Diabetic neuropathy

To figure out if you have diabetic neuropathy, your healthcare professional gives you a physical exam. You're also asked questions about your symptoms and medical history.

During the exam, your healthcare professional most often checks:

• Your overall muscle strength and tone.
• The reflexes of your muscles and tendons.
• How sensitive you are to touch, pain, temperature and vibration.

Along with a physical exam, your healthcare professional may do or order certain tests. The tests can help confirm whether or not you have diabetic neuropathy. They may include:

• Filament testing. A soft nylon fiber called a monofilament is brushed over areas of your skin. This is done to check how sensitive you are to touch.
• Sensory testing. This test is used to tell how your nerves respond to vibration and changes in temperature.
• Nerve conduction testing. This test measures how quickly the nerves in your arms and legs conduct electrical signals.
• Electromyography. Called needle testing, this test is often done along with nerve conduction studies. It measures electrical activity in your muscles.
• Autonomic testing. Special tests may be done to determine how your blood pressure and heartbeat change while you are in different positions. The tests also can help identify whether your sweating is within the standard range.

Diabetic neuropathy has no known cure. The goals of treatment are to:

• Slow the disease from getting worse.
• Relieve pain.
• Manage health issues linked with diabetic neuropathy.
• Help the parts of the body affected by neuropathy work better.

Slowing the disease from getting worse

The key way to prevent or delay nerve damage is to keep your blood sugar within your target range. Good blood sugar control may even improve some of your current symptoms. Your healthcare professional decides on the best target range for you based on certain factors. These include your age, how long you've had diabetes and your overall health.

Target ranges for blood sugar levels need to be tailored for each person. But, in general, the American Diabetes Association (ADA) recommends the following target blood sugar levels for most people with diabetes:

• Between 80 and 130 mg/dL (4.4 and 7.2 mmol/L) before meals.
• Less than 180 mg/dL (10.0 mmol/L) two hours after meals.

In general, the ADA recommends an A1C of 7.0% or lower for most people with diabetes.

Some healthcare professionals encourage slightly lower blood sugar levels for younger people with diabetes. They also may recommend slightly higher levels for older people with other medical conditions and who may be more at risk of low blood sugar complications. In general, your healthcare professional might recommend the following target blood sugar levels before meals:

• Between 80 and 120 mg/dL (4.4 and 6.7 mmol/L) for people age 59 and younger who have no other medical conditions.
• Between 100 and 140 mg/dL (5.6 and 7.8 mmol/L) for people age 60 and older, or for those who have other medical conditions, including heart, lung or kidney disease.

Other ways to help slow or prevent neuropathy from getting worse include:

• • Keep your blood pressure under control.
• Stay at a healthy weight.
• Get regular physical activity.

Relieving pain

Many prescription medicines are available for diabetes-related nerve pain. But they don't work for everyone. If your healthcare professional recommends medicine, be sure to ask about the benefits and side effects.

Pain-relieving prescription treatments include:

• Anti-seizure medicines. Some medicines used to treat seizure disorders also are used to ease nerve pain. The American Diabetes Association recommends starting with pregabalin (Lyrica). Gabapentin (Gralise, Neurontin) also is an option. Side effects can include feeling drowsy or dizzy, and getting swelling in the hands and feet.

• Antidepressants. Some of these medicines ease nerve pain even if you aren't depressed. Tricyclic antidepressants may help with mild to moderate nerve pain. Medicines in this class include amitriptyline, nortriptyline (Pamelor) and desipramine (Norpramin). Side effects can include dry mouth, constipation, drowsiness and trouble focusing. These medicines also can cause dizziness when changing position, such as from lying down to standing. This is a symptom of a sudden drop in blood pressure called orthostatic hypotension.

  Another type of antidepressant may help with nerve pain and have fewer side effects. It's called a serotonin and norepinephrine reuptake inhibitor (SNRI). The American Diabetes Association recommends the SNRI duloxetine (Cymbalta) as a first treatment. Another that may be used is venlafaxine (Effexor XR). Side effects can include nausea, sleepiness, dizziness, less appetite and constipation.

Sometimes, an antidepressant may be combined with an anti-seizure medicine. These medicines also can be used with certain pain relievers sold without a prescription, such as acetaminophen (Tylenol, others).Or you might get relief from a skin patch, cream or gel with a substance that prevents pain such as lidocaine.

Managing complications and restoring function

To manage health conditions linked with diabetic neuropathy, you may need care from specialists. For instance, a specialist called a urologist can treat urinary tract problems. A heart specialist, called a cardiologist, can help prevent or treat heart-related conditions.

The treatment you need depends on the neuropathy-related medical conditions you have:

• Urinary tract problems. Some medicines affect the bladder. Your healthcare professional may suggest that you stop or change these medicines. Some bladder problems can be helped with a strict urination schedule. Or they can be helped by urinating every few hours while putting gentle pressure on the area below the bellybutton. Other methods may be needed to remove urine from a nerve-damaged bladder. For example, the bladder can be drained by placing a thin, flexible tube called a catheter into it.
• Digestive problems. Diabetic neuropathy may slow the gut and cause constipation or slow movement of food from the stomach. This slow movement of food is called gastroparesis. Gastroparesis can cause symptoms such as belching, upset stomach or vomiting. You might get relief from these symptoms if you eat smaller, more frequent meals that are low in fiber and fat. Diet changes and medicines may help ease gastroparesis, diarrhea, constipation and upset stomach.

• Low blood pressure when you stand. This condition is called orthostatic hypotension Treatment starts with simple lifestyle changes. Drink plenty of water. Get physical activity. Don't drink alcohol. Slowly change positions such as from sitting to standing. Sleep with the head of the bed raised 4 to 6 inches to help prevent high blood pressure overnight.

  Your healthcare professional also may suggest compression support for your stomach area and thighs. Examples of products that apply gentle pressure include an abdominal binder and compression shorts or stockings. Many medicines, taken either alone or together, may be used to treat orthostatic hypotension.

• Sexual challenges. Medicines taken by mouth or by shot may improve sexual function in some men. But they aren't safe and effective for everyone. A pump called a vacuum construction device may boost blood flow to the penis. Women may benefit from vaginal lubricants.

These measures can help you feel better overall and lower your risk of diabetic neuropathy:

• Keep your blood pressure under control. If you have high blood pressure and diabetes, you have an even higher risk of other medical problems. Try to keep your blood pressure in the range your healthcare professional recommends. Have it checked at every medical visit.
• Make healthy food choices. Eat a balanced diet. Include a variety of healthy foods, especially vegetables, fruits and whole grains. Limit portion sizes to help reach or stay at a healthy weight.

• Be active every day. Exercise helps lower blood sugar, improves blood flow and keeps your heart healthy. Work up to 150 minutes of moderate or 75 minutes of vigorous aerobic exercise a week. Or do a mix of moderate and vigorous exercise. Also aim to do 2 to 3 sessions of strength training a week. Plus, it's a good idea to take a break from sitting every 30 minutes. Get a few quick bursts of activity during your breaks.

  Talk with your healthcare professional or a physical therapist before you start exercising. If you have less feeling in your legs, some types of exercise may be safer than others. For example, walking with proper shoes tends to be safe. If you have a foot injury or a sore, stick with exercise that doesn't involve putting weight on your injured foot.

• If you smoke, quit. Using tobacco in any form makes you more likely to develop poor blood flow in your feet. And that can cause problems with healing. If you use tobacco, ask your healthcare professional about resources available to help you quit.

Alternative treatments might help with pain relief. They may help on their own or along with medicines. But check with your healthcare professional before using any alternative treatment or dietary supplement. Your healthcare professional needs to make sure that they don't affect your main treatment or cause side effects.

For diabetic neuropathy, you may want to try:

• Capsaicin. When capsaicin cream is put on the skin, it can ease pain in some people. Side effects may include a burning feeling and skin irritation.
• Alpha-lipoic acid. This powerful antioxidant is found in some foods. It may help relieve nerve pain symptoms in some people.
• Acetyl-L-carnitine. This nutrient is made in the body. A lab-made version is sold as a supplement. It may ease nerve pain in some people.
• Transcutaneous electrical nerve stimulation (TENS). This prescription treatment may help prevent pain signals from reaching the brain. TENS sends tiny electrical impulses to specific nerve pathways through small electrode stickers placed on the skin. TENS is safe and painless. But it doesn't work for everyone or for all types of pain.
• Acupuncture. With this technique, a practitioner places very fine needles into the skin. Acupuncture may help relieve the pain of neuropathy. And in general, it doesn't have any side effects. Keep in mind that you may not get relief right away. You may need more than one acupuncture session.

Living with diabetic neuropathy may be a challenge at times. Support groups can offer encouragement and advice. Ask your healthcare professional if there are any groups in your area. Or ask for a referral to a therapist. If you feel depressed, it can help to talk to a counselor or therapist. The American Diabetes Association also offers online support through its website.

Doctors who specialize in treating metabolic disorders and diabetes are called endocrinologists. If you don't already see an endocrinologist, you'll likely be referred to one if you show symptoms of diabetes complications. If you have symptoms of neuropathy, you may be referred to a specialist in brain and nervous system problems. This doctor is called a neurologist.

To prepare for your appointment, take the following steps:

• Ask how to get ready. When you make the appointment, ask if there's anything you need to do beforehand. For example, you might be told to limit what you eat and drink.
• Make a list of any symptoms you're having. Include all symptoms, even if some may not seem related to the reason for the appointment.
• Make a list of key personal information. Include any major stresses or recent life changes.
• Make a list of all medicines, vitamins, herbs and supplements you take. Include the doses.
• Bring a record of your recent blood sugar levels if you check them at home.
• Ask a family member or friend to come with you. It can be hard to remember everything your healthcare professional tells you during a checkup. Someone who joins you may remember something that you missed or forgot.
• Make a list of questions to ask your healthcare professional.

Some basic questions to ask may include:

• Is diabetic neuropathy the most likely cause of my symptoms?
• Do I need tests to confirm the cause of my symptoms? How do I prepare for these tests?
• If I manage my blood sugar, will my symptoms improve or go away?
• What treatments do you recommend?
• What types of side effects can I expect from treatment?
• I have other health conditions. How can I best manage them together?
• Are there brochures or other printed material I can take with me? What websites do you recommend?
• Do I need to see a certified diabetes care and education specialist, a registered dietitian, or other specialists?

What to expect from your doctor

Your healthcare professional is likely to ask you questions such as:

• How well are you managing your diabetes?
• When did you start having symptoms?
• Do you always have symptoms or do they come and go?
• What impact do your symptoms have on your daily life?
• Does anything seem to improve your symptoms?
• What, if anything, seems to make your symptoms worse?
• What's challenging about managing your diabetes?
• What might help you manage your diabetes better?