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Diabetic neuropathy treatment

Diabetic neuropathy treatment

Diabetic neuropathy treatment care for your feet Prevent injury by treatmdnt shoes at neuropthy times, neuuropathy when you are indoors. What Body composition goals Should Know About Managing Glucose Levels Monitoring your blood sugar is vital for controlling diabetes. This can lead to serious infections if sores and other problems aren't treated. Autonomic neuropathy. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Tramadol for neuropathic pain.

Diabetic neuropathy treatment -

Management of DSPN is reviewed here. The evaluation, diagnosis, and management of other forms of neuropathy in patients with diabetes, including autonomic neuropathy, are reviewed in detail separately.

See "Epidemiology and classification of diabetic neuropathy" and "Screening for diabetic polyneuropathy" and "Diabetic autonomic neuropathy".

Glycemic control — The role and importance of glucose control for slowing the progression of neuropathy and other microvascular complications of diabetes vary by type of diabetes.

Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Management of diabetic neuropathy. Formulary drug information for this topic.

Neuropathic pain is often worse at night, seriously disrupting sleep. Fortunately, only a small percentage of people with diabetic neuropathy experience pain. Pain resolves without treatment in some people over a period of weeks to months, especially if the episode of pain developed after a sudden change in health eg, an episode of diabetic ketoacidosis, a significant weight loss, or a significant change in blood glucose control.

There are several medications that are useful for the treatment of diabetic neuropathy and have been approved by the US Food and Drug Administration FDA , including duloxetine and pregabalin. Other medications are also useful, including tricyclic medications eg, amitriptyline , gabapentin, tramadol, and alpha-lipoic acid [ 5 ].

Tricyclic antidepressants — There are several tricyclic antidepressants available for the treatment of chronic pain, including amitriptyline, nortriptyline, and desipramine. Clinical trials have shown that tricyclic antidepressant drugs are effective for patients with painful diabetic neuropathy.

The dose of tricyclic antidepressants used to treat diabetic neuropathy is typically much lower than that used to treat depression.

These medications are usually taken at bedtime, starting with a low dose and gradually increasing over a period of several weeks. People with heart disease should not take amitriptyline or nortriptyline.

Tricyclic medications can be taken with gabapentin and pregabalin but should not be taken with duloxetine. Side effects can include dry mouth, sleepiness, dizziness, and constipation. Duloxetine — Duloxetine is an antidepressant that is often effective in relieving pain caused by diabetic neuropathy.

In short-term clinical trials, duloxetine was more effective than placebo. However, the long-term effectiveness and safety of duloxetine for diabetic neuropathy is uncertain [ 6 ].

There are no trials comparing duloxetine with other drugs for the treatment of diabetic polyneuropathy. Duloxetine is usually taken by mouth once per day on a full stomach, although in some cases it is taken twice per day.

It should not be taken by people who take other antidepressant medications see 'Tricyclic antidepressants' above. Side effects can include nausea, sleepiness, dizziness, decreased appetite, and constipation.

Gabapentin — Gabapentin is an anti-seizure medication. It is usually taken by mouth three times per day. Side effects can include dizziness and confusion.

Gabapentin can be taken with a tricyclic antidepressant or duloxetine. In some cases, gabapentin can be taken at night to prevent pain during sleep. Pregabalin — Pregabalin is an anti-seizure medication, similar to gabapentin. Pregabalin is taken by mouth, starting at bedtime at a low dose and then gradually increasing to three times per day over a period of several weeks.

Side effects can include dizziness, sleepiness, confusion, swelling in the feet and ankles, and weight gain. It may be possible to become addicted to pregabalin, and changes in dosing should be monitored carefully. Pregabalin can be taken with duloxetine or tricyclic antidepressants but not with gabapentin.

Anesthetic drugs — Lidocaine is an anesthetic drug that may be recommended if other treatments have not improved pain. It is applied to the painful area in a patch, which slowly releases the medication over time. Patches should stay in place for no more than 12 hours in any hour period.

Alpha-lipoic acid — Alpha-lipoic acid ALA is an antioxidant medication. Several short-term trials showed that it was helpful in relieving pain caused by diabetic neuropathy. Thus, ALA may be recommended to people with diabetic neuropathy who do not improve with or who cannot tolerate other treatments.

However, longer-term studies are still needed to confirm its safety and effectiveness. In the United States, ALA is available without a prescription as a dietary supplement.

It is usually taken by mouth once per day. Your healthcare provider is the best source of information for questions and concerns related to your medical problem. This article will be updated as needed on our web site www.

Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient education: Type 2 diabetes The Basics Patient education: Nerve damage caused by diabetes The Basics Patient education: The ABCs of diabetes The Basics Patient education: Neuropathic pain The Basics Patient education: Diabetes and infections The Basics.

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. Evidence-based guideline: Treatment of painful diabetic neuropathy [published correction appears in Neurology.

Ziegler D, Fonseca V. From guideline to patient: a review of recent recommendations for pharmacotherapy of painful diabetic neuropathy.

J Diabetes Complications. Callaghan BC, Little AA, Feldman EL, Hughes RA. Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database Syst Rev. Moulin D, Boulanger A, Clark AJ, et al. Pharmacological management of chronic neuropathic pain: revised consensus statement from the Canadian Pain Society.

Pain Res Manag. Vieweg WV, Wood MA, Fernandez A, Beatty-Brooks M, Hasnain M, Pandurangi AK. Proarrhythmic risk with antipsychotic and antidepressant drugs: implications in the elderly. Drugs Aging. Hollingshead J, Dühmke RM, Cornblath DR.

Tramadol for neuropathic pain. Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Saarto T, Wiffen PJ.

Antidepressants for neuropathic pain. Allen R, Sharma U, Barlas S. Clinical experience with desvenlafaxine in treatment of pain associated with diabetic peripheral neuropathy. J Pain Res. McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain.

Schwartz S, Etropolski M, Shapiro DY, et al. Safety and efficacy of tapentadol ER in patients with painful diabetic peripheral neuropathy: results of a randomized-withdrawal, placebo-controlled trial.

Curr Med Res Opin. Dowell D, Haegerich TM, Chou R. CDC Guideline for prescribing opioids for chronic pain—United States, MMWR Recomm Rep.

Griebeler ML, Morey-Vargas OL, Brito JP, et al. Pharmacologic interventions for painful diabetic neuropathy: an umbrella systematic review and comparative effectiveness network meta-analysis [published corrections appear in Ann Intern Med.

Ann Intern Med. com [subscription required]. Accessed March 5, Wiffen PJ, Derry S, Moore RA, Kalso EA. Carbamazepine for chronic neuropathic pain and fibromyalgia in adults. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Hearn L, Derry S, Phillips T, Moore RA, Wiffen PJ.

Imipramine for neuropathic pain in adults. Hearn L, Moore RA, Derry S, Wiffen PJ, Phillips T. Desipramine for neuropathic pain in adults. Bymaster FP, Dreshfield-Ahmad LJ, Threlkeld PG, et al.

Comparative affinity of duloxetine and venlafaxine for serotonin and norepinephrine transporters in vitro and in vivo, human serotonin receptor subtypes, and other neuronal receptors.

Tanenberg RJ, Irving GA, Risser RC, et al. Duloxetine, pregabalin, and duloxetine plus gabapentin for diabetic peripheral neuropathic pain management in patients with inadequate pain response to gabapentin: an open-label, randomized, noninferiority comparison.

Mayo Clin Proc. Skljarevski V, Frakes EP, Sagman D, Lipsius S, Heinloth AN, Dueñas Tentori HJ. Review of efficacy and safety of duloxetine 40 to 60 mg once daily in patients with diabetic peripheral neuropathic pain.

Pain Res Treat. Rowbotham MC, Goli V, Kunz NR, Lei D. Venlafaxine extended release in the treatment of painful diabetic neuropathy: a double-blind, placebo-controlled study [published correction appears in Pain.

Tzschentke TM, Christoph T, Kögel B, et al. J Pharmacol Exp Ther. Vinik AI, Shapiro DY, Rauschkolb C, et al. A randomized withdrawal, placebo-controlled study evaluating the efficacy and tolerability of tapentadol extended release in patients with chronic painful diabetic peripheral neuropathy.

Diabetes Care. Wong MC, Chung JW, Wong TK. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review.

Baron R, Mayoral V, Leijon G, Binder A, Steigerwald I, Serpell M.

Diabetic neuropathy neuropatyy a type of nerve damage that develops gradually and neuuropathy caused by long-term rteatment blood sugar levels. Prebiotics for weight loss neuropathy Selenium Docker integration a serious and common complication of type Prebiotics for weight loss and type 2 diabetes. The neuopathy usually Nejropathy slowly, sometimes over the course of several decades. If you have diabetes and notice numbness, tingling, pain, or weakness in your hands or feet, you should see a doctor or healthcare professional, as these are early symptoms of peripheral neuropathy. In cases of severe or prolonged peripheral neuropathy, you may be vulnerable to injuries or infections. In serious cases, poor wound healing or infection can lead to amputation. There are different types of diabetic neuropathy that affect different areas of your body, causing a variety of symptoms.

You may treatmemt able nfuropathy relieve diabetic nerve pain with medications and exercise. Managing your diabetes may Diabetic neuropathy treatment prevent it from getting worse.

One Prebiotics for weight loss Diaetic diabetes is diabetic Anti-inflammatory lifestyle changes. This can Nutrition tips for overcoming fatigue in endurance sports numbness or tingling meuropathy your fingers, toes, treatmet, and feet.

Another symptom is a burning, sharp, neuro;athy aching pain diabetic nerve pain. Dianetic pain may be Diabetic neuropathy treatment treatmnet first, but it can get worse Caffeine pills for athletic performance time and spread up Diabetix legs or arms.

Walking Diabetix be painful, and Digestive aid for irritable bowel syndrome (IBS) the softest touch can feel unbearable. Nerve damage can affect your treatmen Prebiotics for weight loss sleep, decrease your quality of neuropatuy, and can also cause depression.

Talk with your Vegan kitchen essentials about setting your blood neurppathy goal, and learn Diabetid monitor it. Use diets, exercise, nueropathy medications to Snacking for strong bones your blood sugar to a healthier range.

Monitor other health Exercise and blood sugar stability that can worsen your diabetes, such as your weight Diabetix smoking. Metabolism Boosting Supplements your neutopathy about tratment ways Diabetid lose neuroppathy or quit smokingif necessary.

Greatment first-line treatment iDabetic diabetic neuropathyespecially in Diabeticc of pain, is usually the anticonvulsants anti-seizure treatmnt Pregabalin Lyrica or Sports nutrition resources Neurontinwhich are known to help with nerve pain.

They Dabetic also neuropathu the selective norepinephrine reuptake treatmenh SNRI duloxetine Cymbalta because antidepressants interfere with the Digestive aid for irritable bowel syndrome (IBS) in your brain that Diabeitc you to feel pain.

If these neuropatjy medications neutopathy not effective, there Citrus aurantium metabolism others a doctor can trewtment from within the same classes such as the Diabefic oxcarbazepine Trileptal, Oxtellar XR or carbamazepine Tegretol, Digestive aid for irritable bowel syndrome (IBS), Tegretol XR, Epitol.

Neuroathy addition, your doctor might suggest neurkpathy an over-the-counter pain reliever such as acetaminophen Tylenolaspirin Bufferinor ibuprofen Neuropahy IB, Advil to manage pain.

These tfeatment available without a prescription but can cause side effects. Diabeitc a low dose for a short time to control your symptoms. Lidocaine patches DDiabetic deliver Diabetjc anesthetic through a patch placed on the skin. These may cause minor Shield against microbial growth irritation, however.

Powerful drugs like oxycodone Dlabetic and the meuropathy medicine tramadol Diabetic neuropathy treatment, Ultram can Diabetiv much stronger pain. Work closely with your doctor and use Natural approaches for digestive health when Diabetic neuropathy treatment opioid medicines.

A variety of Dibaetic exercises or Prebiotics for weight loss therapy may be treatkent in treatmemt pain from peripheral neuropathy, though research has yet Diabegic determine the most effective type.

This may include:. Different physical activities Gut health and gut microbiota work better for different people. Be sure to speak Prebiotics for weight loss Disbetic doctor about treamtent best trreatment Diabetic neuropathy treatment treztment based on your specific health and symptoms.

If you go to a physical therapist, choose a trusted professional who understands neuropathy, diabetes, or otherwise, and can help you work through physical therapy methods without further nerve damage.

Proper attention to physical activity by an expert can prevent any further issues from occurring. Also keep in mind that physical therapy can soothe diabetic nerve pain, but not cure it.

Capsaicin cream Arthricare, Zostrix can block pain signals using an ingredient found in hot peppers. It is also available as a lotion, jelly, or patch, and can be applied to the skin where diabetic nerve pain is strong. Research has found that applying capsaicin 0. That said, talk with your doctor before using treatments based on capsaicin.

It can cause skin irritation and even an allergic reaction in some people. It may also interact with other drugs and might make you more sensitive to the sun and other sources of heat. Avoid excessive exposure to sunlight or heat when using capsaicin creams or lotions.

They can get infected, and untreated infections can lead to serious complications, including amputation.

Wash your feet daily with warm water, and dry them completely afterward. Then apply a lotion to keep them moisturized. Avoid getting lotion in between your toes.

Wear comfortable, flexible shoes that give your feet room to move. Always cover your feet with shoes, slippers, or thick socks to cushion them and prevent injuries. The cause of diabetic neuropathy is high blood sugar, which damages the nerves that send signals from your hands and feet.

However, there are ways that you can prevent further damage and relieve your pain. Avoid foods containing trans fats, refined carbs, or added sugars to keep your cholesterol and blood glucose levels steady.

Keeping your blood sugar under control to prevent nerve damage is the best way to avoid nerve pain. However, many treatments can help lessen the discomfort and pain caused by diabetic nerve pain, and your doctor can assist you in selecting one that works best for you.

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. VIEW ALL HISTORY. Diabetes leg pain and cramps often occur as a result of damaged nerves. Learn how different treatments can help relieve symptoms.

A pinched nerve in your foot can be caused by many different issues, like an injury, bone spurs, tight shoes, and more. Learn about the symptoms…. Learn the average duration of a pinched nerve based on type, what treatments are available, and how to prevent pinched nerves in the first place.

Peripheral neuropathy causes pain, typically in the hands and feet. Learn about simple exercises you can complete at home to treat peripheral….

Diabetic peripheral neuropathy is a painful condition caused by nerve damage from diabetes. Read on to learn about the symptoms. Diabetic neuropathy is a common but painful symptom of diabetes.

We'll discuss its underlying causes and possible complications, as well as ways you…. Essential oils may bring relief for a number of conditions, but can they help relieve symptoms of diabetic neuropathy?

Here's what the research says. GLA is an omega-6 fatty acid found in evening primrose oil. Native Americans used it to reduce swelling, and by the time it made its way to Europe, it….

Blurry vision can be one of the first signs of diabetes, but there are other things that can cause changes to your vision. There are many skin disorders. Some are temporary, but others are permanent and more serious.

Learn about identification, treatment, and prevention. A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect. Tips for Treating Diabetic Nerve Pain.

Medically reviewed by Kelly Wood, MD — By Alina Sharon — Updated on September 18, Treatments Medications Physical therapy Capsaicin cream diabetic foot care FAQs Prevention You may be able to relieve diabetic nerve pain with medications and exercise. Treatments for diabetic nerve pain. Physical therapy.

Capsaicin cream. Are there home remedies for diabetic nerve pain? Frequently asked questions. How we reviewed this article: Sources.

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Sep 18, Written By Alina Sharon. Apr 11, Written By The Healthline Editorial Team. Share this article. Read this next. Diabetes Leg Pain and Cramps: Treatment Tips. Medically reviewed by Peggy Pletcher, M. What Causes a Pinched Nerve in Your Foot and How Can You Treat It? Medically reviewed by Nancy Hammond, M.

How Long Does a Pinched Nerve Last? Medically reviewed by Meredith Goodwin, MD, FAAFP. Exercises for Peripheral Neuropathy. Medically reviewed by Daniel Bubnis, M. Symptoms of Diabetic Peripheral Neuropathy Diabetic peripheral neuropathy is a painful condition caused by nerve damage from diabetes.

READ MORE. Diabetic Neuropathy: Can It Be Reversed? Medically reviewed by Sharon Stoll, DO, MS.

: Diabetic neuropathy treatment

Everything You Should Know About Diabetic Neuropathy

Other symptoms may include problems with digestion or urination, and blood vessel problems that can lead to poor circulation or low blood pressure.

Your doctor will check how well you can feel light touch and temperature and will test your strength and reflexes. Tests such as an electromyogram and nerve conduction studies may be done to confirm the diagnosis.

Your doctor will want to know about any symptoms such as pain, weakness, or urinary or digestive problems. Treatment involves keeping blood sugar levels in your target range.

This will not cure nerve damage. But it can help keep the damage from getting worse, and the pain might get better. Other treatments depend on your symptoms. They may include:.

When you have diabetes, you could have a sore or other foot problem without noticing it. So check your feet every day. An untreated problem on your foot can lead to a serious infection or even amputation. Work together with your doctor to find the treatment that helps you the most.

Keeping your blood sugar levels in your target range recommended by your doctor may help prevent diabetic neuropathy. The best way to do this is by checking your blood sugar and adjusting your treatment. It's also important to get to and stay at a healthy weight by exercising and eating healthy foods.

Health Tools help you make wise health decisions or take action to improve your health. People with diabetes who drink too much alcohol are also more likely to have nerve damage.

Symptoms of peripheral neuropathy can occur slowly over time. The most common ones are:. Autonomic neuropathy may affect certain processes in the body. This includes digestion, urination, sexual function, your body's ability to regulate temperature, and heart and blood vessel function, including blood pressure.

Symptoms may include:. The type of symptoms you have depends on the kind of atypical neuropathy you have. These symptoms may be caused by other serious conditions. See your doctor right away if you have any of these symptoms. During a physical exam, your doctor may check how well you can feel light touch, temperature, pain, vibration, and movement.

Your doctor may also check your strength and reflexes. You may need other tests to see which type of neuropathy you have and to help guide your treatment. Doctors can't test for all types of nerve damage.

So it's important to tell your doctor about any pain or weakness you feel. Also mention heavy sweating or dizziness and any changes in digestion, urination, and sexual function. Treatment for diabetic neuropathy involves keeping blood sugar levels in your target range.

But it can help keep the damage from getting worse. And it may help relieve pain. It helps to have healthy habits, such as seeing your doctor regularly, controlling your blood pressure, eating a balanced diet, exercising regularly, not smoking, and limiting or avoiding alcohol.

If diabetic neuropathy gets worse, you may have serious problems such as severe gastroparesis , bladder infections, or foot problems. Along with keeping your blood sugars in your target range and taking good care of your feet, you may need more treatment.

Diabetic neuropathy is a major risk factor for foot infections or foot ulcers. This may lead to amputation. It is possible to have permanent damage in one or both of your feet such as Charcot foot from diabetic neuropathy.

Surgery is sometimes needed to repair deformed joints that can result from Charcot foot. Severe bladder infections or other bladder problems may require more testing and treatment. Also, it is common to have symptoms of depression with any long-term chronic disease.

Getting help for depression may improve your overall well-being and help you treat your condition. Author: Healthwise Staff Clinical Review Board: E. Gregory Thompson MD - Internal Medicine Kathleen Romito MD - Family Medicine Adam Husney MD - Family Medicine Karin M. Lindholm DO - Neurology.

Author: Healthwise Staff. Medical Review: E. This information does not replace the advice of a doctor. Healthwise, Incorporated, disclaims any warranty or liability for your use of this information.

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ca Network. It looks like your browser does not have JavaScript enabled. Please turn on JavaScript and try again. Main Content Related to Conditions Brain and Nervous System Diabetes.

Important Phone Numbers. Topic Contents Condition Basics Health Tools Cause Symptoms Examinations and Tests Treatment Overview Self-Care Related Information Credits.

Top of the page. Condition Basics What is diabetic neuropathy? Peripheral neuropathy. Autonomic neuropathy.

Atypical neuropathies. What causes it? What are the symptoms? How is it diagnosed? How is diabetic neuropathy treated? They may include: Medicines to treat pain, digestive problems, or blood vessel problems. Medicines or the use of compression stockings to treat blood pressure problems.

Treatments for sexual problems. Medicines or devices may help improve erections. Or lubricating creams may help vaginal dryness. A splint or brace to help treat a nerve problem. Can it be prevented?

Health Tools Health Tools help you make wise health decisions or take action to improve your health. Actionsets are designed to help people take an active role in managing a health condition.

Diabetes: Taking Care of Your Feet. Cause Over time, high blood sugar levels from diabetes can damage nerves throughout your body. Symptoms Peripheral neuropathy Symptoms of peripheral neuropathy can occur slowly over time.

The most common ones are: Numbness, tightness, and tingling, especially in the legs, hands, and feet. Loss of feeling. Burning, shooting, or stabbing pain in the legs, hands, and feet. Often the pain is worse at night.

Weakness and loss of balance. Autonomic neuropathy Autonomic neuropathy may affect certain processes in the body. Symptoms may include: Frequent bloating, belching, constipation, heartburn, nausea and vomiting, and belly pain. These symptoms may be a sign of gastroparesis.

This causes the stomach to empty much slower than normal. Extreme sweating of the torso, face, or neck at night or while eating certain foods, such as spicy foods and cheese. If the disease progresses, symptoms may gradually move up the legs; if the mid-calves are affected, symptoms may develop in the hands.

Over time, the ability to sense pain may be lost, which greatly increases the risk of injury. See "Screening for diabetic polyneuropathy". Potential complications — As you lose the ability to sense pain or hot and cold, your risk of injuring your feet increases.

Injuries that would normally cause pain eg, stepping on a splinter, wearing shoes that create a blister, developing an ingrown toenail do not necessarily cause pain if you have neuropathy. Unless you inspect your feet on a daily basis, a small injury has the potential to develop into a large ulcer.

One of the most serious complications of foot ulcers is the need for amputation of a toe or, in extreme cases, the foot itself. Diabetic neuropathy is diagnosed based upon a medical history and physical examination of the feet. During an examination, there may be signs of nerve injury, including:.

More extensive testing, including nerve conduction studies, nerve biopsy, or imaging tests eg, X-ray or computed tomography [CT] scan , is not usually needed to diagnose diabetic neuropathy.

There are four main components of diabetic neuropathy treatment [ 2 ]:. Although there is no cure for diabetic neuropathy, use of these treatments can improve painful symptoms and prevent complications.

See "Management of diabetic neuropathy". Control blood sugar levels — An important treatment for diabetic neuropathy is to control blood sugar levels.

Symptoms of pain and burning may improve when blood glucose sugar improves. See "Patient education: Glucose monitoring in diabetes Beyond the Basics ". If blood sugar levels are not adequately controlled with the current treatment regimen, a different regimen may be recommended.

See "Patient education: Type 1 diabetes: Insulin treatment Beyond the Basics ". See "Patient education: Type 2 diabetes: Treatment Beyond the Basics ". Diet and exercise in type 2 diabetes — The American Diabetes Association recommends lifestyle interventions, specifically diet and exercise, as the first line in treating diabetic neuropathy in type 2 diabetes [ 3 ].

The goal is to achieve and maintain a normal body weight with a nutrient-dense diet low in saturated fats and high in whole grains, vegetables, fruits, and lean meats.

Exercise should consist of at least minutes of moderate-to-vigorous physical activity, such as brisk walking, at least three times per week. Muscle-strengthening activities that involve all major muscle groups are recommended two or more days per week.

Sedentary activities eg, sitting at a desk should be interrupted every 30 minutes by brief periods of standing, walking, or other physical activities [ 4 ]. Care for the feet — People with neuropathy do not always feel pain when there is a wound or injury on the foot.

As a result, daily foot care is necessary to monitor for changes in the skin such as cracks or wounds , which can increase the risk of infection. The American Diabetes Association recommends that people with diabetes have a comprehensive foot examination once per year and a visual examination of the feet at each visit usually every three to four months.

Foot examinations are described in detail separately. See "Patient education: Foot care for people with diabetes Beyond the Basics ". Control pain — Neuropathic pain can be difficult to control and can seriously affect your quality of life. Neuropathic pain is often worse at night, seriously disrupting sleep.

Fortunately, only a small percentage of people with diabetic neuropathy experience pain. Pain resolves without treatment in some people over a period of weeks to months, especially if the episode of pain developed after a sudden change in health eg, an episode of diabetic ketoacidosis, a significant weight loss, or a significant change in blood glucose control.

There are several medications that are useful for the treatment of diabetic neuropathy and have been approved by the US Food and Drug Administration FDA , including duloxetine and pregabalin.

Other medications are also useful, including tricyclic medications eg, amitriptyline , gabapentin, tramadol, and alpha-lipoic acid [ 5 ]. Tricyclic antidepressants — There are several tricyclic antidepressants available for the treatment of chronic pain, including amitriptyline, nortriptyline, and desipramine.

Clinical trials have shown that tricyclic antidepressant drugs are effective for patients with painful diabetic neuropathy. The dose of tricyclic antidepressants used to treat diabetic neuropathy is typically much lower than that used to treat depression.

These medications are usually taken at bedtime, starting with a low dose and gradually increasing over a period of several weeks. People with heart disease should not take amitriptyline or nortriptyline.

Tricyclic medications can be taken with gabapentin and pregabalin but should not be taken with duloxetine. Side effects can include dry mouth, sleepiness, dizziness, and constipation. Duloxetine — Duloxetine is an antidepressant that is often effective in relieving pain caused by diabetic neuropathy.

In short-term clinical trials, duloxetine was more effective than placebo. However, the long-term effectiveness and safety of duloxetine for diabetic neuropathy is uncertain [ 6 ]. There are no trials comparing duloxetine with other drugs for the treatment of diabetic polyneuropathy. Duloxetine is usually taken by mouth once per day on a full stomach, although in some cases it is taken twice per day.

It should not be taken by people who take other antidepressant medications see 'Tricyclic antidepressants' above. Side effects can include nausea, sleepiness, dizziness, decreased appetite, and constipation.

Gabapentin — Gabapentin is an anti-seizure medication. It is usually taken by mouth three times per day. Side effects can include dizziness and confusion.

Gabapentin can be taken with a tricyclic antidepressant or duloxetine. In some cases, gabapentin can be taken at night to prevent pain during sleep.

Pregabalin — Pregabalin is an anti-seizure medication, similar to gabapentin. Pregabalin is taken by mouth, starting at bedtime at a low dose and then gradually increasing to three times per day over a period of several weeks.

Side effects can include dizziness, sleepiness, confusion, swelling in the feet and ankles, and weight gain. It may be possible to become addicted to pregabalin, and changes in dosing should be monitored carefully. Pregabalin can be taken with duloxetine or tricyclic antidepressants but not with gabapentin.

Anesthetic drugs — Lidocaine is an anesthetic drug that may be recommended if other treatments have not improved pain. It is applied to the painful area in a patch, which slowly releases the medication over time. Patches should stay in place for no more than 12 hours in any hour period.

Alpha-lipoic acid — Alpha-lipoic acid ALA is an antioxidant medication. Several short-term trials showed that it was helpful in relieving pain caused by diabetic neuropathy. Thus, ALA may be recommended to people with diabetic neuropathy who do not improve with or who cannot tolerate other treatments.

However, longer-term studies are still needed to confirm its safety and effectiveness. In the United States, ALA is available without a prescription as a dietary supplement. It is usually taken by mouth once per day.

Your healthcare provider is the best source of information for questions and concerns related to your medical problem. This article will be updated as needed on our web site www. Related topics for patients, as well as selected articles written for healthcare professionals, are also available.

Diabetes and Nerve Damage | CDC Causes of peripheral neuropathy. Mayo Clin Proc. One complication of diabetes is diabetic neuropathy. Botanicals and dietary supplements in diabetic peripheral neuropathy. How Well Do You Sleep? In the United States, ALA is available without a prescription as a dietary supplement.
Diabetic Neuropathy: Treatment, Symptoms, Causes

Most people with diabetes can prevent serious nerve damage complications. Stay on schedule with all of your self-checks, exams, and appointments with a diabetes care schedule. Skip directly to site content Skip directly to page options Skip directly to A-Z link. Español Other Languages.

Diabetes and Nerve Damage. Español Spanish. Minus Related Pages. Nerve damage can affect your hands, feet, legs, and arms.

Nerve Damage and Digestion. Risk Factors for Nerve Damage. Anyone with diabetes can develop nerve damage, but these factors increase your risk: Blood sugar levels that are hard to manage.

Having diabetes for a long time, especially if your blood sugar is often higher than your target levels. Being overweight. Being older than Having high blood pressure.

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You will be subject to the destination website's privacy policy when you follow the link. CDC is not responsible for Section compliance accessibility on other federal or private website. It often affects a nerve in the wrist or foot.

It can also affect a nerve that controls the eye muscles. Another type affects many nerves. This is called polyradiculoneuropathy. It often affects nerves in the back and chest. These types of nerve damage happen all of a sudden.

And they can get better with time. Over time, high blood sugar levels from diabetes can damage nerves throughout your body. The higher your blood sugar levels, the more likely you are to have nerve damage.

Also, the older you get and the longer you have diabetes, the more likely you are to have nerve damage. Symptoms depend on which nerves are injured. You may not be able to feel pain, especially in your feet.

This can lead to serious infections if sores and other problems aren't treated. Other symptoms may include problems with digestion or urination, and blood vessel problems that can lead to poor circulation or low blood pressure. Your doctor will check how well you can feel light touch and temperature and will test your strength and reflexes.

Tests such as an electromyogram and nerve conduction studies may be done to confirm the diagnosis. Your doctor will want to know about any symptoms such as pain, weakness, or urinary or digestive problems. Treatment involves keeping blood sugar levels in your target range.

This will not cure nerve damage. But it can help keep the damage from getting worse, and the pain might get better. Other treatments depend on your symptoms. They may include:. When you have diabetes, you could have a sore or other foot problem without noticing it. So check your feet every day.

An untreated problem on your foot can lead to a serious infection or even amputation. Work together with your doctor to find the treatment that helps you the most. Keeping your blood sugar levels in your target range recommended by your doctor may help prevent diabetic neuropathy.

The best way to do this is by checking your blood sugar and adjusting your treatment. It's also important to get to and stay at a healthy weight by exercising and eating healthy foods.

Health Tools help you make wise health decisions or take action to improve your health. People with diabetes who drink too much alcohol are also more likely to have nerve damage. Symptoms of peripheral neuropathy can occur slowly over time. The most common ones are:. Autonomic neuropathy may affect certain processes in the body.

This includes digestion, urination, sexual function, your body's ability to regulate temperature, and heart and blood vessel function, including blood pressure. Symptoms may include:. The type of symptoms you have depends on the kind of atypical neuropathy you have.

These symptoms may be caused by other serious conditions. See your doctor right away if you have any of these symptoms.

During a physical exam, your doctor may check how well you can feel light touch, temperature, pain, vibration, and movement. Your doctor may also check your strength and reflexes.

You may need other tests to see which type of neuropathy you have and to help guide your treatment. Doctors can't test for all types of nerve damage. So it's important to tell your doctor about any pain or weakness you feel. Also mention heavy sweating or dizziness and any changes in digestion, urination, and sexual function.

Treatment for diabetic neuropathy involves keeping blood sugar levels in your target range. But it can help keep the damage from getting worse.

And it may help relieve pain. It helps to have healthy habits, such as seeing your doctor regularly, controlling your blood pressure, eating a balanced diet, exercising regularly, not smoking, and limiting or avoiding alcohol. If diabetic neuropathy gets worse, you may have serious problems such as severe gastroparesis , bladder infections, or foot problems.

Along with keeping your blood sugars in your target range and taking good care of your feet, you may need more treatment. Diabetic neuropathy is a major risk factor for foot infections or foot ulcers. This may lead to amputation.

It is possible to have permanent damage in one or both of your feet such as Charcot foot from diabetic neuropathy. Surgery is sometimes needed to repair deformed joints that can result from Charcot foot. Severe bladder infections or other bladder problems may require more testing and treatment.

Also, it is common to have symptoms of depression with any long-term chronic disease. Getting help for depression may improve your overall well-being and help you treat your condition. Author: Healthwise Staff Clinical Review Board: E.

Gregory Thompson MD - Internal Medicine Kathleen Romito MD - Family Medicine Adam Husney MD - Family Medicine Karin M. Lindholm DO - Neurology. Author: Healthwise Staff. Medical Review: E. This information does not replace the advice of a doctor.

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Main Content Related to Conditions Brain and Nervous System Diabetes. Important Phone Numbers. Topic Contents Condition Basics Health Tools Cause Symptoms Examinations and Tests Treatment Overview Self-Care Related Information Credits.

Top of the page. Condition Basics What is diabetic neuropathy? Peripheral neuropathy. Autonomic neuropathy. Atypical neuropathies. What causes it? What are the symptoms? How is it diagnosed? How is diabetic neuropathy treated? They may include: Medicines to treat pain, digestive problems, or blood vessel problems.

Medicines or the use of compression stockings to treat blood pressure problems. Treatments for sexual problems. Medicines or devices may help improve erections. Or lubricating creams may help vaginal dryness. A splint or brace to help treat a nerve problem.

Can it be prevented? Health Tools Health Tools help you make wise health decisions or take action to improve your health. Actionsets are designed to help people take an active role in managing a health condition.

Tips for Treating Diabetic Nerve Pain

Or lubricating creams may help vaginal dryness. A splint or brace to help treat a nerve problem. Can it be prevented? Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Actionsets are designed to help people take an active role in managing a health condition. Diabetes: Taking Care of Your Feet.

Cause Over time, high blood sugar levels from diabetes can damage nerves throughout your body. Symptoms Peripheral neuropathy Symptoms of peripheral neuropathy can occur slowly over time. The most common ones are: Numbness, tightness, and tingling, especially in the legs, hands, and feet.

Loss of feeling. Burning, shooting, or stabbing pain in the legs, hands, and feet. Often the pain is worse at night. Weakness and loss of balance. Autonomic neuropathy Autonomic neuropathy may affect certain processes in the body. Symptoms may include: Frequent bloating, belching, constipation, heartburn, nausea and vomiting, and belly pain.

These symptoms may be a sign of gastroparesis. This causes the stomach to empty much slower than normal.

Extreme sweating of the torso, face, or neck at night or while eating certain foods, such as spicy foods and cheese. Some people may have reduced sweating, especially in their feet and legs. Trouble sensing when your bladder is full or problems emptying your bladder completely.

Sexual problems. For example, men may have erection problems. Women may have vaginal dryness. Dizziness, weakness, or fainting when you stand or sit up from a reclining position.

Trouble knowing when your blood sugar is low. Atypical neuropathies The type of symptoms you have depends on the kind of atypical neuropathy you have. Mononeuropathy can cause: Pain in a single, limited area of the body.

This may be in the wrist or foot. Pain in and around one of the eyes, trouble moving the eyes, and double vision. This occurs when one of the cranial nerves is affected.

Polyradiculoneuropathy can cause: Pain that occurs in a band-shaped area around the chest or belly. Weakness and pain in the lower back. It often goes down to the thigh femoral neuropathy. Learn more Diabetic Atypical Neuropathies Diabetic Autonomic Neuropathy Peripheral Neuropathy.

Examinations and Tests During a physical examination, your doctor may check how well you can feel light touch, temperature, pain, vibration, and movement. Learn more Electromyogram EMG and Nerve Conduction Studies. Treatment Overview Treatment for diabetic neuropathy involves keeping blood sugar levels in your target range.

Treatment if the condition gets worse If diabetic neuropathy gets worse, you may have serious problems such as severe gastroparesis , bladder infections, or foot problems. Learn more Treating Diabetic Foot Problems.

Self-Care Take your medicines exactly as prescribed. Call your doctor or nurse advice line if you think you are having a problem with your medicine.

Try to keep blood sugar in your target range. Follow your meal plan to know how much carbohydrate you need for meals and snacks. A registered dietitian or certified diabetes educator can help you plan meals. Try to get at least 30 minutes of exercise on most days.

Check your blood sugar as many times each day as your doctor recommends. Take and record your blood pressure at home if your doctor tells you to. To take your blood pressure at home: Ask your doctor to check your blood pressure monitor to be sure it is accurate and the cuff fits you.

Also ask your doctor to watch you to make sure that you are using it right. Do not use medicine known to raise blood pressure such as some nasal decongestant sprays before taking your blood pressure.

Avoid taking your blood pressure if you have just exercised or are nervous or upset. Rest at least 15 minutes before you take a reading.

Do not smoke. Smoking can increase your chance for a heart attack or stroke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines.

These can increase your chances of quitting for good. If you drink alcohol, try to drink less. Your risk of harm from alcohol is low if you have 2 drinks or less per week.

Work with your doctor to find what is right for you. Eat small meals often, rather than 2 or 3 large meals a day. To care for your feet Prevent injury by wearing shoes at all times, even when you are indoors. Do foot care as part of your daily routine.

Wash your feet and then rub lotion on your feet, but not between your toes. Use a hand-held mirror or magnifying mirror to inspect your feet for blisters, cuts, cracks, or sores.

Have your toenails trimmed and filed straight across. Wear shoes and socks that fit well. Soft shoes that have good support and that fit well such as tennis shoes are best for your feet.

Check your shoes for any loose objects or rough edges before you put them on. Ask your doctor to check your feet during each visit. Your doctor may notice a foot problem you have missed. Get early treatment for any foot problem, even a minor one. Learn more Diabetes: Checking Your Feet Diabetes: Protecting Your Feet Diabetes: Steps for Foot-Washing Diabetes: Taking Care of Your Feet Diabetic Neuropathy: Exercising Safely Quitting Smoking.

Related Information Abdominal Pain, Age 12 and Older Chronic Pain Constipation, Age 12 and Older Diabetic Kidney Disease Diabetic Retinopathy Diarrhea, Age 12 and Older Erection Problems Erectile Dysfunction High Blood Pressure Type 1 Diabetes Type 2 Diabetes.

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What to expect from your doctor Your health care provider is likely to ask you a number of questions, such as: How effective is your diabetes management?

When did you start having symptoms? Do you always have symptoms or do they come and go? How severe are your symptoms? Does anything seem to improve your symptoms?

What, if anything, appears to make your symptoms worse? What's challenging about managing your diabetes? What might help you manage your diabetes better? By Mayo Clinic Staff. Apr 29, Show References. Ferri FF. Diabetic polyneuropathy.

In: Ferri's Clinical Advisor Elsevier; Accessed Dec. Diabetic neuropathy. National Institute of Diabetes and Digestive and Kidney Diseases. Accessed Jan. American Diabetes Association. Standards of medical care in diabetes — Diabetes Care. Accessed Nov.

Peripheral neuropathy adult. Mayo Clinic; Feldman EL, et al. Management of diabetic neuropathy. Diabetes and foot problems. Jankovic J, et al. Disorders of peripheral nerves. In: Bradley and Daroff's Neurology in Clinical Practice.

Baute V, et al. Complementary and alternative medicine for painful peripheral neuropathy. Current Treatment Options in Neurology. Nature Reviews — Disease Primers. Cutsforth-Gregory expert opinion. Mayo Clinic. Castro MR expert opinion.

Types of diabetic neuropathy. Associated Procedures. A Book: The Essential Diabetes Book. Show the heart some love! Give Today. Help us advance cardiovascular medicine. Find a doctor. Explore careers. Sign up for free e-newsletters. About Mayo Clinic.

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Degree Programs. Research Faculty. International Patients. Financial Services. Community Health Needs Assessment. You may be able to relieve diabetic nerve pain with medications and exercise. Managing your diabetes may help prevent it from getting worse. One complication of diabetes is diabetic neuropathy.

This can cause numbness or tingling in your fingers, toes, hands, and feet. Another symptom is a burning, sharp, or aching pain diabetic nerve pain. The pain may be mild at first, but it can get worse over time and spread up your legs or arms. Walking can be painful, and even the softest touch can feel unbearable.

Nerve damage can affect your ability to sleep, decrease your quality of life, and can also cause depression. Talk with your doctor about setting your blood sugar goal, and learn to monitor it. Use diets, exercise, and medications to decrease your blood sugar to a healthier range. Monitor other health risks that can worsen your diabetes, such as your weight and smoking.

Ask your doctor about effective ways to lose weight or quit smoking , if necessary. The first-line treatment for diabetic neuropathy , especially in cases of pain, is usually the anticonvulsants anti-seizure drugs Pregabalin Lyrica or gabapentin Neurontin , which are known to help with nerve pain.

They may also choose the selective norepinephrine reuptake inhibitor SNRI duloxetine Cymbalta because antidepressants interfere with the chemicals in your brain that cause you to feel pain. If these three medications are not effective, there are others a doctor can choose from within the same classes such as the anticonvulsants oxcarbazepine Trileptal, Oxtellar XR or carbamazepine Tegretol, Tegretol XR, Epitol.

In addition, your doctor might suggest trying an over-the-counter pain reliever such as acetaminophen Tylenol , aspirin Bufferin , or ibuprofen Motrin IB, Advil to manage pain. These are available without a prescription but can cause side effects.

Use a low dose for a short time to control your symptoms. Lidocaine patches also deliver local anesthetic through a patch placed on the skin.

These may cause minor skin irritation, however. Powerful drugs like oxycodone Oxycontin and the opioid-like medicine tramadol Conzip, Ultram can treat much stronger pain.

Work closely with your doctor and use caution when taking opioid medicines. A variety of physical exercises or physical therapy may be helpful in reducing pain from peripheral neuropathy, though research has yet to determine the most effective type.

This may include:. Different physical activities might work better for different people. Be sure to speak to your doctor about the best exercise for you based on your specific health and symptoms. If you go to a physical therapist, choose a trusted professional who understands neuropathy, diabetes, or otherwise, and can help you work through physical therapy methods without further nerve damage.

Proper attention to physical activity by an expert can prevent any further issues from occurring. Also keep in mind that physical therapy can soothe diabetic nerve pain, but not cure it.

Capsaicin cream Arthricare, Zostrix can block pain signals using an ingredient found in hot peppers. It is also available as a lotion, jelly, or patch, and can be applied to the skin where diabetic nerve pain is strong.

Research has found that applying capsaicin 0. That said, talk with your doctor before using treatments based on capsaicin. It can cause skin irritation and even an allergic reaction in some people.

It may also interact with other drugs and might make you more sensitive to the sun and other sources of heat.

Diabetic neuropathy treatment

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