Diagnosis

Diabetic neuropathy is usually diagnosed based on your symptoms, your medical history and a physical exam. During the exam, your doctor is likely to check your muscle strength and tone, tendon reflexes, and sensitivity to touch, temperature and vibration.

Your doctor may also conduct tests that include:

  • Filament test. Sensitivity to touch may be tested using a soft nylon fiber called a monofilament.
  • Nerve conduction studies. This test measures how quickly the nerves in your arms and legs conduct electrical signals. It's often used to diagnose carpal tunnel syndrome.
  • Electromyography (EMG). Often performed along with nerve conduction studies, electromyography measures the electrical discharges produced in your muscles.
  • Quantitative sensory testing. This noninvasive test is used to assess how your nerves respond to vibration and changes in temperature.
  • Autonomic testing. If you have symptoms of autonomic neuropathy, your doctor may request special tests to look at your blood pressure in different positions and assess your ability to sweat.

The American Diabetes Association recommends that all people with diabetes have a comprehensive foot exam — either by a doctor or by a foot specialist (podiatrist) — at least once a year. In addition, your feet should be checked for sores, cracked skin, calluses, blisters, and bone and joint abnormalities at every office visit.

Treatment

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

Relieving pain

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:

  • 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.

Lifestyle and home remedies

These measures can help reduce your risk of diabetic neuropathy:

  • Keep your blood pressure under control. People with diabetes are more likely to have high blood pressure than are people who don't have diabetes. Having both high blood pressure and diabetes greatly increases your risk of complications because both damage your blood vessels and reduce blood flow. Try to keep your blood pressure in the range your doctor recommends, and be sure to have it checked at every office visit.
  • Make healthy food choices. Eat a balanced diet that includes a variety of healthy foods — especially fruits, vegetables and whole grains — and limit portion sizes to help achieve or maintain a healthy weight.
  • Be active every day. Daily activity protects your heart and improves blood flow. It also plays a major role in keeping your blood sugar and blood pressure under control. The American Diabetes Association generally recommends about 30 minutes of moderate exercise a day at least five times a week.

    If you have severe neuropathy and decreased sensation in your legs, your doctor may recommend that you participate in non-weight-bearing activities, such as bicycling or swimming.

  • Stop smoking. If you have diabetes and use tobacco in any form, you're more likely than are nonsmokers with diabetes to die of heart attack or stroke. And you're more likely to develop circulation problems in your feet. If you use tobacco, talk to your doctor about finding ways to quit.

Alternative medicine

There are a number of alternative treatments that may help relieve the pain of diabetic neuropathy, such as:

  • Capsaicin. When applied to the skin, capsaicin cream can reduce pain sensations in some people. Side effects may include a burning feeling and skin irritation.
  • Alpha-lipoic acid. This powerful antioxidant is found in some foods and may help relieve the symptoms of peripheral neuropathy.
  • Transcutaneous electrical nerve stimulation (TENS). Your doctor may prescribe this therapy, which can help prevent pain signals from reaching your brain. TENS delivers tiny electrical impulses to specific nerve pathways through small electrodes placed on your skin. Although safe and painless, TENS doesn't work for everyone or for all types of pain.
  • Acupuncture. Acupuncture may help relieve the pain of neuropathy, and generally doesn't have any side effects. Keep in mind that you may not get immediate relief with acupuncture and will likely require more than one session.

Coping and support

Living with diabetic neuropathy can be difficult and frustrating. If you find yourself getting down, it may help to talk to a counselor or therapist.

Members of support groups can also offer you encouragement, as well as advice about living with diabetic neuropathy. Ask your doctor about support groups in your area, or for a referral to a therapist. The American Diabetes Association offers online support through its website.

Preparing for your appointment

If you don't already see an endocrinologist, you'll likely be referred to one if you start showing signs of diabetes complications. An endocrinologist is a doctor who specializes in treating metabolic disorders, such as diabetes. You may also be referred to a doctor who specializes in treating nervous system problems (neurologist).

To prepare for your appointment, you may want to:

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet.
  • Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any major stresses or recent life changes.
  • Make a list of all medications, vitamins and supplements you're taking.
  • Write down your recent blood sugar levels, if you check them at home.
  • Ask a family member or friend to come with you. It can be difficult to remember everything your doctor tells you during an appointment. Someone who accompanies you may remember something that you missed or forgot.
  • Write down questions to ask your doctor.

Preparing a list of questions can help you make the most of your time with your doctor. For diabetic neuropathy, some basic questions include:

  • Is diabetes the most likely cause of my symptoms?
  • Do I need tests to confirm the cause of my symptoms? Do these tests require any special preparation?
  • Is this condition temporary or long lasting?
  • If I control my blood sugar, will these symptoms improve or go away?
  • Are there treatments available, and which 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 other doctors, a certified diabetes educator or a dietitian?

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

  • How is your blood sugar control?
  • When did you begin experiencing symptoms?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • Does anything seem to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • What aspects of diabetes management do you find most challenging?
  • What might help you manage your diabetes better?
Feb. 24, 2015
References
  1. 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.
  2. Neuropathy (nerve damage). The American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/neuropathy/. Accessed Dec. 17, 2014.
  3. 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.
  4. Kidney disease (neuropathy). American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/kidney-disease-nephropathy.html. Accessed Dec. 17, 2014.
  5. 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.
  6. Feldman EL, et al. Treatment of diabetic neuropathy. http://www.uptodate.com/home. Accessed Dec. 17, 2014.
  7. Feldman EL, et al. Patient information: Diabetic neuropathy (beyond the basics). http://www.uptodate.com/home. Accessed Dec. 22, 2014.
  8. 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.
  9. 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.
  10. Castro MR (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 3, 2014.