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Diabetes

Third Nerve Palsy and other issues

11/07/2003

Question:

Hello,

I am a 46yr old male, diagnosed with Diabetes 6 years ago. I currently take Glucophage 850mg, 1 tab 3 times a day, and Glyburide 5mg, 2 tabs twice a day. I am about 100lbs over-weight, with most of it in my belly. I have fibrosis of the liver, and see a liver specialist at University Hospital in Cincy twice a year for monitoring.

This past March ,I started watching my carb grams per meal, keeping them under 38grams per meal. I gradually lost about 15 lbs and felt pretty good, but my sugars were still high in the morning after fasting. Also, out of the blue, about 6 weeks into it in mid April, I got a kidney stone.

In June I started taking a Lantus Insulin shot at night before bedtime, 10 units and then gradually to 15. My numbers will still in the 150-180 range in the morning, but were in the "normal" range the rest of the day. I can`t think of the name of the test, but its the one that shows blood sugar levels over a long period of time. My number was 6.2 in August, down from 9.0 in Feb. I am due to go to my Primary Physician again next week, who I see 3-4 times a year for my Diabetes.

On Oct 13th, I started experiencing what I thought was a sinus headache. After about a week, I started experiencing double vision along with the headaches. I had an MRI done on my brain which came back normal, and went to an Opthomoligist and have been diagnosed with "third nerve palsy". If I cover or close one of my eyes, I can see out of the other one. If I open both eyes at once, I have double vision, and one or both of my eyes goes sideways. I am told that my vision may return in 3 to 6 months and that there is really nothing that I can do. I still have a slight headache-eyeache. I was told that the "third nerve palsy" was not caused by anything that I have been doing recently, but simply because I am Diabetic. I was also told that this usually occurs in older patients who have had Diabetes 15-20 years.

My numbers have been high during all this, in the 200 to 300 range. I started increasing my Lantus units last week and am up to 25units, but this morning it was 210 after fasting for 12 hours. Earlier this week it has ranged from 165 to 210 today.

I am VERY scared and frustrated with all that has been going on recently. I really would like to work with a Diabetes specialist. Earlier this summer I was testing my blood 4 times a day and keeping a journal, and am willing to do this again with someone who has the time and knowledge to help me get things under control. I also want to lose weight.

1. Is the information I mentioned about "third nerve palsy" correct? Is there anything that you know of that I can do to possibly speed up the return of my vision other than taking control of my sugar levels?

2. Do you have any recommendations of who I could see at University Hospital in Cincy? Is there someone there that specializes in Diabetes? I really don`t need Diabetes education, just someone who can work closely with me. I feel that I need someone who has the time to look at the meds that I am taking, my journal with my numbers and the things I am eating and try and come up with a plan to get things under control.

I apologize for all this information that I have given you here, and I thank you in advance for any help or direction you may have.

Thanks!

Answer:

Let me answer your two questions in order and generalize the issues so others can learn from your questions: 1) Third nerve palsy refers to paralysis (palsy) of the third of 12 cranial nerves, nerves in the head that control either the senses or movements related to the senses or the head. The third cranial nerve is one of three nerves which control the movements of the eyes. If one of the nerves controlling movements of the eyes doesn`t work correctly, then the two eyes don`t necessarily focus on the same point, resulting in each seeing a different image - so-called double vision. The third cranial nerve is one that can be affected by "peripheral neuropathy," a disease process associated with diabetes that affects nerves outside the brain and spinal cord. The more common form of peripheral neuropathy involves the sensory nerves to the legs, resulting in numbness, tingling and sometimes pain. There can also be nerve damage that affects the urinary bladder, bowel movements or erections in men. The main things I think of as helping peripheral neuropathy clear up are better blood sugar control and time. It is a matter of blood sugar control over weeks and months not a few days that counts. 2) Each of the institutions underlying NetWellness, University of Cincinnati, Case Western Reserve in Cleveland and Ohio State University, has diabetes specialists as do most medical schools and referral "tertiary care" centers. They can help to improve blood sugar control by careful review of how your diabetes is being treated and the blood sugar results being treated and recommend alternative approaches, as well as provide information on whether there are any other options that I`ve missed. You can access the diabetes specialists at any of the NetWellness member institutions through the NetWellness physician access tab. You can also find diabetes/endocrinology specialists through the physician search functions of the Hormone Foundation or the American Association of Clinical Endocrinologists or by contacting the local American Diabetes Association.

Related Resources:

The Hormone Foundation
American Association of Clinical Endocrinologists

For more information:

Go to the Diabetes health topic, where you can:

Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati