Treatments and drugsBy Mayo Clinic Staff
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 target range can help prevent or delay the progression of diabetic neuropathy and may even improve some of the symptoms you already have. Your doctor will determine the best target range for you based on several factors, such as your age, how long you've had diabetes, and your overall health and the presence of other medical conditions.
For many people who have diabetes, Mayo Clinic generally recommends target blood sugar levels that are:
- Between 80 and 120 mg/dL, or 4.4 and 6.7 mmol/L, for people age 59 and younger who have no other underlying medical conditions
- Between 100 and 140 mg/dL, or 5.6 and 7.8 mmol/L, for people age 60 and older, or those who have other medical conditions, such as heart, lung or kidney disease
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, drink only in moderation
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), physical therapy or acupuncture, that may help with pain relief. Doctors frequently use them in conjunction with medications, but some may be effective on their own.
Pain-relieving treatments may include:
- Anti-seizure medications. Although drugs such as gabapentin (Gralise, Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Tegretol) 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, 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, weight gain, constipation 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.
Managing complications and restoring function
Specific treatments exist for many of the complications of neuropathy, including:
Feb. 24, 2015
- 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. To relieve mild signs and symptoms of gastroparesis — indigestion, belching, nausea or vomiting — doctors suggest eating smaller, more-frequent meals, reducing fiber and fat in the diet, and, for many people, eating soups and pureed foods. Dietary changes and medications may help relieve diarrhea, constipation and nausea.
- Low blood pressure on standing (orthostatic hypotension). This is often helped with simple lifestyle measures, such as avoiding alcohol, drinking plenty of water, and sitting or standing slowly. Your doctor may recommend an abdominal binder, a compression support for your abdomen, and compression stockings. Several medications, either alone or together, may be used to treat orthostatic hypotension.
- Sexual dysfunction. Sildenafil (Revatio, Viagra), tadalafil (Adcirca, Cialis) and vardenafil (Levitra) may improve sexual function in some men, but these medications aren't effective or safe for everyone. Mechanical vacuum devices may increase blood flow to the penis. Women may find relief 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/index.aspx. Accessed Dec. 17, 2014.
- Neuropathy (nerve damage). The American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/neuropathy/. Accessed Dec. 17, 2014.
- Steps to prevent or delay nerve damage. The American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/neuropathy/steps-to-prevent-or-delay.html. Accessed Dec. 17, 2014.
- Kidney disease (neuropathy). American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html. Accessed Dec. 17, 2014.
- Amato AA, et al. Peripheral neuropathy. In: Harrison's Principles of Internal Medicine. 18th ed. New York, N.Y.: The McGraw-Hill Companies; 2012. http://www.accessmedicine.com. Accessed Dec. 17, 2014.
- Feldman EL, et al. Treatment of diabetic neuropathy. http://www.uptodate.com/home. Accessed Dec. 17, 2014.
- Feldman EL, et al. Patient information: Diabetic neuropathy (beyond the basics). http://www.uptodate.com/home. Accessed Dec. 22, 2014.
- High blood pressure (hypertension). The American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/high-blood-pressure-hypertension.html. Accessed Dec. 22, 2014.
- Checking your blood glucose. The American Diabetes Association. http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-glucose-control/checking-your-blood-glucose.html. Accessed Dec. 23, 2014.
- Castro MR (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 3, 2014.