What to do about knee pain being caused by your unmanaged or uncontrolled Type 2 diabetes
In this article, we will explore the challenges faced by people with knee pain and unmanaged or uncontrolled type 2 diabetes. If you are someone suffering from type 2 diabetes and knee pain, one challenge you may be facing is your reduced ability to heal the damage in your joints and avoid knee replacement. If you are recommended to knee replacement, complication risk in Type 2 diabetes patients is another great concern.
When treatment makes knee pain worse – “I take a lot of pills.”
Many patients that we see in our offices describe a long medical history filled with conservative care treatments for their knee pain. As many patients put it, “I take a lot of pills.” In August 2019, a multi-national team of researchers published troubling findings in how pain management of patients with type 2 diabetes and osteoarthritis could lead to serious side effect concerns. What the researchers discussed is the taking of “lots of pills.” This research was published in the journal Seminars in arthritis and rheumatism. (1)
- “Type 2 Diabetes mellitus has a pathogenic effect on osteoarthritis through 2 major pathways involving oxidative stress and low-grade chronic inflammation resulting from chronic hyperglycemia and insulin resistance. Type 2 Diabetes mellitus is a risk factor for osteoarthritis progression and has a negative impact on (joint replacement) outcomes. Evidence is mounting for safety concerns with some of the most frequently prescribed anti-osteoarthritis medications, including paracetamol (Tylenol), non-steroidal anti-inflammatory drugs, and corticosteroid injections.”
The reason patients are in our office seeking options for the treatment of their knee pain is that they have concerns about knee replacement and their diabetes problems. Further, if they have diabetes, they will most likely have problems with high blood pressure, being overweight, high cholesterol, fatigue, and muscle pain. The muscle pain of course not only comes from spasms caused by damaged joints, but they can also come from medications the patient is one to combat these problems. When you add these problems on top of the safety and health concerns expressed by the researchers above, these people are not in a good place for healing.
Type 2 diabetes can create a toxic non-healing joint environment and cause joint damage and joint erosion by itself, no wear and tear necessary
Above I briefly outlined some of the many challenges someone with diabetes and osteoarthritis can have. Let’s throw another challenge into this mix. The challenge that Type 2 diabetes has been described as an independent risk factor for osteoarthritis. This means type 2 diabetes can create a toxic non-healing joint environment and cause joint damage and joint erosion by itself, no wear and tear necessary. This means resting or “staying off your knee,” will not be beneficial in reversing or even stopping continued knee damage. The reality is one day you will most likely be sent to knee replacement surgery.
Is this you?
Here is a general description of what patients who have knee pain and type 2 diabetes tell us when they first visit us.
- I have been on metformin for a couple of years, I am now on statins and other medications to help control my blood glucose and my cholesterol levels. I have been having a lot of knee pain lately. One of my doctors is looking into my statins prescriptions. My doctor thinks my statins may be the cause of my knee pain. I have been told that I need to change my diet
- (For more on knee pain and statins please see my article My doctor says that my knee pain is being made worse by my elevated cholesterol).
There is nothing earth breaking here, in fact, it is a routine description that many patients offer. A patient has knee pain, is on lots of medications, has high glucose and high cholesterol. The recommendations to manage this knee pain range from more medications to change in diet and lifestyle. Change and increasing medication is easy, there is nothing more to it than getting your new prescriptions filled. Change in diet and lifestyle is hard. I am going to review some research now that may inspire you to take the more difficult path of lifestyle change.
I will also invite you to read my article: Your big belly is destroying your joints and will send you to a nursing home
Getting rid of “sugar on the knee”
Here are highlights of a recent research paper from doctors at Sorbonne University in Paris writing in Diabetes research and clinical practice. (2) In this research, the doctors examined how type 2 diabetes causes knee pain.
Point number 1:
- The development of knee osteoarthritis IS associated with obesity and metabolic syndrome. Simply, the excess weight and diabetes are destroying your knee.
Point number 2:
- The negative impact of diabetes on joints could be explained by the induction of oxidative stress and pro-inflammatory cytokines (lots of inflammation), advanced age and accumulation and exposure to chronic high glucose concentrations.
- In other words:
- What these researchers are saying is that your knee is swimming in a toxic soup of inflammation caused by oxidant stress. Look down at your knees. The swelling you see, that is the toxic soup that may be caused by chronic high glucose concentration. In simplest terms – you have “sugar on the knee.”
Point number 3: chronic low-grade inflammation that is constantly eating at your knee.
- Insulin resistance might also impair joint tissue because of local insulin resistance of diabetic synovial membrane but also by the systemic low-grade inflammation state related to obesity and insulin-resistant state.
- In other words Insulin resistance, this is where you cannot produce enough insulin to manage your sugar levels and in your swollen knee, this not only leads to inflammation as we just mentioned but also a chronic low-grade inflammation that is constantly eating at your knee.
- Please see my article: Is weight loss the best anti-inflammatory medication?
As you can see the impact of type 2 diabetes on degenerative joint disease is multi-factoral and a battle your body fights on many fronts.
Type 2 diabetes prevents bone repair which damages your cartilage
All the factors mentioned in the research above significantly impacts how your knee repairs itself from wear and tear damage.
In the medical journal Bone Research, (3) a team of researchers from among China’s leading medical universities investigated Type 2 diabetes’ association with knee osteoarthritis. They found that patients with type 2 diabetes have unique abnormal subchondral bone remodeling and microstructural and mechanical knee impairments which caused greater cartilage degradation.
- In other words, the type 2 diabetes prevents proper bone remodeling/healing. This abnormal bone compromises the structure of the articular cartilage of the knee. Type 2 diabetes accelerates knee osteoarthritis. Type 2 diabetes is attacking the whole knee.
- In other words, all the components of a recommendation to knee replacement are coming into play.
The more you ignore your type 2 diabetes the greater the likelihood that you will need knee replacement
An international team of researchers led by the University of California at San Francisco publishing in February 2018 in the Journal of Magnetic Resonance Imaging (4) found that not only did Diabetes type 2 accelerate knee osteoarthritis, the more unmanaged or severe the diabetes, the more severe the cartilage degeneration.
In other words, the more you ignore this or do not properly manage your type 2 diabetes, the greater the likelihood that you will need a knee replacement. Before you think knee replacement is a good solution, read on:
The problems with knee replacement complications and type 2 diabetes.
There is a lot of research into knee replacement complications. Those surrounding type 2 diabetes find complication rates higher because of many factors including the compromised ability of the patient’s bone to heal. This was noted in The Journal of arthroplasty by a leading team of Japanese medical university researchers who noted restricted knee range of motion and poorer functional recovery after total knee replacement.(5)
Medical university doctors in China writing in Medical Science Monitor wrote in May 2017 that successful outcomes for patients with knee replacement and Diabetes Type 2 required close monitoring for deep vein thrombosis, preventing post-surgical infections, and monitoring heart and lung function.(6)
Prolotherapy injections and uncontrolled type 2 diabetes
Prolotherapy is a regenerative injection therapy where we inject a simple sugar into the knee. I know what you are saying, if I already have “sugar on the knee,” how will injecting dextrose (a simple sugar), help me? Won’t it make it worse?
Please see our very detailed article on to learn more about Prolotherapy and Knee Osteoarthritis.
In this video, Ross Hauser, MD explains a Prolotherapy knee treatment as performed at our Caring Medical clinics. This is not typical of the way treatment may be performed in other doctor’s offices.
Video learning and demonstrated points:
- Prolotherapy is an injection technique that stimulates growth factor cells that work to repair damaged joints.
- Prolotherapy can be very helpful in patients with knee instability or hypermobility caused by damaged knee ligaments and tendons. Knee instability is a cause of knee osteoarthritis and degenerative wear and tear.
- In this video, Ross Hauser, MD is seen demonstrating intra-articular (inside the knee) as well as injections surrounding the outside of the knee.
How does Prolotherapy work in your knees?
In a study that we cite, in other articles on our website, published in the prestigious international journal Therapeutic advances in musculoskeletal disease, doctors wrote of excellent patient outcomes in a study of Prolotherapy injections for with knee osteoarthritis (7).
- Unfortunately, there were patients excluded from the study because of concerns over the likelihood of poor outcomes because of poorly controlled diabetes mellitus with fasting blood sugar greater than 11.1 mmol/L.
- Another well-known study on the success of Prolotherapy treatments for knee osteoarthritis lead by our friend and colleague Dr. David Rabago, MD of the University of Wisconsin also excluded patients with uncontrolled diabetes mellitus defined as glycosylated hemoglobin (HbA1c levels) >7.5%). (8)
Poor blood glucose control and an elevated HbA1c increase the risk for poor healing, as well as the development of adult-onset diabetes and its associated health risks, which can lead to heart disease. Every day we treat patients with joint pain, arthritis, and sports injuries whose goal is to heal and return to their normal lives. High glucose levels compromise that goal and put them at risk for further diseases in the future.
Fortunately, we have worked with many patients over the years with type 2 diabetes and have helped them on their path to healing and a better dietary lifestyle.
Do you have questions about diabetes, joint repair and Prolotherapy?
1 Veronese N, Cooper C, Reginster JY, Hochberg M, Branco J, Bruyère O, Chapurlat R, Al-Daghri N, Dennison E, Herrero-Beaumont G, Kaux JF. Type 2 diabetes mellitus and osteoarthritis. In Seminars in arthritis and rheumatism 2019 Jan 11. WB Saunders. [Google Scholar]
2 Courties A, Sellam J. Osteoarthritis and type 2 diabetes mellitus: What are the links?. diabetes research and clinical practice. 2016 Dec 31;122:198-206. [Google Scholar]
3 Chen Y, Huang YC, Yan CH, Chiu KY, Wei Q, Zhao J, Guo XE, Leung F, Lu WW. Abnormal subchondral bone remodeling and its association with articular cartilage degradation in knees of type 2 diabetes patients. Bone research. 2017 Nov 7;5:17034. [Google Scholar]
4 Chanchek N, Gersing AS, Schwaiger BJ, Nevitt MC, Neumann J, Joseph GB, Lane NE, Zarnowski J, Hofmann FC, Heilmeier U, Mcculloch CE. Association of diabetes mellitus and biochemical knee cartilage composition assessed by T2 relaxation time measurements: Data from the osteoarthritis initiative. Journal of Magnetic Resonance Imaging. 2018 Feb 1;47(2):380-90. [Google Scholar]
5 Wada O, Nagai K, Hiyama Y, Nitta S, Maruno H, Mizuno K. Diabetes is a risk factor for restricted range of motion and poor clinical outcome after total knee arthroplasty. The Journal of arthroplasty. 2016 Sep 1;31(9):1933-7. [Google Scholar]
6 Liu P, Liu J, Xia K, Chen L, Wu X. Clinical Outcome Evaluation of Primary Total Knee Arthroplasty in Patients with Diabetes Mellitus. Medical science monitor: international medical journal of experimental and clinical research. 2017;23:2198. [Google Scholar]
7 Eslamian F, Amouzandeh B. Therapeutic effects of prolotherapy with intra-articular dextrose injection in patients with moderate knee osteoarthritis: a single-arm study with 6 months follow up. Ther Adv Musculoskelet Dis. 2015 Apr;7(2):35-44. [Google Scholar]
8 Rabago D, Zgierska A, Fortney L, Kijowski R, Mundt M, Ryan M, Grettie J, Patterson JJ. Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-arm uncontrolled study with 1-year follow-up. Journal of Alternative and Complementary Medicine. 2012 Apr 1;18(4):408-14. [Google Scholar]