Diabetic neuropathy has no known cure. The goals of treatment are to:
- Slow progression of the disease
- Relieve pain
- Manage complications and restore function
Slowing progression of the disease
Consistently keeping your blood sugar within your target range is the key to preventing or delaying nerve damage. Doing so may even improve some of your current symptoms. Your doctor will determine the best target range for you based on several factors, such as your age, how long you’ve had diabetes and your overall health.
For many people who have diabetes, the American Diabetes Association generally recommends the following target blood sugar levels:
- Between 80 and 130 mg/dL (4.4 and 7.2 mmol/L) before meals
- Less than 180 mg/dL (10.0 mmol/L) two hours after meals
For many people who have diabetes, Mayo Clinic generally recommends the following target blood sugar levels before meals:
- Between 80 and 120 mg/dL (4.4 and 6.7 mmol/L) for people age 59 and younger who have no other medical conditions
- Between 100 and 140 mg/dL (5.6 and 7.8 mmol/L) for people age 60 and older, or for those who have other medical conditions, including heart, lung or kidney disease
Keep in mind, your doctor may need to adjust these target ranges to meet your individual health needs.
Other important ways to help slow or prevent disease progression include keeping your blood pressure under control and maintaining a healthy weight and lifestyle.
Many prescription medications are available for diabetes-related nerve pain, but they don’t work for everyone. Side effects are always possible. When considering any medication, talk to your doctor about the benefits and drawbacks to determine what might work best for you.
Pain-relieving prescription treatments may include:
- Anti-seizure drugs. Some medications used to treat seizure disorders (epilepsy) are also used to ease nerve pain. The American Diabetes Association recommends starting with pregabalin (Lyrica). Others that have been used to treat neuropathy are gabapentin (Gralise, Neurontin) and carbamazepine (Carbatrol, Tegretol). Side effects may include drowsiness, dizziness and swelling.
- Antidepressants. Some antidepressants disrupt the chemical processes in the brain that make you feel pain. You don’t need to have depression for these medicines to ease nerve pain. Two classes of antidepressants have been used for neuropathy treatment.
Tricyclics, including amitriptyline, desipramine (Norpramin) and imipramine (Tofranil), may provide relief for mild to moderate symptoms. But side effects can be bothersome and include dry mouth, sweating, weight gain, constipation and dizziness.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) may ease pain with fewer side effects. The American Diabetes Association recommends duloxetine (Cymbalta) as a first treatment. Another that may be used is venlafaxine (Effexor XR). Possible side effects of SNRIs include nausea, sleepiness, dizziness, decreased appetite and constipation.
Sometimes, an antidepressant may be combined with an anti-seizure drug or pain-relieving medication.
Managing complications and restoring function
Your diabetes health care team will likely include different specialists, such as doctor that treats urinary tract problems (urologist) and a heart doctor (cardiologist), who can help prevent or treat complications.
Treatment depends on the neuropathy-related complication you have:
- Urinary tract problems. Some medications can interfere with bladder function. Your doctor may recommend stopping or changing medications. A strict urination schedule or urinating every few hours (timed urination) while applying gentle pressure to the bladder area (below your bellybutton) is recommended. Other methods, including self-catheterization, may be needed to remove urine from a nerve-damaged bladder.
- Digestive problems. To relieve mild signs and symptoms of gastroparesis — indigestion, belching, nausea or vomiting — doctors suggest eating smaller, more-frequent meals, reducing fiber and fat in the diet, and, for many people, eating soups and pureed foods. Diet changes and medications may help relieve diarrhea, constipation and nausea.
- Low blood pressure on standing (orthostatic hypotension). Treatment starts with simple lifestyle changes, such as avoiding alcohol, drinking plenty of water, and sitting or standing slowly. Sleeping with the head of the bed raised 6 to 10 inches helps prevent swings in blood pressure. Your doctor may also recommend compression stockings and similar compression support for your abdomen (abdominal binder). Several medications, either alone or together, may be used to treat orthostatic hypotension.
- Sexual dysfunction. Medications taken by mouth or injection may improve sexual function in some men, but they aren’t safe and effective for everyone. Mechanical vacuum devices may increase blood flow to the penis. Women may find relief with vaginal lubricants.