Arm Pain in Diabetic Patients: Injection vs. Medication

Arm pain

Your mother has chronic conditions such as diabetes, hypertension, hyperlipidemia, and gout, and her kidney function is poor.
She has recently started insulin therapy.
She has been complaining of arm pain and has been requesting injections at the clinic for years whenever she feels unwell.
What is the composition of these injections? Now she claims that the injections at the clinic are ineffective, and I took her to Taipei Medical University, where she requested injections again, believing they are more effective here.
Is it advisable to continue with the injections? I am unsure of their composition and whether oral medications might be less harmful to her kidneys.
She is adamant about receiving injections because she is concerned about the side effects of oral medications affecting her appearance.
Should I support her decision? I am very worried about the potential harm to her kidneys.

Yijing, 40~49 year old female. Ask Date: 2018/08/23

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
With abnormal kidney function, both injections and oral medications need to be approached with caution.
The injections administered at hospitals or clinics are generally similar, but it is important to remind the prescribing physician that the elderly patient has poor kidney function.
They will then be more careful in prescribing medications or injections to avoid adversely affecting kidney function, which will be safer.
Therefore, both injectable and oral medications can potentially impact kidney function, so it is essential to remind the prescribing physician.
Of course, if the underlying cause of chronic pain can be identified, it may not be necessary to use pain relief medications long-term.
This should be discussed with your physician to determine the best management approach for the elderly patient.
Best regards from the Allergy, Immunology, and Rheumatology Department of Changhua Hospital, Ministry of Health and Welfare.

Reply Date: 2018/08/23

More Info

When considering the management of arm pain in a diabetic patient with multiple chronic conditions, including hypertension, gout, and impaired kidney function, it is essential to weigh the benefits and risks of both injection therapy and oral medication. Your mother's insistence on receiving injections, despite the potential risks, raises important questions about the safety and efficacy of her treatment options.

Firstly, it's crucial to understand the nature of her arm pain. Chronic pain can stem from various causes, including musculoskeletal issues, neuropathy (common in diabetes), or even complications related to her other chronic conditions. Identifying the underlying cause of the pain is vital for effective treatment. If the pain is neuropathic, for example, certain medications like gabapentin or pregabalin may be more appropriate than injections.

Regarding the injections she has been receiving, it is important to clarify what substances are being administered. Common injections for pain relief include corticosteroids, which can effectively reduce inflammation and pain but may also elevate blood sugar levels and have potential side effects, especially in patients with compromised kidney function. Corticosteroids can lead to fluid retention, increased blood pressure, and further strain on the kidneys. Therefore, if her injections contain corticosteroids, this could be a significant concern given her existing health issues.

On the other hand, oral medications, such as non-steroidal anti-inflammatory drugs (NSAIDs), may also pose risks to kidney function, particularly in patients with pre-existing renal impairment. However, certain medications may be safer than others, and the choice of medication should be tailored to her specific health profile. For instance, acetaminophen is generally considered safer for the kidneys compared to NSAIDs, but it may not provide the same level of pain relief for inflammatory conditions.

Your concern about her preference for injections due to fears of weight gain or changes in appearance from oral medications is understandable. However, it is essential to have an open discussion with her about the potential risks and benefits of both treatment options. It may be beneficial to involve her healthcare provider in this conversation to ensure she understands the implications of her choices.

In terms of managing her diabetes, it is crucial to monitor her blood sugar levels closely, especially if she is receiving treatments that could affect her glucose control. Pain and stress can indeed elevate blood sugar levels, and any new medication or treatment should be assessed for its impact on her diabetes management.

Ultimately, the decision between injections and oral medications should be made collaboratively, considering her preferences, the potential risks to her kidney function, and the overall management of her chronic conditions. It may also be worthwhile to explore non-pharmacological approaches to pain management, such as physical therapy, acupuncture, or other complementary therapies, which could provide relief without the risks associated with medications.

In conclusion, while injections may provide immediate relief, they come with risks that must be carefully considered in the context of her overall health. A thorough evaluation by her healthcare provider, including a review of her current medications and health status, will help determine the safest and most effective approach to managing her arm pain.

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