Diabetic Neuropathy

Treatment Overview

There is currently no cure for diabetic neuropathy. When you have it, treatment is done to keep the disease from getting worse. Good control of diabetes over time is the key to treating neuropathy. Getting to and staying at a healthy weight is a good start.

To help control your diabetes, eat food that is good for you and exercise. Controlling diabetes means maintaining blood sugar levels within the target range—near normal hemoglobin A1c (HbA1c) levels. This will do more than anything else to help prevent diabetic neuropathy from getting worse.

For more information on good diabetes control, see the topics Type 1 Diabetes: Living With the Disease or Type 2 Diabetes: Living With the Disease.

Initial treatment

Treatment for diabetic neuropathy depends on your symptoms and the type of neuropathy that you have. In general, treatment focuses on reducing current symptoms and preventing the condition from getting worse by keeping your blood sugar level within a narrow target range—hemoglobin A1c (HbA1c) levels near normal. You can keep your blood sugar levels within the target range by taking your insulin or oral diabetes medicine as prescribed, checking your blood sugar levels, following your diet for diabetes, exercising, and seeing your doctor regularly. For more information, see the topics Type 1 Diabetes: Living With the Disease or Type 2 Diabetes: Living With the Disease.

Also, it is important to properly care for your feet when you have diabetic neuropathy. Diabetic neuropathy may cause a loss of feeling in your feet. It is possible for a sore or other foot problem to go unnoticed. Without proper foot care, an untreated foot sore can lead to a serious infection or possibly amputation.³ For more information, see:

Diabetes: Taking care of your feet.

It is also wise to maintain healthy habits such as seeing your doctor regularly, controlling your blood pressure, eating a balanced diet, exercising regularly, not smoking, and limiting or avoiding alcohol. Additional treatment depends on the specific type of diabetic neuropathy that you have along with your current symptoms.

Many people with peripheral neuropathy have mild to severe pain in specific parts of their bodies. Talk with your doctor about treatment that can reduce your pain and improve your physical functioning, mood, and mental well-being. These treatments may include:

• Medicines such as pain relievers or creams to relieve pain. Prescription medicines often used to reduce pain from diabetic neuropathy may include medicines that are more commonly used to treat depression, such as tricyclic antidepressants and the antidepressant duloxetine hydrochloride, and medicines that control seizures, such as pregabalin and gabapentin. These medicines may be tried to reduce your pain even though you do not have depression or seizures.
• Complementary therapies such as acupuncture. Acupuncture has not been well studied as a treatment for diabetic neuropathy. But some studies show that it may help with pain.⁴
• Physical therapy such as exercises, stretching, and massage. If you are told to use heat or ice, be careful. Neuropathy can make it hard for you to feel changes in temperature.
• Transcutaneous electrical nerve stimulation (TENS), which is a type of therapy that attempts to reduce pain by applying brief pulses of electricity to nerve endings in the skin.

Autonomic neuropathy—which affects nerves that regulate internal functions—can affect digestion, urination, sweating, sexual function, blood pressure, and other involuntary body functions. Some symptoms of autonomic neuropathy can be hard to manage, but others respond well to treatment:

• Mild constipation. Eating small, frequent meals that are high in fiber and low in fat may help.
• Frequent diarrhea. Eating foods that are high in fiber may help. You may need medicines that slow the rate at which digested food and waste travel through the intestines, or you may need antibiotics such as tetracycline, amoxicillin, or metronidazole.
• Mild gastroparesis. This is a condition that causes the stomach to empty very slowly. It may get better if you eat small, frequent meals that are low in fiber and fat. Medicines that help the stomach empty more quickly may also be needed. Controlling blood sugar levels may reduce symptoms of gastroparesis.⁵
• Abnormal sweating. If you sweat a lot, try to avoid intense heat and humidity. If you sweat severely while eating certain foods, anticholinergic medicines may help. But these medicines have side effects that may sometimes be more troublesome than the abnormal sweating. Botulinum toxin (Botox) injections may also help.⁶ If you don't sweat enough, you can use moisturizers to help with dry or cracked skin. Drinking more water can prevent overheating. Try to avoid places that are very hot or very cold.
• Lack of awareness of low blood sugar level. This is also called hypoglycemia unawareness. You can adjust your insulin and allow your blood sugar levels to be a little bit higher than the normal range. Usually it is recommended that you keep your hemoglobin A1c (HbA1c) at near normal levels.
• Urinary problems. Urinary problems can be treated with antibiotics for urinary tract infections and medicines to improve bladder control.
• Sexual problems. Your doctor may suggest using medicines or devices to improve erections. Or you may need nonprescription lubricants and estrogen creams for vaginal dryness. For more information, see sexual problems.
• Blood pressure problems. Blood pressure problems can be treated with medicines and by wearing support stockings (also called compression stockings).

Ongoing treatment

Ongoing treatment for diabetic neuropathy includes making sure your blood sugar levels stay tightly controlled within a narrow target range. Tight blood sugar control means a near normal level of hemoglobin A1c (HbA1c). You also need to practice wise health habits such as seeing your doctor regularly, controlling your blood pressure, getting regular exercise, limiting or avoiding alcohol, and not smoking. Also, take good care of your feet so that foot sores and other foot problems do not develop. For more information, see:

Diabetes: Taking care of your feet.

Other treatment is tailored to your specific symptoms and the type of diabetic neuropathy that you have.

Many people with peripheral neuropathy—which affects nerves that supply sensation and touch—have mild to severe pain in specific parts of their bodies. Treatment can reduce pain and improve physical functioning, mood, and mental well-being and may include:

• Medicines such as nonprescription pain relievers or creams to relieve pain. The most common medicines used to treat symptoms of diabetic neuropathy include anticonvulsant drugs such as pregabalin and gabapentin, tricyclic antidepressants, and the antidepressant duloxetine hydrochloride.
• Complementary therapies such as acupuncture. Acupuncture has not been well studied as a treatment for diabetic neuropathy. But some studies show that it may help with pain.
• Physical therapy such as exercises, stretching, and massage. If you are told to use heat or ice, be careful. Neuropathy makes it hard for you to feel changes in temperature.
• Transcutaneous electrical nerve stimulation (TENS), which is a type of therapy that tries to reduce pain by applying brief pulses of electricity to nerve endings in the skin.

Autonomic neuropathy—which affects nerves that regulate internal functions—can cause problems with digestion, urination, sweating, sexual function, blood pressure, and other involuntary body functions. Some symptoms of autonomic neuropathy can be hard to manage, but others respond well to treatment:

• Mild constipation. Eating small, frequent meals that are high in fiber and low in fat may help.
• Frequent diarrhea. Eating foods that are high in fiber may help. You may need medicines that slow the rate at which digested food and waste travel through the intestines, or you may need antibiotics such as tetracycline, amoxicillin, or metronidazole.
• Mild gastroparesis. This is a condition that causes the stomach to empty very slowly. It may get better if you eat small, frequent meals that are low in fiber and fat. Medicines that help the stomach empty more quickly may also be needed. Controlling blood sugar levels may reduce symptoms of gastroparesis.⁵
• Abnormal sweating. If you sweat a lot, try to avoid intense heat and humidity. If you sweat severely while eating certain foods, anticholinergic medicines may help. But these medicines have side effects that may sometimes be more troublesome than the abnormal sweating. Botulinum toxin (Botox) injections may also help.⁶ If you don't sweat enough, you can use moisturizers to help with dry or cracked skin. Drinking more water can prevent overheating. Try to avoid places that are very hot or very cold.
• Lack of awareness of low blood sugar level. This is also called hypoglycemia unawareness. You can adjust your insulin and allow your blood sugar levels to be a little bit higher than the normal range. Usually it is recommended that you keep your hemoglobin A1c (HbA1c) near normal.
• Urinary problems. Urinary problems can be treated with antibiotics for urinary tract infections and medicines to improve bladder control.
• Sexual problems. Your doctor may suggest using medicines or devices to improve erections. Or you may need nonprescription lubricants and estrogen creams for vaginal dryness. For more information, see sexual problems.
• Blood pressure problems. Blood pressure problems can be treated with medicines and by wearing support stockings (also called compression stockings).

Treatment if the condition gets worse

If diabetic neuropathy gets worse, you may have serious problems such as severe gastroparesis, bladder infections, or foot problems. In addition to striving for tightly controlled target range blood sugar levels—hemoglobin A1c (HbA1c) near normal—and taking good care of your feet, you may need further treatment if diabetic neuropathy progresses.

Diabetic neuropathy is a major risk factor for foot infections or foot ulcers leading to amputation.³ It is possible to have permanent disfigurement in one or both of your feet—Charcot foot—from diabetic neuropathy. Surgery is sometimes needed to correct deformed joints that can result from Charcot foot. See a picture of Charcot foot .

Severe gastroparesis may require other treatment, such as medicines that empty the stomach more quickly or a feeding tube that is inserted into the stomach.⁵

Severe bladder infections or other bladder problems, such as loss of control, may require further diagnostic testing and treatments such as medicines or surgery to improve bladder function.

Also, it is common to experience symptoms of depression with any chronic disease, such as diabetes or diabetic neuropathy. Seeking help for depression may improve your overall well-being and aid in the treatment of your condition.

What To Think About

No matter what you or your doctor try, you may not be pain-free. Be clear with your doctor about what is helping and what is not. You and your doctor can work together to find the right combination of medicine and other treatments to help you the most.

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Author:	Caroline Rea, RN, BS, MS	Last Updated: June 3, 2008
Medical Review:	Martin Gabica, MD - Family Medicine Barrie J. Hurwitz, MD - Neurology
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