Diabetic Neuropathy

Treatments

Treatment aims to relieve discomfort and prevent further tissue damage. The first step is to bring blood sugar under control by diet and oral drugs or insulin injections, if needed, and by careful monitoring of blood sugar levels.

Although symptoms can sometimes worsen at first as blood sugar is brought under control, maintaining lower blood sugar levels helps reverse the pain or loss of sensation that neuropathy can cause. Good control of blood sugar may also help prevent or delay the onset of further problems.

Another important part of treatment involves special care of the feet, which are prone to problems.

A number of medications and other approaches are used to relieve the symptoms of diabetic neuropathy.

For, burning, tingling, or numbness, the doctor may suggest an analgesic such as aspirin or acetaminophen or anti-inflammatory drugs containing ibuprofen. Nonsteroidal anti-inflammatory drugs should be used with caution in people with renal disease.

Antidepressant medications such as amitriptyline (sometimes used with fluphenazine) or nerve medications such as carbamazepine or phenytoin sodium may be helpful. Codeine is sometimes prescribed for short-term use to relieve severe pain. In addition, a topical cream, capsaicin, is now available to help relieve the pain of neuropathy.

The doctor may also prescribe a therapy known as transcutaneous electronic nerve stimulations (TENS). In this treatment, small amounts of electricity block pain signals as they pass through a patient's skin. Other treatments include hypnosis, relaxation training, biofeedback, and acupuncture. Some people find that walking regularly or using elastic stockings helps relieve leg pain. Warm (not hot) baths, massage, or an analgesic ointment such as Ben Gay may also help.

Indigestion, belching, nausea, or vomiting are symptoms of gastroparesis. For patients with mild symptoms of slow stomach emptying, doctors suggest eating small, frequent meals and avoiding fats. Eating less fiber may also relieve symptoms. For patients with severe gastroparesis, the doctor may prescribe metoclopramide, which speeds digestion and helps relieve nausea.

Other drugs that help regulate digestion or reduce stomach acid secretion may also be used or erythromycin may be prescribed. In each case, the potential benefits of these drugs need to be weighed against their side effects.

To relieve diarrhea or other bowel problems, antibiotics or clonidine HCl, a drug used to treat high blood pressure, are sometimes prescribed. The antibiotic tetracycline may be prescribed. A wheat-free diet may also bring relief since the gluten in flour sometimes causes diarrhea.

Neurological problems affecting the urinary tract can result in infections or incontinence. The doctor may prescribe an antibiotic to clear up an infection and suggest drinking more fluids to prevent further infections. If incontinence is a problem, patients may be advised to urinate at regular times (every 3 hours, for example) since they may not be able to tell when the bladder is full.

Sitting or standing slowly may help prevent light-headedness, dizziness, or fainting, which are symptoms that may be associated with some forms of autonomic neuropathy. Raising the head of the bed and wearing elastic stockings may also help. Increased salt in the diet and treatment with salt-retaining hormones such as fludrocortisone are other possible approaches.

In certain patients, drugs used to treat hypertension can instead raise blood pressure, although predicting which patients will have this paradoxical reaction is difficult.

Muscle weakness or loss of coordination caused by diabetic neuropathy can often be helped by physical therapy.

Nerve and circulatory problems of diabetes can disrupt normal male sexual function, resulting in impotence. After ruling out a hormonal cause of impotence, the doctor can provide information about methods available to treat impotence caused by neuropathy.

Short-term solutions involve using a mechanical vacuum device or injecting a drug called a vasodilator into the penis before sex. Both methods raise blood flow to the penis, making it easier to have and maintain an erection. Surgical procedures, in which an inflatable or semirigid device is implanted in the penis, offer a more permanent solution. For some people, counseling may help relieve the stress caused by neuropathy and thereby help restore sexual function.

In women who feel their sexual life is not satisfactory, the role of diabetic neuropathy is less clear. Illness, vaginal or urinary tract infections, and anxiety about pregnancy complicated by diabetes can interfere with a woman's ability to enjoy intimacy. Infections can be reduced by good blood glucose control. Counseling may also help a woman identify and cope with sexual concerns.

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