By Dr Ananya Mandal, MD
Diabetic neuropathy is a progressive condition that may often go unnoticed in the initial stages but become painful and debilitating in the later stages. If treatment is begun early, the microvascular damage underlying the progression of diabetic neuropathy may be prevented or slowed down.
The treatment of diabetic neuropathy involves:
Blood sugar control
Persistently high or fluctuating levels of blood sugar increases the risk of nerve damage. Controlling blood sugar with insulin or other antidiabetic medications, diet control and regular exercise helps to prevent or slow down the progression of diabetic neuropathy.
In most patients, advanced diabetic neuropathy causes severe pain. These pain symptoms are treated with several medications including:
Tricyclic antidepressants such as amitriptyline, imipramine, and desipramine
Other antidepressant medications such as duloxetine, venlafaxine, bupropion and paroxetine
Antiseizure medications such as pregabalin, gabapentin, carbamazepine and lamotrigine
Pain relieving opioids such as oxycodone and tramadol
A combination of these therapies may be required in many patients, depending on their efficacy. Some patients with additional depression and anxiety due to diabetic neuropathy may also benefit from counselling and cognitive behavioral therapy.
Pain relieving medications such as lidocaine or lignocaine can be applied to the skin across affected areas. Alternative pain relief methods include physical therapy, acupuncture, electrical nerve stimulation and magnetic therapy.
Relief of gastrointestinal problems
Eating small and frequent meals helps relieve some gastrointestinal symptoms. Slow gastric transit or diabetic gastroparesis is treated using medications such as erythromycin and metoclopramide.
Medications and vaginal lubricants are used to correct erectile dysfunction and vaginal dryness.
Preventing diabetic foot
The foot is the area of the body most likely to be affected by diabetic neuropathy and, in severe cases, gangrene of the foot may manifest. It is therefore important that diabetic individuals attend regular checkups and maintain good foot care.
Reviewed by Sally Robertson, BSc