Diabetic neuropathy has no known cure. Treatment for diabetic neuropathy focuses on:
- Slowing progression of the disease
- Relieving pain
- Managing complications and restoring function
Slowing progression of the disease
Consistently keeping blood sugar within a narrow target range can help delay the progression of peripheral neuropathy and may even cause an improvement in symptoms you already have. With intense glucose control you may reduce your overall risk of diabetic neuropathy by as much as 60 percent.
For intense blood sugar control, your goals will likely be:
- Blood sugar level before meals — 70 to 130 mg/dL (3.9 to 7.2 mmol/L)
- Blood sugar level two hours after meals — less than 180 mg/dL (10 mmol/L)
- Hemoglobin A1C, an indicator of your blood sugar control for the past few months — less than 7 percent
A1C is the amount of sugar that has attached to hemoglobin — the substance that carries oxygen inside red blood cells — in your blood. The higher your average blood sugar level for the past two or three months, the higher your A1C number will be. People who don't have diabetes have an A1C between 4 and 6 percent.
To help slow nerve damage:
- Follow your doctor's recommendations for good foot care
- Keep your blood pressure under control
- Follow a healthy-eating plan
- Get plenty of physical activity
- Maintain a healthy weight
- Stop smoking
- Avoid alcohol or, if drinking is allowed, have no more than one drink a day if you're a woman and no more than two drinks a day if you're a man
Several medications are used to relieve nerve pain, but they don't work for everyone and most have side effects that must be weighed against the benefits they offer. There are also a number of alternative therapies, such as capsaicin cream (made from chili peppers) and acupuncture, that may help with pain relief. Doctors frequently use them in conjunction with medications, but some may be effective on their own.
Among the pain-relieving treatments that may be tried are the following:
- Anti-seizure medications. Although drugs such as gabapentin (Gralise, Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Tegretol, others) are used to treat seizure disorders (epilepsy), they're also prescribed for nerve pain. Side effects may include drowsiness, dizziness and swelling.
- Antidepressants. Tricyclic antidepressant medications, such as amitriptyline, nortriptyline (Pamelor), desipramine (Norpramin) and imipramine (Tofranil), may provide relief for mild to moderate symptoms by interfering with chemical processes in your brain that cause you to feel pain, but they also cause a number of side effects, such as dry mouth, sweating, sedation and dizziness. For some people, antidepressants called serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta), can relieve pain with fewer side effects. Possible side effects of SNRIs include nausea, sleepiness, dizziness, decreased appetite and constipation.
- Lidocaine patch. This patch contains the topical anesthetic lidocaine. You apply it to the area where your pain is most severe. It has almost no side effects, although it may cause a rash in some people.
- Opioids. Opioid analgesics, such as tramadol (Conzip, Ultram, others) or oxycodone (Oxecta, OxyContin, others), may be used to relieve pain. However, this class of medications may produce serious side effects, including addiction, constipation, drowsiness and headaches, that make long-term use of them undesirable. The Food and Drug Administration recently released warnings about tramadol, which include the risk of seizure and the risk of suicide for people with histories of emotional disturbances or who are prone to addiction.
Managing complications and restoring function
Specific treatments exist for many of the complications of neuropathy, including:
Oct. 28, 2014
- Urinary tract problems. Antispasmodic medications (anticholinergics), behavioral techniques such as timed urination, and devices such as pessaries — rings inserted into the vagina to prevent urine leakage — may be helpful in treating loss of bladder control. A combination of therapies may be most effective.
- Digestive problems. Gastroparesis can usually be helped by eating smaller, more-frequent meals, reducing fiber and fat in the diet, and, for many people, eating soups and pureed foods. Diarrhea, constipation and nausea may be helped with dietary changes and medications.
- Low blood pressure on standing (orthostatic hypotension). This is often helped with simple lifestyle measures, such as avoiding alcohol, drinking plenty of water and standing up slowly. Your doctor may recommend an abdominal binder, a compression support for your abdomen, and compression stockings. Several medications, either alone or together, also may be used to treat orthostatic hypotension.
- Sexual dysfunction. Sildenafil (Revatio,Viagra), tadalafil (Adcirca, Cialis) and vardenafil (Levitra, Staxyn) can improve sexual function in some men, but these medications aren't effective or safe for everyone. When medications don't work, many men turn to vacuum devices, or, if these fail, to penile implants. Women may be helped with vaginal lubricants.
- Diabetic neuropathies: The nerve damage of diabetes. National Institute of Diabetes and Digestive and Kidney Diseases. http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/neuropathies.pdf. Accessed Nov. 10, 2011.
- Feldman EL, et al. Treatment of diabetic neuropathy. http://www.uptodate.com/home/index.html. Accessed Nov. 10, 2011.
- Bril V, et al. Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnosticc Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2011;76:1758.
- Ultram (tramadol hydrochloride), Ultracet (tramadol hydrochloride/acetaminophen): Label change. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm213264.htm. Accessed Nov. 20. 2011.
- Neuropathy (nerve damage). The American Diabetes Association. http://www.diabetes.org/living-withdiabetes/complications/neuropathy/. Accessed Nov. 21, 2011.
- Standards of medical care in diabetes, 2011. American Diabetes Association. Diabetes Care. 2011;34(suppl):11.
- Kidney disease (neuropathy). American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html. Accessed Nov. 21, 2011.
- Amato AA, et al. Peripheral neuropathy. In: Fauci AS, et al. Harrison's Principles of Internal Medicine. 18th ed. New York, N.Y.: McGraw-Hill Medical; 2012. http://www.accessmedicine.com/content.aspx?aID=9148461. Accessed Nov. 21, 2011.
- Diabetic neuropathy. The AGS Foundation for Health in Aging. http://www.healthinaging.org/public_education/diabetes/neuropathy.php. Accessed Nov. 21, 2011.
- Diabetic neuropathies. American Diabetes Association. Diabetes Care. 2005;28:956.
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