Q: I am a 45 years old diabetic man having pain in my feet and hands for the last two days. I am finding it extremely difficult to walk or to hold something in my hands, especially when I wake up from sleep. My serum uric acid is 7.4 mg/dl. What should I exclude from my diet to get back to normal? The doctor has prescribed me Mysospaz thrice daily for 3 days. I have a family history of arthritis. Please advise.

A:We are dealing with two separate problems; one is hyperuricaemia. Your symptom of pain in the hands and feet is possible in diabetics. But you have not mentioned the status of your diabetic control. Usually, pain is in the lower limbs presents at rest worsening at night. There may be numbness and tingling in the palms and the sole. Good physical examination will reveal the nature of the problem, usually a diabetic neuropathy. The severity of neuropathy may have nothing to do with the correctness of diabetic control. However, your diabetic control must be good and you have to be in touch with a good internal physician or diabetologist / endocrinologist for appropriate management of this. You will also need to be in touch with your physician regarding your diet because the calorific requirement for a diabetic needs to be calculated very carefully looking at height, weight, activity levels and blood sugar levels. I cannot guide you without these parameters being available.

Pain from hyperuricaemia is usually in the lower limbs particularly the joint of the great toe but may also be present in the upper limb also. This pain may also be worse at night. This can reduce only with reduction in the uric acid levels either by diet control or by drugs. Diets that are rich in purines (a component of high protein diet) if you are a vegetarian the usual foods to be avoided are those that contain large beans (soya beans, rajma, large Bengal gram). If you are a non-vegetarian, please stay off red meat (mutton, beef) fish is safer and healthier.

I am not sure if Myospaz will really give you relief. Pain in the hands and feed are rarely because of muscle spasm. Therefore you do not need a muscle relaxant for that. Even a simple analgesic like Paracetamol will work (it may be safer). If you are diabetic you are vulnerable to kidney damage and I would recommend that you do not self medicate with painkillers or anti-inflammatory drugs. Low doses of some anti-inflammatory also retain uric acid for example (Aspirin) therefore taking these without prescription also raises your Uric acid levels.

It is possible your pain is also from other causes. Pain in the hands and feet may be as part of any arthritic condition. But these are usually worse in the morning and associated with morning stiffness. From the brief description you have given me, I do not think you have that.