Diabetic neuropathy is a chronic, progressive condition. Fortunately, this condition can be managed with medication and lifestyle changes. The most effective medications are drugs that control your diabetes, which helps to slow the progression of this complication. Show
This article will look at how diabetic neuropathy is diagnosed and treated, including the most effective medication options and the drugs to avoid. Pornpak Khunatorn /iStock / Getty Images Plus Types of Diabetic NeuropathyThere are four main types of diabetic neuropathy that may develop in relation to diabetes: peripheral, autonomic, proximal, and focal. Some people may experience just one type, while others may develop multiple types. Peripheral NeuropathyPeripheral neuropathy refers to damage of nerves that innervate (supply with nerves) the parts of the body located outside the brain and spinal cord. Damage to this vast communication network can lead to symptoms of weakness, numbness, and pain in the hands and feet, although digestion, urination, and circulation may also be affected. Autonomic NeuropathyAutonomic neuropathy refers to damage to the nerves that serve your internal organs. These organs help carry out daily functions like digestion, sweating, and urination. Autonomic nerves control largely involuntary functions of the body performed by the bladder, intestinal tract, and genitals, among other organs. This type of neuropathy can manifest in additional health complications, including: Digestion problems: Damage to the nerves that serve the gut can delay the emptying of the stomach (diabetic gastroparesis) and distort the control of intestinal motility (how waste is moved through the intestines). This can lead to a variety of symptoms such as diarrhea, constipation, intestinal distension (bloating), intestinal blockages, and abdominal pain. Diabetes neuropathy may also affect the sensory nerves of the gut, and depending on which pathways are involved, your perception of being full or not full may be increased or reduced. Cardiovascular problems: One of the most overlooked complications of diabetes is cardiovascular autonomic neuropathy (CAN), or damage to the autonomic nerve fibers that innervate the heart and blood vessels. Damage to the nerves that serve the heart can result in abnormalities in heart rate control and vascular dynamics, as well as symptoms of light-headedness, weakness, palpitations, and syncope (loss of consciousness due to a drop in blood pressure) that occurs when standing. CAN also represents a significant cause of morbidity and mortality in diabetic patients because it is associated with a high risk of cardiac arrhythmias (irregular heartbeats) and sudden death due to the possibility of having a silent heart attack. Sexual and bladder problems: Damage to the small nerves that serve the genitals in men and women can lead to a wide range of problems. Sexual problems in men with diabetes include erectile dysfunction and retrograde ejaculation (this occurs when semen enters the bladder instead of emerging through the penis during orgasm), whereas sexual problems in women include vaginal dryness, painful intercourse, decreased libido, and decreased or absent sexual response. Damage to the small nerves that serve the bladder can lead to overactive bladder, urinary retention, urinary tract infections (UTIs), and poor control of sphincter muscles that surround the urethra. Urinary Problems and Type 2 Diabetes Proximal NeuropathyProximal neuropathy involves nerve damage to the hip, buttock, or thigh. It can cause severe pain and muscle shrinkage to the affected area. Focal NeuropathyDiabetic focal neuropathy, also called mononeuropathy, involves damage to a single nerve, usually in the wrist or feet. It is less common than peripheral and autonomic neuropathy. Carpal tunnel syndrome and Bell's palsy are examples of focal neuropathy. Early Signs of Diabetes: Watch for These Symptoms Symptoms of Diabetic NeuropathySymptoms of diabetic neuropathy vary depending on the type of neuropathy that you have. Symptoms can range from mild to disabling. Symptoms of peripheral neuropathy include:
Symptoms of autonomic neuropathy depend on the organ that is affected. Common symptoms include:
Proximal neuropathy can cause:
Focal neuropathy can cause tingling, pain, or numbness in the body area near the affected nerve, usually in a hand, wrist, or foot. Causes of Diabetic NeuropathyAlthough the exact cause of diabetic neuropathy is unknown, chronically high blood sugar levels have been shown to be toxic to nerves around the body. Managing and Preventing Complications of Diabetes Diagnosing Diabetic NeuropathyIf you have type 1 or type 2 diabetes, getting checked for damage to nerves in your hands, feet, and lower legs, is critical. Early diagnosis can relieve pain, protect your feet from small injuries before they become more serious, and motivate you to keep your blood sugar (glucose) within healthy limits. Your assessment will start with a healthcare provider taking a thorough history and checking your vitals. Next, they will perform a physical exam. A physical exam that emphasizes an assessment of your neurological function, including checking your muscle strength, reflexes, and ability to move, is the first step in assessing your nerve health. What Is a Microfilament Exam?A microfilament exam is often used in the diagnosis of diabetic neuropathy. This exam uses nylon filaments (thin thread-like fibers) to help determine your ability to feel pressure. You will be asked to close your eyes while a healthcare provider presses a filament onto your skin. If you cannot feel the pressure caused by the filament, it may indicate diabetic neuropathy. A healthcare provider may also order some blood tests to rule out other causes of nerve damage. This may include:
If your nerve pain cannot be explained by other causes, it becomes more likely that your nerve pain is the result of diabetic neuropathy. Other tests that may be used to confirm the diagnosis include a nerve conduction velocity (NCV) test, which measures how long it takes nerves to transmit signals, and electromyography (EMG) tests, which help assess how well muscles are responding to the signals from nerves. These tests are performed by a physiatrist (a doctor trained in physical medicine and rehabilitation). Diabetic Neuropathy MedicationsDiabetic nerve pain impacts 25% of all diabetics who are treated in the hospital, and an estimated 30%–40% of all people with diabetes. Unfortunately, many people with this condition do not report symptoms or do not seek care in a hospital setting. Therefore, these figures are likely huge underestimations. Diabetic neuropathy poses a great threat to the quality of life experienced by those with diabetes. Several drugs within various drug classes have been shown to reduce diabetic nerve pain and increase one’s quality of life. Currently, the anticonvulsant Lyrica (pregabalin), the antidepressant Cymbalta (duloxetine), and the opioid Nucynta (tapentadol) are the only drugs approved by the Food and Drug Administration (FDA) approved drugs in the treatment of diabetic neuropathy. Anti-Seizure Drugs
Antidepressants
Other Nerve Pain Medication
What Type of Nerve Pain Medication Is Right for Me? Other Treatment Options
Topicals
Topical Creams For Neuropathy Drugs to Be AvoidedOpioids generally have not been found to help with neuropathic pain. Even more, some medicines have shown that they can worsen peripheral neuropathy. The following antibiotics were included in a safety warning issued by the FDA:
Managing Diabetic NeuropathyLifestyle ChangesNerve damage can reduce blood flow throughout the body and disrupt nerve signals, impacting sensation and motor function of the arms, legs, and major organs of the body resulting in a host of symptoms that may range from mild discomfort to severely debilitating. The following lifestyle changes can help decrease your symptoms of diabetic neuropathy:
PreventionThe following steps may help you prevent diabetic neuropathy:
The 9 Best Diabetic Socks of 2022 OutlookWhile diabetic neuropathy cannot be reversed, you can slow down its progression and improve your symptoms over time. Your general outlook ultimately depends on how well you control your diabetes. SummaryDiabetic neuropathy is a late manifestation of uncontrolled or long-standing diabetes. Its main symptom is nerve pain. the anticonvulsant Lyrica, the antidepressant Cymbalta, and the opioid Nucynta are the only FDA-approved drugs in the treatment of diabetic neuropathy. However, other nerve pain medications, such as Neurontin, have been shown to reduce nerve pain symptoms and increase quality of life. A Word From VerywellDiabetic neuropathy is a highly treatable condition with oral medications, helping to relieve pain and restore function. However, the best way to limit symptoms and slow the progression of your condition is through strict management of your diabetes. Frequently Asked Questions
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