Prevention:
Keeping your blood glucose levels as near to normal range is the best way of preventing neuropathy. This is the best way to protect the nerves throughout your body.
And how I know how difficult this can be. Especially at this time of year. Christmas is almost upon us and with it comes all the wonderful treats made for the season. Almost every home you go in to has platters of cookies, cakes, chip and dips, ciders and eggnogs. It is so very easy to over eat and ignore our blood sugars. Make sure you eat regular meals and take your insulin. I find that, if I have eaten and followed my regime, it is far easier to resist the temptations put in front of me. I will also take only a nibble or two of a treat. Maybe 2 or 3 chips. Or one cookie. And then leave the rest alone. At least I have had a taste and it doesn’t usually affect my blood glucose by very much at all.
Diagnoses of Diabetic Neuropathies:
Usually diabetic neuropathy is diagnosed by your doctor based on symptoms and physical exam. Your doctor will most likely check your heart rate, reflexes, muscle strength, and blood pressure. He/she may also test your sensitivity to changes in position, vibration, light touch, or temperature.
If you feel you have symptoms, talk to your doctor so that he can test you. We know our own bodies better than anyone and when it is not reacting normally to anything, we can tell. Listen to your body. If your feet are going numb, even slightly, let your doctor know. The same goes for your hands or any other part of your body. Don’t ignore warning signs like tingling, weakness, pounding in the ears, the sensation of hearing your own heartbeat, or even small injuries that you don’t feel at the time of injury. Early detection of neuropathies will help you and your doctor combat it.
Foot Exams:
Because I have signs of peripheral neuropathy now my doctor does a comprehensive foot exam about every six months, though it is recommended once a year for most diabetics. Your doctor will examine the skin, muscles, circulation, sensation and bones in your feet.
When I had my first exam at the diabetic clinic they used a feather, with me not looking, to see if I could feel it. I couldn’t. Then she used a nylon monofilament (like a bristle on a hairbrush), poking my feet with it, again with me not looking. (Some will use a pin instead). I could feel that.
These tests will indicate to your doctor whether you have lost the protective sensation in your feet (and other areas). Loss of sensation can cause you to develop foot sores or have unnoticed injuries that may not heal properly.
Your doctor may also use a tuning fork to test your sensitivity to vibration. It is more accurate than touch pressure. Checking temperature sensitivity is another test he may use.
Other Tests:
Though not often needed to diagnose neuropathy, there are other tests used to tell him what type of nerve damage there is and to what extent it has progressed.
To show how organs, like the bladder and urinary tract, preserve a normal structure and whether the bladder is emptying properly he may do an ultrasound.
Your doctor may check on the flow of electrical current through a nerve using a nerve conduction study. This can tell him what type of neuropathy is there and to what extent the nerves are damaged.
To test muscle response to electrical signals sent by nearby nerves he may order an electromyography.
A heart rate variability test will tell your doctor how the heart is responding to deep breathing and changes in blood pressure and posture.
Treatment of Diabetic Neuropathies:
The best and first treatment of diabetic neuropathies, and to prevent further damage, is to bring your diabetes under control and keep it in normal range. This will include taking medication and insulin as directed, planning meals, testing often for blood glucose levels, and physical activity.
As a note, the amount of physical activity you do can greatly affect your blood glucose levels and thereby affect how much insulin you will need to take.
To begin with your symptoms may seem to get worse, however getting and keeping your blood glucose levels controlled well will help lessen them in the long run.
For instance, at first I couldn’t see well. My vision was very blurry. As I got my blood glucose levels under control, the sugar build up at the back of my eyes that was causing the blurriness was lessened and, over time, my eyesight cleared. (As much as it ever does as I already wore glasses.) This was NOT caused by a neuropathy, but because I had gone undiagnosed for so long.
When you have high blood sugar that is uncontrolled it can cause a buildup of sugar/glucose behind the eyes, affecting vision. By bringing blood glucose under control, this will clear up and your vision will revert to what it normally was.
Keeping your blood glucose levels under control may also prevent or delay further problems. As scientists learn more, new treatments to help slow, prevent or even reverse the nerve damage may become available.
Other treatments depend on the type of nerve problem and symptom.
Pain Relief
Oral medications are usually used for painful diabetic neuropathy, though other treatments could help some. Those with severe nerve pain my find relief from a combination of medications and treatments.
Some oral medications used to help relieve diabetic nerve pain include:
tricyclic antidepressants, such as amitriptyline, imipramine, and desipramine (Norpramin, Pertofrane)
other types of antidepressants, such as duloxetine (Cymbalta), venlafaxine, bupropion (Wellbutrin), paroxetine (Paxil), and citalopram (Celexa)
anticonvulsants, such as pregabalin (Lyrica), gabapentin (Gabarone, Neurontin), carbamazepine, and lamotrigine (Lamictal)
opioids and opioid-like drugs, such as controlled-release oxycodone, an opioid; and tramadol (Ultram), an opioid that also acts as an antidepressant
Duloxetine and pregabalin are approved by the U.S. Food and Drug Administration specifically for treating painful diabetic peripheral neuropathy.
Many experts say to avoid over-the-counter medications like acetaminophen or ibuprofen. They may not work very well and can have serious side affects. Often antidepressants can help relieve pain. This does not mean you have to be depressed to have them be effective. Some medications are not recommended for use in older patients or those with heart disease. All medications have some side effects.
Topical treatments (applied to the skin) can be effective depending on your type of neuropathy. These include capsaicin cream and lidocaine patches (lidoderm, lidopain), as well as nitrate sprays or patches used on the feet for pain relief.
Studies of alpha-lipoic acid, an antioxidant, and evening primrose oil have shown that they can help relieve symptoms and may improve nerve function.
A device called a bed cradle can keep sheets and blankets from touching sensitive feet and legs.
Acupuncture, biofeedback, or physical therapy may help relieve pain in some people.
Treatments that involve electrical nerve stimulation, magnetic therapy, and laser or light therapy may be helpful and are being studied further. Researchers are also studying several new therapies in clinical trials.
Gastrointestinal Problems
Eating small, frequent meals, avoiding fats and eating less fiber can relieve mild symptoms of gastroparesis (indigestion, belching, nausea, vomiting). If your symptoms become severe erythromycin may be used to speed digestion or perhaps metoclopramide (which also helps to relieve nausea). There are other medications as well that help regulate digestion or reduce stomach acid.
I take a combination of Nexium and metoclopramide to help with the nausea, along with eating small meals frequently.
To relieve diarrhea or other bowel problems, doctors may prescribe an antibiotic such as tetracycline, or other medications as appropriate.
Dizziness and Weakness
Have you ever stood up too fast and had the room spin? A rapid change in blood pressure is the culprit in most cases. Blood pressure and circulation problems can cause light-headedness, dizziness, or fainting. Sitting or standing slowly may help. Raising the head of your bed, or wearing elastic stockings can also aid in preventing these episodes.
Treatment with salt-retaining hormones or increasing salt in the diet may be of benefit for some.
High blood pressure medications may be used.
When muscle weakness or loss of coordination is a problem, physical therapy may be of help
Urinary and Sexual Problems:
Drinking plenty of fluid can help prevent urinary tract infections. An antibiotic will most likely be prescribed if you do develop a urinary tract infection. For those who suffer from incontinence, urinating at regular intervals—every 3 hours, for example--- may be helpful as you may not be able to tell when the bladder is full.
To treat erectile dysfunction in men, the doctor will first do tests to rule out a hormonal cause. Some oral medications have been developed and are available to help men get and maintain an erection by increasing blood flow to the penis. There are also injections that are injected right into the penis or inserted into the urethra at the tip of the penis. Mechanical vacuum devices have also been used to increase blood flow to the penis. A surgically implanted inflatable or semirigid device in the penis have been used as well.
Vaginal lubricants may be useful for women when neuropathy causes vaginal dryness. To treat problems with arousal and orgasm, the doctor may refer women to a gynecologist.
Foot Care
The nerves affected most often by neuropathy are those to the feet. These nerves are the longest in the body. Loss of sensation in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers.
More than half of all lower-limb amputations occur in people with diabetes—86,000 amputations per year in the US alone. Doctors estimate that nearly half of the amputations caused by neuropathy and poor circulation could have been prevented by careful foot care.
Follow these steps to take care of your feet:
Clean your feet daily, using warm—not hot—water and a mild soap and dry them with a soft towel drying carefully between your toes. Avoid soaking your feet.
Inspect your feet and toes every day for cuts, blisters, redness, swelling, calluses, or other problems. Use a mirror—laying a mirror on the floor works well—or get help from someone else if you cannot see the bottoms of your feet. Notify your health care provider of any problems.
Keeping your blood glucose levels as near to normal range is the best way of preventing neuropathy. This is the best way to protect the nerves throughout your body.
And how I know how difficult this can be. Especially at this time of year. Christmas is almost upon us and with it comes all the wonderful treats made for the season. Almost every home you go in to has platters of cookies, cakes, chip and dips, ciders and eggnogs. It is so very easy to over eat and ignore our blood sugars. Make sure you eat regular meals and take your insulin. I find that, if I have eaten and followed my regime, it is far easier to resist the temptations put in front of me. I will also take only a nibble or two of a treat. Maybe 2 or 3 chips. Or one cookie. And then leave the rest alone. At least I have had a taste and it doesn’t usually affect my blood glucose by very much at all.
Diagnoses of Diabetic Neuropathies:
Usually diabetic neuropathy is diagnosed by your doctor based on symptoms and physical exam. Your doctor will most likely check your heart rate, reflexes, muscle strength, and blood pressure. He/she may also test your sensitivity to changes in position, vibration, light touch, or temperature.
If you feel you have symptoms, talk to your doctor so that he can test you. We know our own bodies better than anyone and when it is not reacting normally to anything, we can tell. Listen to your body. If your feet are going numb, even slightly, let your doctor know. The same goes for your hands or any other part of your body. Don’t ignore warning signs like tingling, weakness, pounding in the ears, the sensation of hearing your own heartbeat, or even small injuries that you don’t feel at the time of injury. Early detection of neuropathies will help you and your doctor combat it.
Foot Exams:
Because I have signs of peripheral neuropathy now my doctor does a comprehensive foot exam about every six months, though it is recommended once a year for most diabetics. Your doctor will examine the skin, muscles, circulation, sensation and bones in your feet.
When I had my first exam at the diabetic clinic they used a feather, with me not looking, to see if I could feel it. I couldn’t. Then she used a nylon monofilament (like a bristle on a hairbrush), poking my feet with it, again with me not looking. (Some will use a pin instead). I could feel that.
These tests will indicate to your doctor whether you have lost the protective sensation in your feet (and other areas). Loss of sensation can cause you to develop foot sores or have unnoticed injuries that may not heal properly.
Your doctor may also use a tuning fork to test your sensitivity to vibration. It is more accurate than touch pressure. Checking temperature sensitivity is another test he may use.
Other Tests:
Though not often needed to diagnose neuropathy, there are other tests used to tell him what type of nerve damage there is and to what extent it has progressed.
To show how organs, like the bladder and urinary tract, preserve a normal structure and whether the bladder is emptying properly he may do an ultrasound.
Your doctor may check on the flow of electrical current through a nerve using a nerve conduction study. This can tell him what type of neuropathy is there and to what extent the nerves are damaged.
To test muscle response to electrical signals sent by nearby nerves he may order an electromyography.
A heart rate variability test will tell your doctor how the heart is responding to deep breathing and changes in blood pressure and posture.
Treatment of Diabetic Neuropathies:
The best and first treatment of diabetic neuropathies, and to prevent further damage, is to bring your diabetes under control and keep it in normal range. This will include taking medication and insulin as directed, planning meals, testing often for blood glucose levels, and physical activity.
As a note, the amount of physical activity you do can greatly affect your blood glucose levels and thereby affect how much insulin you will need to take.
To begin with your symptoms may seem to get worse, however getting and keeping your blood glucose levels controlled well will help lessen them in the long run.
For instance, at first I couldn’t see well. My vision was very blurry. As I got my blood glucose levels under control, the sugar build up at the back of my eyes that was causing the blurriness was lessened and, over time, my eyesight cleared. (As much as it ever does as I already wore glasses.) This was NOT caused by a neuropathy, but because I had gone undiagnosed for so long.
When you have high blood sugar that is uncontrolled it can cause a buildup of sugar/glucose behind the eyes, affecting vision. By bringing blood glucose under control, this will clear up and your vision will revert to what it normally was.
Keeping your blood glucose levels under control may also prevent or delay further problems. As scientists learn more, new treatments to help slow, prevent or even reverse the nerve damage may become available.
Other treatments depend on the type of nerve problem and symptom.
Pain Relief
Oral medications are usually used for painful diabetic neuropathy, though other treatments could help some. Those with severe nerve pain my find relief from a combination of medications and treatments.
Some oral medications used to help relieve diabetic nerve pain include:
tricyclic antidepressants, such as amitriptyline, imipramine, and desipramine (Norpramin, Pertofrane)
other types of antidepressants, such as duloxetine (Cymbalta), venlafaxine, bupropion (Wellbutrin), paroxetine (Paxil), and citalopram (Celexa)
anticonvulsants, such as pregabalin (Lyrica), gabapentin (Gabarone, Neurontin), carbamazepine, and lamotrigine (Lamictal)
opioids and opioid-like drugs, such as controlled-release oxycodone, an opioid; and tramadol (Ultram), an opioid that also acts as an antidepressant
Duloxetine and pregabalin are approved by the U.S. Food and Drug Administration specifically for treating painful diabetic peripheral neuropathy.
Many experts say to avoid over-the-counter medications like acetaminophen or ibuprofen. They may not work very well and can have serious side affects. Often antidepressants can help relieve pain. This does not mean you have to be depressed to have them be effective. Some medications are not recommended for use in older patients or those with heart disease. All medications have some side effects.
Topical treatments (applied to the skin) can be effective depending on your type of neuropathy. These include capsaicin cream and lidocaine patches (lidoderm, lidopain), as well as nitrate sprays or patches used on the feet for pain relief.
Studies of alpha-lipoic acid, an antioxidant, and evening primrose oil have shown that they can help relieve symptoms and may improve nerve function.
A device called a bed cradle can keep sheets and blankets from touching sensitive feet and legs.
Acupuncture, biofeedback, or physical therapy may help relieve pain in some people.
Treatments that involve electrical nerve stimulation, magnetic therapy, and laser or light therapy may be helpful and are being studied further. Researchers are also studying several new therapies in clinical trials.
Gastrointestinal Problems
Eating small, frequent meals, avoiding fats and eating less fiber can relieve mild symptoms of gastroparesis (indigestion, belching, nausea, vomiting). If your symptoms become severe erythromycin may be used to speed digestion or perhaps metoclopramide (which also helps to relieve nausea). There are other medications as well that help regulate digestion or reduce stomach acid.
I take a combination of Nexium and metoclopramide to help with the nausea, along with eating small meals frequently.
To relieve diarrhea or other bowel problems, doctors may prescribe an antibiotic such as tetracycline, or other medications as appropriate.
Dizziness and Weakness
Have you ever stood up too fast and had the room spin? A rapid change in blood pressure is the culprit in most cases. Blood pressure and circulation problems can cause light-headedness, dizziness, or fainting. Sitting or standing slowly may help. Raising the head of your bed, or wearing elastic stockings can also aid in preventing these episodes.
Treatment with salt-retaining hormones or increasing salt in the diet may be of benefit for some.
High blood pressure medications may be used.
When muscle weakness or loss of coordination is a problem, physical therapy may be of help
Urinary and Sexual Problems:
Drinking plenty of fluid can help prevent urinary tract infections. An antibiotic will most likely be prescribed if you do develop a urinary tract infection. For those who suffer from incontinence, urinating at regular intervals—every 3 hours, for example--- may be helpful as you may not be able to tell when the bladder is full.
To treat erectile dysfunction in men, the doctor will first do tests to rule out a hormonal cause. Some oral medications have been developed and are available to help men get and maintain an erection by increasing blood flow to the penis. There are also injections that are injected right into the penis or inserted into the urethra at the tip of the penis. Mechanical vacuum devices have also been used to increase blood flow to the penis. A surgically implanted inflatable or semirigid device in the penis have been used as well.
Vaginal lubricants may be useful for women when neuropathy causes vaginal dryness. To treat problems with arousal and orgasm, the doctor may refer women to a gynecologist.
Foot Care
The nerves affected most often by neuropathy are those to the feet. These nerves are the longest in the body. Loss of sensation in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers.
More than half of all lower-limb amputations occur in people with diabetes—86,000 amputations per year in the US alone. Doctors estimate that nearly half of the amputations caused by neuropathy and poor circulation could have been prevented by careful foot care.
Follow these steps to take care of your feet:
Clean your feet daily, using warm—not hot—water and a mild soap and dry them with a soft towel drying carefully between your toes. Avoid soaking your feet.
Inspect your feet and toes every day for cuts, blisters, redness, swelling, calluses, or other problems. Use a mirror—laying a mirror on the floor works well—or get help from someone else if you cannot see the bottoms of your feet. Notify your health care provider of any problems.
Moisturize your feet with lotion, but avoid getting the lotion between your toes.
File corns and calluses gently with a pumice stone. After a bath is best because they have become softer and easier to work with.
Keep your toenails cut to the shape of your toes, filing the edges with an emery board.
Always wear shoes or slippers to protect your feet from injuries. Prevent skin irritation by wearing thick, soft, seamless socks.
Make sure your shoes fit well and allow your toes to move. Wear new shoes for only an hour or so at a time, breaking them in slowly.
Make sure your shoes have no tears, sharp edges, or objects inside them that could injure your feet before putting them on.
If you need help taking care of your feet, make an appointment to see a foot doctor, also called a podiatrist.
Points to Remember
- Diabetic neuropathies are nerve disorders caused by many of the abnormalities common to diabetes, such as high blood glucose.
- Neuropathy can affect nerves throughout the body, causing numbness and sometimes pain in the hands, arms, feet, or legs, and problems with the digestive tract, heart, sex organs, and other body systems.
- Treatment first involves bringing blood glucose levels within the normal range. Good blood glucose control may help prevent or delay the onset of further problems.
- Foot care is an important part of treatment. People with neuropathy need to inspect their feet daily for any injuries. Untreated injuries increase the risk of infected foot sores and amputation.
- Treatment can include pain relief and/or other medications depending on the type of nerve damage.
- Smoking in itself causes circulatory problems which greatly increases the risk of foot problems and amputation. If you smoke, ask your health care provider for help with quitting.
Though I have interjected much of my own experiences, my technical information has come from the NDIC (National Diabetic Information Clearing House). This material is not copyrighted and is available for all to use. Check out the site at
Other Resources and information links:
www.ClinicalTrials.gov. Studies and clinical trials
American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1–800–DIABETES (342–2383)
Email: AskADA@diabetes.org
Internet: www.diabetes.org
American Urological Association Foundation
1000 Corporate Boulevard
Linthicum, MD 21090
Phone: 1–866–RING–AUA (746–4282)
or 410–689–3700
Fax: 410–689–3800
Email: patienteducation@auafoundation.org
Internet: www.auafoundation.org
American Podiatric Medical Association
9312 Old Georgetown Road
Bethesda, MD 20814–1621
Phone: 1–800–FOOTCARE (366–8227)
or 301–581–9200
Fax: 301–530–2752
Email: askapma@apma.org
Internet: www.apma.org
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
4770 Buford Highway NE, Mail Stop K–10
Atlanta, GA 30341–3717
Phone: 1–800–CDC–INFO (232–4636) or 770–488–5000
Email: cdcinfo@cdc.gov
Internet: www.cdc.gov/diabetes
Juvenile Diabetes Research Foundation International
120 Wall Street
New York, NY 10005–4001
Phone: 1–800–533–CURE (2873)
Fax: 212–785–9595
Email: info@jdrf.org
Internet: www.jdrf.org
Lower Extremity Amputation Prevention Program
Health Resources and Services Administration
5600 Fishers Lane
Rockville, MD 20857
Phone: 1–888–ASK–HRSA (275–4772)
Internet: www.hrsa.gov/leap
National Diabetes Education Program
1 Diabetes Way
Bethesda, MD 20892–3560
Phone: 1–800–438–5383
Fax: 703–738–4929
Email: ndep@mail.nih.gov
Internet: www.ndep.nih.gov
National Digestive Diseases Information Clearinghouse
2 Information Way
Bethesda, MD 20892–3570
Phone: 1–800–891–5389
Fax: 703–738–4929
Email: nddic@info.niddk.nih.gov
Internet: www.digestive.niddk.nih.gov
National Heart, Lung, and Blood Institute Information Center
P.O. Box 30105
Bethesda, MD 20824–0105
Phone: 301–592–8573
Fax: 240–629–3246
Email: nhlbiinfo@nhlbi.nih.gov
Internet: www.nhlbi.nih.gov
National Institute of Neurological Disorders and Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone: 1–800–352–9424 or 301–496–5751
Internet: www.ninds.nih.gov
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892–3580
Phone: 1–800–891–5390
Fax: 703–738–4929
Email: nkudic@info.niddk.nih.gov
Internet: www.kidney.niddk.nih.gov
Pedorthic Footwear Association
2025 M Street NW, Suite 800
Washington, DC 20036
Phone: 1–800–673–8447 or 202–367–1145
Fax: 202–367–2145
Email: info@pedorthics.org
Internet: www.pedorthics.org
