There is no cure for diabetic neuropathy. The treatment of diabetic neuropathy focuses on: delaying the course of the disease, relieving pain, managing complications and functional reconstruction.
I. Delaying the course of the disease
Stabilizing blood sugar in the target range can help prevent or delay the progression of diabetic neuropathy and may even improve existing symptoms. Your doctor will determine your optimal blood glucose goal based on factors such as your age, how long you have had diabetes, your overall health status, and the presence of other medical conditions.
For most people with diabetes, the usual recommended target blood glucose levels are
Patients aged ≤59 years with no other underlying disease: 80-120 mg/dL or 4.4-6.7 mmol/L
Patients aged ≥ 60 years or with other diseases (such as heart, lung or kidney disease): 100-140 mg/dL or 5.6- 7.8 mmol/L
Second, in order to mitigate nerve damage.
1.Follow the doctor’s instructions for good foot care
2.Strictly control blood pressure
3.Follow a healthy diet plan
4.Ensure adequate physical activity
5, maintain a normal weight
6.Quit smoking
7.Avoid drinking alcohol, or drink in moderation (if allowed)
Pain relief
A variety of drugs can be used to relieve neuropathic pain, but these drugs may not be suitable for all patients, and most of them have side effects, so the possible side effects and benefits of these drugs must be weighed before use. There are also alternative therapies that can help relieve pain, such as capsaicin cream (made from cayenne pepper), physical therapy or acupuncture. Doctors usually combine them with medications, but certain methods used alone can also relieve pain.
Fourth, pain relief methods include.
Anti-epileptic drugs. Although drugs such as gabapentin (Gralise, Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Tegretol) are primarily used to treat epilepsy, they can also treat neuropathic pain. Side effects of these medications include drowsiness, dizziness, and swelling.
Antidepressants. Tricyclic antidepressants, such as amitriptyline, desipramine (Norpramin), and promethazine (Tofranil), can relieve mild to moderate pain by interfering with the chemical processes that produce nociception in the brain, but these drugs can cause a variety of side effects, such as dry mouth, sweating, weight gain, constipation, and dizziness.
For some patients, 5-hydroxytryptamine and norepinephrine reuptake inhibitor (SNRI) antidepressants such as duloxetine (Symbicort) can provide pain relief with fewer side effects. possible side effects of SNRIs include nausea, drowsiness, dizziness, loss of appetite, and constipation.
V. Management of Complications and Functional Reconstruction
Specific treatment measures for neuropathy complications include
1. Urinary tract problems: Antitussive medications (anticholinergic drugs), behavior change therapy (such as timed urination), and devices such as uterine supports and vaginal rings can help treat urinary incontinence due to loss of bladder control. Combination therapy is usually the most effective.
2. Gastrointestinal problems: To relieve mild signs and symptoms such as indigestion, belching, nausea or vomiting caused by gastroparesis, doctors recommend eating smaller, more frequent meals, reducing the fiber and fat content of the diet, and many patients need to consume soups and semi-liquid diets. Changes in diet structure and medications can help reduce diarrhea, constipation and nausea.
3. Upright hypotension (postural hypotension): Postural hypotension can be reduced by simple lifestyle changes such as avoiding alcohol, drinking large amounts of water, or slowly changing positions (such as sitting or standing up). Your doctor may recommend the use of a lap band and compression stockings. Some medications (alone or in combination) can be used to treat postural hypotension.
4. Sexual dysfunction: Sildenafil (Revatio ,Viagra), tadalafil (Adcirca, Cialis) and vardenafil (Levitra) can improve sexual dysfunction in some patients, but these drugs may not be safe or effective in all patients. Mechanical negative pressure devices can increase blood flow to the penis. Women can use vaginal lubricants to improve vaginal dryness.
The following measures can help you reduce your risk of diabetic neuropathy.
Keeping blood pressure in the normal range. People with diabetes are usually more likely to have high blood pressure than non-diabetic people. Having both diabetes and high blood pressure can significantly increase the risk of complications due to the ability of each of these conditions to damage blood vessels and cause a decrease in blood flow. Try to keep your blood pressure within the range recommended by your doctor and have it measured at each clinic visit.
1. Choose healthy foods: Consume a variety of healthy foods with balanced nutrients, especially fruits, vegetables and coarse grains, and limit the amount of food and drink to achieve or maintain a normal body weight.
2.Appropriate daily exercise: Regular daily exercise can protect the heart and improve blood flow. Exercise also has an important role in controlling blood sugar and stabilizing blood pressure. The American Diabetes Association recommends: usually moderate exercise lasting about 30 minutes a day, at least five times a week. If severe neuropathy and sensory loss in the lower extremities occur, your doctor may recommend non-weight-bearing exercise, such as bicycling or swimming.
3. Quit smoking: If you have diabetes and are also smoking tobacco products, your risk of dying from heart attacks and strokes is significantly higher than for non-smoking diabetics. Moreover, the feet are more likely to have blood circulation problems. If you use tobacco products, you should talk to your doctor about ways to quit.
Many alternative treatments can help relieve the pain caused by diabetic neuropathy, such as
1. Capsaicin: Some patients can get relief from pain when they apply capsaicin cream. Side effects of the drug include a burning sensation and skin irritation.
2. alpha-lipoic acid: Certain foods contain this healing antioxidant, which helps relieve the symptoms of peripheral neuropathy.
3. transcutaneous electrical nerve stimulation (TENS): Your doctor may recommend TENS, a method that blocks pain signals from reaching the brain. tens delivers weak electrical impulses to specific nerve pathways through small electrodes placed on the skin. Although this method is safe and painless, TENS is not used in all patients and cannot treat all types of pain.
4. Acupuncture: Acupuncture can help relieve pain caused by neuropathy and generally does not produce any side effects. However, it should be remembered that acupuncture is unlikely to produce an immediate analgesic effect and, moreover, usually requires multiple treatments.
Diabetic neuropathy can cause a lot of inconvenience and frustration in your life. If you are feeling depressed, talking to a counselor or therapist can reduce stress.
Members of a support group can also provide encouragement and advice on living with diabetic neuropathy. Ask your doctor if there is a patient support group in your area, or ask your doctor to recommend a therapist. The American Diabetes Association also offers online support through its website.
You can prevent diabetic neuropathy and complications or slow their progression through good blood glucose control, careful foot care, and a healthy lifestyle.
VI. Blood glucose control
Blood sugar can be effectively controlled by continuously monitoring blood sugar and using insulin as often as needed. Stabilizing blood glucose within the target range is the best way to prevent diabetic neuropathy and complications. Because changes in blood glucose can accelerate nerve damage, it is extremely important to keep blood glucose stable.
The American Diabetes Association recommends that people with diabetes have an A1C test at least twice a year, which determines the average blood sugar level over the past two to three months. If your blood sugar is not well controlled, or if you start switching to a new medication, you should increase the frequency of your A1C test.
VII. Foot care
Foot problems, including the development of sores or ulcers that do not heal or even the need for amputation, are common complications of diabetic neuropathy. You can prevent these common complications by having a comprehensive foot exam at least once a year, a foot exam at every clinic visit, and careful foot care at home.
VIII. To protect your foot health, you should.
1. Check your feet daily. Look for blisters, cuts, bruises, cracked and peeling skin, redness and swelling on your feet. With the help of a mirror or ask your friends or family members to help you check the foot area you can not observe
2. Keep your feet clean and dry. Wash your feet daily with warm water and mild soap. Avoid soaking your feet. Use a soft towel to gently soak up or pat dry the water between your feet and toes.
3. Keep your feet moist to prevent chapped skin. However, avoid applying moisturizer between the toes, as this is conducive to fungal growth;
4, carefully trim toenails. The correct way is to cut the toenails flat, and then carefully thwart the sharp corners on both sides of the toenails.
5, wear clean, dry socks. Choose socks made of pure cotton or waterproof fiber, without elastic band at the sock opening and not too thick at the seam.
6. Choose shock-absorbing shoes that fit your feet. Always wear shoes or slippers to protect the feet. Make sure the shoes fit well and that your toes can move freely when you wear them. A podiatrist can guide you on how to buy shoes that fit well and prevent foot problems such as corns and calluses.
If any of these problems occur, your doctor will help you deal with them to prevent them from getting worse. If left untreated, even very small wounds can quickly become seriously infected.