Diabetes can lead to intense itching

Question: Can intense itching be a side effect for someone with diabetes whose blood sugars are poorly controlled?

Answer: Poorly controlled diabetes is one possible cause for unexplained itching. Exactly how diabetes causes itching isn't certain, but suggested causes include diabetic nerve root injury, metabolic abnormalities from widely fluctuating blood sugars, and dry skin. If this is the cause, it should improve with better efforts to lower the blood sugars.


That said, there are many other causes for severe itching. Dry skin from eczema is a common cause that's fairly easy to treat with moisturizers and steroid cream/ointment. Cholestatic liver disease with high blood levels of bilirubin is another cause of severe itching. A normal set of liver enzyme tests will rule this out. Either a very slow or a very fast thyroid can cause itching, so be sure to check thyroid function. Severe chronic kidney failure can also cause itching from the buildup of toxins. High levels of circulating blood histamines from a tumor can cause itching, so be sure to check a blood histamine level. Folks who have a disorder called polycythemia vera may experience itching due to high circulating levels of histamine-producing mast cells.

Certain cancers such as carcinoid syndrome or Hodgkin's/non-Hodgkin's lymphoma can cause extreme itching, so these need to be considered. Parasitic infections are another possible cause, especially after recent travel to endemic areas. Severe emotional stress/anxiety is one more interesting cause for unexplained itching I've encountered in my practice.

Q: My blood pressure averages 120/60. I'm concerned about the bottom reading of 60 being too low. I seem to be rather drained, and wonder if it's because my pressure is too low. Is there any food or vitamin I can take to raise it?


A: There's absolutely nothing wrong with your blood pressure. In fact, 120/80 is considered to be the equivalent of 20-20 vision; your blood pressure is analogous to having even better vision than normal.


What do those numbers mean? The first, higher number (systolic) is the pressure of the blood against the artery walls when the heart contracts (e.g., 120). It's the maximum pressure generated when the heart contracts, sending blood out to the body. The second, lower number (diastolic) is the pressure against the artery walls when the heart relaxes between beats (e.g., 80). It's the minimum blood pressure we see. Organs depend upon that maximum pressure with every heartbeat for blood's nutrients and oxygen. As long as the upper (systolic) pressure is sufficient, the lower pressure isn't really too important.

It's really pretty rare for otherwise healthy folks to have blood pressure that's too low. Sure, with high fever, infection, or dehydration, blood pressures can get too low, but the upper blood pressure reading would be expected to be low as well. For some young healthy people, especially thin young women, blood pressures of 80-90/60-70 are completely normal. When a blood pressure is truly too low, folks will feel quite dizzy or lightheaded every time they stand up, and they'll feel tired.

I'd search for other causes to explain your fatigue such as anemia, a sluggish thyroid, low blood sugar, depression, adrenal gland insufficiency, poor sleep, or a side effect of one of your medications. Be sure to discuss how you feel with your doctor.


Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H," Box 767787, Atlanta, Ga. 30076. Due to the large volume of mail received, personal replies are not possible.