Diabetic neuropathy

Alternative Names

Nerve damage - diabetic; autonomic neuropathy; peripheral neuropathy; gastroparesis

Treatment

The goals of treating diabetic neuropathy are to prevent the disease from getting worse and to reduce the symptoms of the disease.

Tight control of blood sugar (glucose) is important to prevent symptoms and problems from getting worse.

Medications may be used to reduce the symptoms in the feet, legs, and arms. These medications include:

• Antidepressant drugs, such as amitriptyline (Elavil), doxepin (Sinequan), or duloxetine (Cymbalta)
• Anti-seizure medications, such as gabapentin (Neurontin), pregabalin (Lyrica), carbamazepine (Tegretol), and valproate (Depakote)
• Drugs that block bladder contractions may be used to help with urinary control problems.
• Erythromycin, domperidone (Motilium), or metoclopramide (Reglan) may help with nausea and vomiting.
• Pain medications (analgesics) may work for some patients on a short-term basis, but in most cases they do not provide much benefit.
• Phosphodiesterase type 5 (PDE-5) drugs, such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are safe and effective for treating impotence in patients with diabetes.
• Capsaicin can be used topically to reduce pain.

Regular foot exams are important to identify small infections and prevent foot injuries from getting worse. If foot injuries go unnoticed for too long, amputation may be required.

Outlook (Prognosis)

Treatment relieves pain and can control some symptoms, but the disease generally continues to get worse.

Possible Complications

• Injury to the feet due to loss of feeling
• Muscle breakdown and imbalance
• Poor blood sugar control due to nausea and vomiting
• Skin and soft tissue breakdown (ulceration) that may require amputation

In addition, neuropathy may mask angina, the warning chest pain for heart disease and heart attack.

When to Contact a Medical Professional

Call your health care provider if you develop symptoms of diabetic neuropathy.

References

Vinik AI. Diabetic neuropathies. Med Clin North Am. 2004; 88(4): 947-99.

Vardi M, Nini A. Phosphodiesterase inhibitors for erectile dysfunction in patients with diabetes mellitus. Cochrane Database Syst Rev. 2007; Jan 24(1):CD002187.

Wong MC, Chung JW, Wong TK. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ. 2007; 335:87.

Hunt D. American Diabetes Association (ADA). Standards of medical care in diabetes--2008. Diabetes Care. 2008;31:S12-S54.