Treatment For Painful Neuropathy
Appropriate pain management can significantly improve the lives of people with diabetes and painful neuropathy. A number of different medications are available, which produce comparable effects.Most people would begin with one of either:
- serotonin-norepinephrine reuptake inhibitors
- tricyclics antidepressants
- anti-epileptics .
If one type fails to provide the response required, it is usual to switch to or add another. If all three agents alone or in combination fail, then opioid analgesics and tramadol may be used as second-line treatments.
Can Diabetic Neuropathy Be Prevented
Keeping your blood sugar levels in your target range, set with your doctor, may help prevent neuropathy from ever developing. The best way to do this is by checking your blood sugar and adjusting your treatment. It is also important to get to and stay at a healthy weight by exercising and eating healthy foods.
Research Design And Methods
The sample of healthy control subjects on which the ASP normative data are based consisted of 245 participants drawn from the population-based Rochester Diabetic Neuropathy Study normal control subjects to ensure comparable age and sex distribution. The demographics of this cohort have been fully described .
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Group Comparisons: Type 1 Versus Type 2 Diabetes
Results revealed only limited differences in autonomic function between patients with type 1 and type 2 diabetes. On the ASP, participants with type 2 diabetes had significantly higher scores on the diarrhea and urinary domains compared with participants with type 1 diabetes . Participants with type 2 diabetes also received significantly higher scores on the CASS cardiovagal scale than participants with type 1 diabetes. In addition, those with type 2 diabetes were significantly more likely to have a diabetic autonomic neuropathy, as indicated by a CASS total score 2 , than those with type 1 diabetes .
Causes Of Diabetic Neuropathy
High glucose and lipid levels in the blood, and the toxic byproducts they generate through their metabolism, are thought to be the major causes of neuropathy associated with diabetes. However, good glucose control in people with type 1 diabetes can reduce neuropathy by 60 per cent.The benefits of good glucose control in people with type 2 diabetes are more modest. Improving lipid levels may also reduce the incidence of nerve damage in people with type 2 diabetes.
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What Are The Symptoms
Your symptoms will depend on which nerves are injured. You may not be able to feel pain, especially in your feet. This can lead to serious infections, because sores or other problems may not get treated.
When other parts of your body are affected, symptoms may include:
- Problems with digestion, such as bloating, belching, constipation, nausea and vomiting, diarrhea, and belly pain.
- Problems with body temperature, such as heavy sweating at night or when you eat certain foods. Some people may have reduced sweating, especially in their feet and legs.
- Problems with urination, such as finding it hard to tell when your bladder is full or finding it hard to empty your bladder completely.
- Sexual problems, such as erection problems in men and vaginal dryness in women.
- Heart and blood vessel problems, leading to poor circulation or low blood pressure. This may cause dizziness, weakness, or fainting when you stand or sit up from a reclining position.
- Trouble sensing when your blood sugar is low.
Why Is Foot Care So Important
Diabetes can lead to foot complications, and controlling your blood sugar levels is the best way to prevent foot complications. You have a higher chance of getting diabetic neuropathy if you are not managing your diabetes well, so it’s important to take care of yourself!
To take care of your feet at home you can wear proper shoes for your condition, like diabetic shoes or orthopedic shoes with insoles.
You can also use foot creams on areas that are hurting to soothe any pain caused by neuropathy. The last thing you want is to walk around in excruciating pain because of something that could have been prevented!
If you’re planning on being out and about this summer make sure you wear good quality sandals or flip-flops when possible as well as always wearing socks. This will help prevent getting a blister which may lead to an infection since we’ll be sweating more than normal outdoors too!
Don’t forget to check your feet daily for for blisters, cuts, bruises, cracked and peeling skin, redness, and swelling.
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How Is Neuropathy Treated
Diffuse neuropathy is treated by bringing blood glucose levels under control and keeping them well regulated. This can help to prevent problems from this diabetic complication.
Diet, exercise or medication may be adjusted to reach these goals. Exercise can be particularly effective, helping the patient to improve circulation, strengthen muscle and lose weight.
Smoking should be stopped and the amount of alcohol consumed should be reduced. Taking regular care of your feet and skin is essential.
Causes Of Peripheral Neuropathy
In the UK diabetes is the most common cause of peripheral neuropathy.
Over time, the high blood sugar levels associated with diabetes can damage the nerves.
This type of nerve damage is known as diabetic polyneuropathy.
Peripheral neuropathy can also have a wide range of other causes.
For example, it can be caused by:
- physical injury to the nerves
- a viral infection, such as shingles
- a side effect of certain medicines or drinking too much alcohol
People who are known to be at an increased risk of peripheral neuropathy may have regular check-ups so their nerve function can be assessed.
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Prevention Of Diabetic Neuropathy
Be guided by your doctor, but general suggestions to reduce the risk of diabetic neuropathy include:
- Maintain blood glucose levels within the target ranges.
- Exercise regularly.
- Maintain a healthy weight for your height.
- Stop smoking.
- Reduce your blood pressure and lipid levels through diet and lifestyle changes, and medication where appropriate
- Consult your doctor promptly if you have symptoms including pain, numbness or tingling in your hands or feet.
- Have your feet checked at least yearly by your doctor, podiatrist or diabetes educator, or more often if you have signs of problems with your feet or other complications of your diabetes.
Why Am I Sore
You may begin to notice sores or blisters on your feet that you cant explain. It could be that you hurt yourself and didnt feel it at the time.
Sometimes you dont feel pain or injury because of the nerve damage. This can be very dangerous. For example, you could scald yourself with hot water because youre unable to feel a pain response to heat.
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Treatment For Diabetic Neuropathy
Damaged nerves cannot be repaired. However, the risk of further complications in the feet can be reduced by:
- vigilance regular inspection of the feet for early signs of trouble or potential problem areas (such as breaks in skin, signs of infection or deformity
- getting help at the first sign of trouble early treatment of foot ulcers gives the best chance that they will heal
- good foot and nail hygiene
- choosing appropriate socks and shoes properly fitted to the shape of your foot
- avoiding activities that may injure the feet. Check shoes for stones, sticks and other foreign objects that might hurt your feet every time before putting your shoes on.
A referral to a podiatrist may be appropriate for assessment and ongoing preventive management of foot complications.
Risk Factors For Diabetic Neuropathy
The longer a person has diabetes and the worse the control of their diabetes, the more likely they will develop diabetic neuropathy.Those people experiencing complications of their diabetes elsewhere in their body are also more likely to have or develop neuropathy, as the same factors that cause these problems also contribute to neuropathy. Smoking, high blood pressure and being overweight also make it more likely that people with diabetes will get nerve damage.
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What Are The Stages Of Diabetes Neuropathy
Its vital that you familiarize yourself with the initial signs and symptoms of neuropathy so that you can get the required treatment. In the early stages, it may be possible to reverse the damage or at least put an end to the progression.
Here are the 5 stages you should be aware of that will help differentiate when you actually need to seek medical attention:
How Can I Best Learn To Cope With Neuropathy Pain
People with nerve damage may get depressed or discouraged. Talk with your healthcare provider about your mental health. You may benefit from:
- Joining a support group to connect with others.
- Practicing destressing techniques, such as meditation or breathing exercises.
- Starting therapy.
- Taking medications such as antidepressants, which can reduce pain.
A note from Cleveland Clinic
Diabetic neuropathy is nerve damage caused by elevated blood sugar. You are more likely to develop diabetic neuropathy if you have diabetes that is not well-managed. Smoking, excessive drinking and high blood pressure are also risk factors. If you have diabetic neuropathy, your healthcare provider may prescribe pain medications. You also need to manage your blood sugar with proper nutrition and exercise. Many people with nerve damage may feel depressed or discouraged. Talk with your healthcare provider about your mental health. You may consider starting therapy or joining a support group for people with diabetic nerve damage.
Last reviewed by a Cleveland Clinic medical professional on 04/29/2021.
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Asymmetrical Proximal Diabetic Neuropathy
Figure 2Proximal muscle wasting in a 55 year old diabetic male patient with diabetic lumbosacral radiculoplexoneuropathy. He had severe pain and weight loss for three months.
In patients with proximal DN, especially if it is bilateral and the distal muscles are also involved electrodiagnostic testing may show demyelinating features resembling chronic inflammatory demyelinating neuropathy . In such patients apart from CIDP, monoclonal gammopathy and vasculitic neuropathy should also be considered., Biopsy of obturator nerve has shown demyelination, inflammatory cell infiltrate, and immunoglobulin deposits in vasanervosa. Cerebrospinal fluid protein may be raised without lymphocytic pleocytosis.
It is important to differentiate CIDP from lumbosacral radiculoplexoneuropathy attributable to ischaemic origin because of different therapeutic options. Diabetic patients are 11 times more vulnerable to develop CIDP and they respond to immunomodulation by corticosteroid, plasma exchange, or IVIg.
Diabetic truncal neuropathy is associated with pain and paresthesia in T4T12 distribution in chest or abdominal distribution. Bulging of abdominal wall may occur because of muscle weakness. It usually occurs in older patients with NIDDM. The onset may be abrupt or gradual and the patient may be confused with an intraabdominal, thoracic disease, or herpes zoster. The symptoms may generally persist for months before gradually subsiding. Electromyography may show paraspinal denervation.
The Length Of Your Diabetes
The length of your diabetes can also play a role in the development of diabetic neuropathy. The longer you have had diabetes, the higher risk there is for developing complications like this one. The most common form of neuropathy that develops from poorly managed diabetes are called focal or segmental mononeuropathies and affect only certain nerves in parts of your body.
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Controlling Blood Glucose Levels
Getting blood glucose levels under control cant reverse nerve damage but can prevent further damage from occurring. Your doctor will give you specific blood sugar goals. Managing these levels includes eating a healthy diet high in protein and low in carbs. When you eat carbs, try to choose food with a higher fiber content, avoiding chips and soda.
Regular exercise can help keep blood sugar levels manageable by increasing insulin sensitivity, meaning youll need to take less insulin each day. Getting enough sleep is also important, as we often crave high-carb foods when overly tired.
Measures To Prevent It
As there is no known cure for diabetic neuropathy, it is best that you adopt all the measures to prevent it. Some important steps to take:
- Keep sugar levels under control.
- Monitor your sugar levels regularly and adjust insulin or medicine dosage.
- Lose weight if required.
- Get in some exercise regularly.
- Make dietary changes, eating more whole foods, fruit, vegetables, and include some white meat and fish in your diet, reducing your dependency on red meat and processed foods.
- Dont smoke.
- If you have high blood pressure, make sure to keep it under control
You can also try alternative remedies like acupuncture, natural supplements, and herbal remedies after checking with your doctor. Do take conventional remedies and change your diabetic medicines if called for. And always be aware of the symptoms of diabetic neuropathy.
- Diabetic neuropathy is not inevitable if it is caught early enough, it can be manageable as long as you ensure that your sugar levels are under control.
- Even occasionally, feeling off can be a sign of neuropathy in the initial stages, you may feel some pain or numbness or poor reflexes or loss of balance once in a while. One or more symptoms signal the start of neuropathy.
- Keeping your sugar levels at bay is crucial higher than normal blood sugar levels can damage organs and nerves.
- Diabetic neuropathy is largely irreversible symptoms can be managed with various treatments, and the damage controlled or reversed.
Braden G. Barnett, MD
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Shooting Pain And Painful Cramps
This type of neuropathy affects the motor nerves and is commonly associated with muscle weakness. Painful cramps that are felt in the legs, particularly when walking that cease when at rest, may need a further workup from a vascular surgeon. This doctor specializes in surgery to correct problems with blood flow.
This symptom, referred to as intermittent claudication, can be a symptom of peripheral vascular disease, in which an artery supplying the limb is partially blocked.
Types Of Nerve Damage
There are four main types of nerve damage. You can have more than one type. Symptoms depend on the type of nerve damage you have and which nerves are affected.
Peripheral nerve damage
Have you felt pins and needles or tingling in your feet? Maybe you feel like youre wearing socks or gloves when you arent. Your feet may be very sensitive to toucheven a bed sheet can hurt. These are all symptoms of peripheral nerve damage.
Peripheral nerve damage affects your hands, feet, legs, and arms, and its the most common type of nerve damage for people with diabetes. It generally starts in the feet, usually in both feet at once.
Other symptoms may include:
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Other Diabetes Nerve Damage
People with diabetes can also get other nerve-related conditions, such as nerve compressions .
Carpal tunnel syndrome is a very common type of entrapment syndrome. It causes numbness and tingling of in the hand and sometimes muscle weakness or pain.
If you think you may have any type of nerve problem, talk with your doctor, so they can check for the cause.
How Can I Help Prevent Diabetic Neuropathy
The following steps may help to prevent or slow the worsening of diabetic neuropathy :
Control diabetes try to keep blood sugar at a normal level
Maintain normal blood pressure
Exercise regularly, according to the healthcare provider’s recommendation
Limit the amount of alcohol intake because excessive alcohol also can cause neuropathy or make it worse
Eat a healthy diet and avoid elevated levels of triglycerides in the blood
Maintain a healthy weight
Keep follow-up appointments with the healthcare provider
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Nerve Conduction Studies And Emg
Nerve conduction studies and electromyography testing may be used to confirm the presence of peripheral neuropathy and assess its pattern and severity, prognosis, and possible treatment options.The ADA suggests that these types of tests are rarely needed except when the clinical features are atypical and the diagnosis is unclear.
Numbness And Loss Of Protective Sensation
Numbness in the hands and feet is a type of sensory neuropathy and affects the large nerve fibers. People can also experience numbness in the legs and arms.
LOPS indicates the presence of distal sensorimotor polyneuropathy and is a risk factor for diabetic foot ulceration. When you have a loss of sensation in your feet, you are less likely to feel a foot injury. A foot injury that is undetected can become infected.
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What Is The Treatment For Diabetic Neuropathy
You should see your GP, Practice Nurse or Diabetes Nurse if you think you may have diabetic neuropathy or if you have any concerns about your feet.
Good blood sugar and blood pressure control and not smoking are very important to prevent the symptoms of diabetic neuropathy becoming any worse. It is also very important to prevent any minor injuries to your feet, including avoiding walking barefoot and wearing comfortable well-fitted shoes.
Your doctor or nurse may refer you to see a podiatrist to help prevent or treat any problems with your feet. A podiatrist is a person who is qualified to diagnose and treat foot disorders.
There are many treatments available to relieve the symptoms caused by neuropathy. This may include medications for feeling sick and being sick or treatment to help with impotence .
The pain caused by neuropathy can also be treated. See also separate leaflet called Neuropathic Pain.