The goals of treating diabetic neuropathy are to prevent the disease from getting worse and to reduce the symptoms of the disease.
Tight control of blood sugar (glucose) is important to prevent symptoms and problems from getting worse.
Before you read this article, we would like to recommend this article to understand first what actually a Diabetic Neuropathy is ?
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
Providing effective pain relief is one of the most difficult parts of managing diabetic neuropathy. 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.
Medications may be used to reduce the symptoms in the feet, legs, and arms. These medications include:
- Antidepressant drugs, such as amitriptyline (Elavil), doxepin (Sinequan), or duloxetine (Cymbalta)
- Antiseizure medications, such as gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol), and valproate (Depakote)
- Drugs that block bladder contractions may be used to help with urinary control problems.
- Erythromycin, domperidone (Motilium), or metoclopramide (Reglan) may help with nausea and vomiting.
- Pain medications (analgesics) may work for some patients on a short-term basis, but in most cases they do not provide much benefit.
- Phosphodiesterase type 5 (PDE-5) drugs, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are safe and effective for treating impotence in patients with diabetes.
- Capsaicin can be used topically to reduce pain.
Regular foot exams are important to identify small infections and prevent foot injuries from getting worse. If foot injuries go unnoticed for too long, amputation may be required.
Diabetic neuropathy can cause a number of serious complications, including
- Loss of a limb. Because nerve damage can cause a lack of feeling in your feet, cuts and sores may go unnoticed and eventually become severely infected or ulcerated — a condition in which the skin and soft tissues break down. The risk of infection is high because diabetes reduces blood flow to your feet.Infections that spread to the bone and cause tissue death (gangrene) may be impossible to treat and require amputation of a toe, foot or even the lower leg. More than half the nontraumatic lower limb amputations performed every year in the United States are due to diabetes.
- Charcot joint. This occurs when a joint, usually in the foot, deteriorates because of nerve damage. Charcot joint is marked by pain, as well as swelling, instability and sometimes deformity in the joint itself.
- Urinary tract infections and urinary incontinence. Damage to the nerves that control your bladder can prevent it from emptying completely. This allows bacteria to multiply in your bladder and kidneys, leading to urinary tract infections. Nerve damage can also affect your ability to feel when you need to urinate or to control the muscles that release urine.
- Hypoglycemia unawareness. Normally, when your blood sugar drops too low — below 70 milligrams per deciliter (mg/dL), or below 3.9 millimoles per liter (mmol/L) — you develop symptoms such as shakiness, sweating and a fast heartbeat. These symptoms alert you to the problem so that you can take steps to raise your blood sugar quickly. Autonomic neuropathy can interfere with your ability to notice these symptoms. This is extremely serious — untreated hypoglycemia can be fatal.
- Low blood pressure. Damage to the nerves that control circulation can affect your body’s ability to adjust blood pressure. This can cause a sharp drop in pressure when you stand after sitting (orthostatic hypotension), which may lead to dizziness and fainting.
- Digestive problems. Damage to the nerves in the digestive system can cause a range of problems, including severe constipation or diarrhea — or alternating bouts of constipation and diarrhea — as well as nausea, vomiting, bloating and loss of appetite. One particularly serious digestive problem is gastroparesis, a condition in which the stomach empties too slowly or not at all. This can interfere with digestion, cause nausea and vomiting, and severely affect blood sugar levels and nutrition.
- Sexual dysfunction. Autonomic neuropathy often damages the nerves that affect the sex organs, leading to erectile dysfunction in men and problems with lubrication and arousal in women.
- Increased or decreased sweating. When the sweat glands don’t function normally, your body isn’t able to regulate its temperature properly. A reduced or complete lack of perspiration (anhidrosis) can be life-threatening. Autonomic neuropathy also causes excessive sweating, particularly at night.
- Social isolation. The pain, disability and embarrassment caused by nerve damage can rob people — particularly older adults — of their independence, leaving them increasingly isolated and depressed.
In addition, neuropathy may mask angina, the warning chest pain for Heart disease and heart attack.
Tight control of blood sugar levels may prevent neuropathy in many people with type 1 diabetes, and may reduce the severity of symptoms.
In addition, regular foot care can prevent a small infection from getting worse. This is why no appointment for diabetes care is complete without a thorough foot examination.