Diabetic neuropathy has no known cure. The goals of treatment are to:
- Slow the disease from getting worse.
- Relieve pain.
- Manage health issues linked with diabetic neuropathy.
- Help the parts of the body affected by neuropathy work better.
Slowing the disease from getting worse
The key way to prevent or delay nerve damage is to keep your blood sugar within your target range. Good blood sugar control may even improve some of your current symptoms. Your healthcare professional decides on the best target range for you based on certain factors. These include your age, how long you've had diabetes and your overall health.
Target ranges for blood sugar levels need to be tailored for each person. But, in general, the American Diabetes Association (ADA) recommends the following target blood sugar levels for most people with diabetes:
- Between 80 and 130 mg/dL (4.4 and 7.2 mmol/L) before meals.
- Less than 180 mg/dL (10.0 mmol/L) two hours after meals.
In general, the ADA recommends an A1C of 7.0% or lower for most people with diabetes.
Some healthcare professionals encourage slightly lower blood sugar levels for younger people with diabetes. They also may recommend slightly higher levels for older people with other medical conditions and who may be more at risk of low blood sugar complications. In general, your healthcare professional might recommend the following target blood sugar levels before meals:
- Between 80 and 120 mg/dL (4.4 and 6.7 mmol/L) for people age 59 and younger who have no other medical conditions.
- Between 100 and 140 mg/dL (5.6 and 7.8 mmol/L) for people age 60 and older, or for those who have other medical conditions, including heart, lung or kidney disease.
Other ways to help slow or prevent neuropathy from getting worse include:
- Keep your blood pressure under control.
- Stay at a healthy weight.
- Get regular physical activity.
Relieving pain
Many prescription medicines are available for diabetes-related nerve pain. But they don't work for everyone. If your healthcare professional recommends medicine, be sure to ask about the benefits and side effects.
Pain-relieving prescription treatments include:
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Anti-seizure medicines. Some medicines used to treat seizure disorders also are used to ease nerve pain. The American Diabetes Association recommends starting with pregabalin (Lyrica). Gabapentin (Gralise, Neurontin) also is an option. Side effects can include feeling drowsy or dizzy, and getting swelling in the hands and feet.
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Antidepressants. Some of these medicines ease nerve pain even if you aren't depressed. Tricyclic antidepressants may help with mild to moderate nerve pain. Medicines in this class include amitriptyline, nortriptyline (Pamelor) and desipramine (Norpramin). Side effects can include dry mouth, constipation, drowsiness and trouble focusing. These medicines also can cause dizziness when changing position, such as from lying down to standing. This is a symptom of a sudden drop in blood pressure called orthostatic hypotension.
Another type of antidepressant may help with nerve pain and have fewer side effects. It's called a serotonin and norepinephrine reuptake inhibitor (SNRI). The American Diabetes Association recommends the SNRI duloxetine (Cymbalta) as a first treatment. Another that may be used is venlafaxine (Effexor XR). Side effects can include nausea, sleepiness, dizziness, less appetite and constipation.
Sometimes, an antidepressant may be combined with an anti-seizure medicine. These medicines also can be used with certain pain relievers sold without a prescription, such as acetaminophen (Tylenol, others).Or you might get relief from a skin patch, cream or gel with a substance that prevents pain such as lidocaine.
Managing complications and restoring function
To manage health conditions linked with diabetic neuropathy, you may need care from specialists. For instance, a specialist called a urologist can treat urinary tract problems. A heart specialist, called a cardiologist, can help prevent or treat heart-related conditions.
The treatment you need depends on the neuropathy-related medical conditions you have:
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Urinary tract problems.
Some medicines affect the bladder. Your healthcare professional may suggest that you stop or change these medicines. Some bladder problems can be helped with a strict urination schedule. Or they can be helped by urinating every few hours while putting gentle pressure on the area below the bellybutton. Other methods may be needed to remove urine from a nerve-damaged bladder. For example, the bladder can be drained by placing a thin, flexible tube called a catheter into it.
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Digestive problems. Diabetic neuropathy may slow the gut and cause constipation or slow movement of food from the stomach. This slow movement of food is called gastroparesis. Gastroparesis can cause symptoms such as belching, upset stomach or vomiting. You might get relief from these symptoms if you eat smaller, more frequent meals that are low in fiber and fat. Diet changes and medicines may help ease gastroparesis, diarrhea, constipation and upset stomach.
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Low blood pressure when you stand. This condition is called orthostatic hypotension Treatment starts with simple lifestyle changes. Drink plenty of water. Get physical activity. Don't drink alcohol. Slowly change positions such as from sitting to standing. Sleep with the head of the bed raised 4 to 6 inches to help prevent high blood pressure overnight.
Your healthcare professional also may suggest compression support for your stomach area and thighs. Examples of products that apply gentle pressure include an abdominal binder and compression shorts or stockings. Many medicines, taken either alone or together, may be used to treat orthostatic hypotension.
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Sexual challenges. Medicines taken by mouth or by shot may improve sexual function in some men. But they aren't safe and effective for everyone. A pump called a vacuum construction device may boost blood flow to the penis. Women may benefit from vaginal lubricants.