Treatment and drugs
Diabetic neuropathy has no cure.
Treatment focuses on:
- Slowing progression of a disease
- Relieving pain
- Managing complications and restoring function
Slowing progression of a disease
- Keeping blood sugar under check prevents or delays the progression of diabetic neuropathy and may even improve some symptoms.
- The target sugar levels recommended are:
1. 80 – 120 mg% or 4.4 – 6.7 mmol/L for patients below 60 years
2. 100 – 140 mg% or 5.6 – 7.8 mmol/L for patients over 60 years or those with other medical ailments like heart, lung or kidney disease.
To help slow nerve damage the following is recommended:
1. Regular foot care
2. BP under control
3. Healthy diet
4. Plenty of physical activity
5. Maintain a healthy weight
6. Stop smoking
7. Avoid alcohol or drink in moderation
Most drugs are not very helpful and some have more side-effects than benefits. One should try:
- Capsaicin cream ( from chilli pepper)
- Acupuncture or physical therapy
Pain relieving medications used include:
- Anti-seizure medications – these include gabapentin (Neurontin, grab life), pregabalin (Lyrica), and carbamazepine (Carbatrol, Tegretol). These drugs treat epilepsy and also used for nerve pain relief. Side effects include drowsiness, dizziness, and swelling.
- Antidepressants – tricyclic antidepressant medications like amitriptyline, desipramine (Norpramin) and imipramine (Tofranil) may case relief for mild to moderate symptoms by interfering with the chemical processes in your brain that cause you to feel pain but they may also have many side-effects like dry mouth. sweating, weight gain, constipation, and dizziness. for some antidepressants like serotonin and norepinephrine reuptake inhibitors (SNRIs) like duloxetine can relieve pain with a few side effects like nausea, sleepiness, dizziness, reduced appetite, and constipation.
Managing complications and restoring function
- Urinary tract problems – Antispasmodic medications (anticholinergics), behavioural techniques like times urination, devices like pessaries (rings inserted into the vagina to prevent urine leak) could be helpful in treating loss of bladder control. A combination of therapies could be most helpful.
- Digestive problems – This is due to gastroparesis – indigestion, belching, nausea vomiting. this is treated by eating smaller frequent meals, reducing fibre and fat in the diet and eating soups and mashed foods. dietary changes and medication may help to treat nausea, vomiting, diarrhoea and constipation.
- Low blood pressure on standing (orthostatic hypotension). This is helped by simple measures like avoiding alcohol, drinking a lot of water and sitting or standing slowly. Abdominal binder and compression stocking may help. Several medications may be used
- Sexual dysfunction – Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) may improve sexual function in men but they are not safe or effective for everyone. Mechanical vacuum devices may improve the blood supply to the penis. Women may find relief with vaginal creams.
Lifestyle and home remedies
These measures help reduce the risk of diabetic neuropathy:
- Keep your blood pressure under control – this increases the risk to your blood vessels and should be kept under check.
- Make healthy food choices – eat fruits, vegetables, and whole grain and limit portions to maintain a healthy weight.
- Be active daily – this protects your heart and improves blood flow. It also keeps your blood sugar and blood pressure under control. Exercise for 30 mins, 5 times a week is recommended. In severe neuropathy and reduced sensations in the legs, one must do non-weight bearing activities like swimming and bicycling.
- Stop smoking – Do not smoke or have tobacco with diabetes because you have a high chance of dying of heart attack or stroke. You are also likely to have circulatory problems in your feet. Talk to your doctors about the waist quit.
There are alternative ways to relieve symptoms from this problem:
- Capsaicin – this is a cream which can reduce pain sensation in some. Side effects are skin irritation and burning.
- Alpha-lipoic acid.- this powerful antioxidant is found in some foods and may relieve symptoms of peripheral neuropathy.
- Transcutaneous Electrical Nerve Stimulation (TENS) – this helps pain signals from reaching your brain. TENS delivers tiny electrical impulses to specific nerve pathways through small electrodes placed on your skin. Though safe it does not work for everyone.
- Acupuncture – It may relieve the pain of neuropathy and has no side effects. More than one session may be needed.
Coping and support
Living with diabetic neuropathy could be frustrating and difficult and may need counselling.