When your knee pain is coming from your unmanaged or uncontrolled Type 2 diabetes
In this article we will explore the challenges people with unmanaged or uncontrolled type 2 diabetes face with knee pain.
If you are someone suffering with type 2 diabetes and knee pain, one challenge you may be facing is a diminished ability to heal your damaged knee. This non-healing will eventually lead to irreversible knee degenerative disease and the eventual recommendation to a knee replacement. Knee replacement complications in Type 2 diabetes is of course another great concern.
Type 2 diabetes can create a toxic non-healing joint environment and causes joint damage and joint erosion by itself, no wear and tear necessary
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 causes joint damage and joint erosion by itself, no wear and tear necessary. This means resting or knee braces or “staying off your knee,” will not be beneficial in reversing or even stopping continued knee damage. The reality is one day you most likely are going to 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 maybe 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: The evidence that abdominal obesity, hypertension, and diabetes is destroying your joints and will send you to a nursing home
You have “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. (1) In this research the role of type 2 diabetes in causing your knee pain is examined.
Point number 1:
- Development of knee osteoarthritis IS associated with obesity and metabolic syndrome. Simply, the excess weight and the diabetes is 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) and by advanced age products accumulation in joint tissues exposed to chronic high glucose concentration.
- 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 a 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 whioch 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, (2) 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 remodelling/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 lead by the University of California at San Francisco publishing in February 2018 in the Journal of magnetic resonance imaging (3) 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 unmanage your type 2 diabetes the greater the likelihood that you will need knee replacement. Before you think knee replacement is an 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.(4)
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.(5)
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 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 (6).
- Unfortunately there were patients excluded from the study because of concerns over likelihood of poor outcome 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%). (7)
Poor blood glucose control and an elevated HbA1c increase the risk for poor healing, as well as 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 better dietary lifestyle.
Do you have questions about diabetes, joint repair and Prolotherapy?
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