance, which is why runners get camps if they get dehydrated. Three of the key electrolytes in muscle action are magnesium, potassium, and calcium (which is technically a reactive metal, not a electrolyte, but it functions the same for our purposes). Remember those. They play a key role later. But for now, know that when your blood sugar is out of whack, so too, are your electrolytes. 

In addition to disharmony in glucose and electrolytes, cramps can also be a side effect of some medications, including cholesterol-lowering agents, some blood pressure pills, and even insulin itself—all of which are common in the medicine cabinets of PWDs. And, bummer of bummers, cramps can also be caused by nerve damage from long-term out-of-control blood sugars.

Stitch all of that together, and I think you can see why cramps are a common plague for those of us with diabetes.

But what to do? Let’s break this out into prevention of attacks and treatment of attacks—regardless of their cause. In the prevention department, the first line of defense against cramps is good overall diabetes control with a minimum of glucose swings. Yeah, that tired old saw of keeping your diabetes in tight control is, once again, no old wives' tale.

But that’s easier said than done. I find that when I screw up and my blood sugar goes up or down very fast, I get horrible cramps in the undersides of all of my toes. It sounds funny, I know, but it’s an excruciating experience in pain. The common advice of just massaging out a cramp is not so easily done when you have ten simultaneous cramps. Plus, even though the muscles are small and close to the surface, I find the cramps to be stubborn and resistant to rubbing out. My prevention solution? I avoid like the plague anything I know can cause a rapid excursion in my blood sugar.

But other than living a saintly blood sugar life, what else can you do to prevent cramps in the first place? Well, if your blood sugar is running high for any reason, it will have the same dehydrating effect as running a marathon. So if you’re having a high day, load up on some replacement electrolytes by drinking a sugar-free Gatorade or other sports drink. This replenishes the electrolytes you’ve lost to the high glucose, and can prevent the cramps before they attack. Another prevention strategy taken from sports, especially if your cramps are striking at night, is to do a good athletic-style set of stretching exercises before bed.

Next, take the time to read up on your drugs to find out which ones are more likely to cause cramps. Talk to your doctor about alternatives that are less cramp-prone. And lastly, consider a daily multivitamin. Diabetes, and all the meds we take, tends to suck out all those little minerals, vitamins, and electrolytes we need to maintain the delicately balanced running of the human body. Re-stocking all those trace minerals and the like in advance can help prevent a host of trouble, cramps included.

But what if, despite your ounce of prevention, you still get a pound of cramps? Stretch, rub, and swear—then reach for the magic. I’ve found two silver bullets that can stop an ongoing cramp attack in its tracks.

The first is a calcium pill, but make sure it’s the liquid gel cap type. This quickly beefs up one of the key “electrolytes,” that when deficient, can trigger a cramp. Using a liquid cap, rather than a solid pill, gets the calcium into your system quicker. Within minutes, these magic pills can make a cramp attack disappear. A related option is one of those little packs of magnesium powder that you mix into some water and chug (added benefit: rehydration).

In theory, a potassium pill should be equally effective, as it’s the third pillar of muscle operation on the electrolyte front, but I’ve never actually talked to anyone using that track, while I’ve heard from scores of people who’ve had good luck with calcium and magnesium. 

So there you have it, hardly a remedy, but a good therapeutic chain instead. First, do your best to keep your sugar in a good range. Talk to your doc about your cramp-causing meds. Load up on electrolytes when you’ve had a bad blood sugar day, and be sure to stretch your muscles before hitting the sack and if the damn cramps hit anyway reach for the calcium or magnesium.

Because after all, detonating those cramps connotes good health.

 

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. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.