There is no cure for diabetic neuropathy. The treatment of diabetic neuropathy focuses on
1.Delaying the course of the disease
2. Pain relief
3.Management of complications and functional reconstruction
Delaying the course of the disease.
Stabilizing your 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 patients with diabetes, the Mayo Clinic typically recommends a target blood glucose level of.
1. Patients aged ≤59 years with no other underlying disease: 80-120 mg/dL or 4.4-6.7 mmol/L
2. Patients aged ≥60 years or with other diseases (e.g., heart, lung or kidney disease): 100-140 mg/dL or 5.6- 7.8 mmol/L
To mitigate nerve damage.
1. Follow medical advice for proper 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 alcohol, or drink in moderation (if allowed)
Pain relief.
A variety of medications can be used to relieve neuropathic pain, but these medications may not be appropriate for all patients and most have side effects, so the possible side effects and benefits of these medications 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 provide pain relief.
Pain relief methods include.
1. antiepileptic 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 drugs include drowsiness, vertigo and swelling.
2. Antidepressants. Tricyclic antidepressants, such as amitriptyline, desipramine (Norpramin) and promethazine (Tofranil), can relieve mild to moderate pain by interfering with the chemical process of nociceptive production in the brain, but these drugs can cause a variety of side effects, such as dry mouth, sweating, weight gain, constipation, and dizziness.
3. For some patients, 5-hydroxytryptamine and norepinephrine reuptake inhibitor (SNRI) antidepressants, such as duloxetine (Symbicort), can relieve pain with fewer side effects. possible side effects of SNRI include nausea, drowsiness, dizziness, loss of appetite, and constipation.
4. Management of complications and functional reconstruction.
Specific treatment measures for neuropathy complications include.
1. Urinary tract problems. Antispasmodic medications (anticholinergics), behavior change therapies (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 most effective.
2. Gastrointestinal problems. To relieve mild signs and symptoms such as indigestion, belching, nausea or vomiting caused by gastroparesis, physicians 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 your position (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) may 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 the risk of diabetic neuropathy.
1. Keep your blood pressure in the normal range. People with diabetes are usually more likely to develop 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 decreased blood flow. Try to keep your blood pressure within the range recommended by your doctor and have it measured at each clinic visit.
2. Choose healthy foods. Consume a variety of healthy foods with balanced nutrition, especially fruits, vegetables and coarse grains, and limit the amount of food you eat to achieve or maintain a normal weight.
3.Appropriate exercise every day. Regular exercise every day 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 that moderate exercise lasting about 30 minutes a day, usually 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.
4. Quit smoking. If you have diabetes and also smoke 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. Certain patients can get pain relief 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). Doctors may recommend transcutaneous electrical nerve stimulation, 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 cause 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.
Blood glucose control.
Blood glucose can be effectively controlled by continuously monitoring it 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.
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.
To protect your foot health, you should.
1. Inspect 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 to help you check the areas of your feet that you can’t see. 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 moisture from your feet and between your toes. Keep your feet moist to prevent cracked skin. However, you should avoid applying moisturizer between your toes, as this is conducive to fungal growth;
2. Trim your toenails carefully. The correct way is to cut the toenails flat, and then carefully thwart the sharp corners on both sides of the toenails.
3, wear clean, dry socks. Choose socks made of pure cotton or waterproof fibers, without elastic bands at the sock opening and not too thick at the seams.
Choose shock-absorbing shoes that fit your feet. Always wear shoes or slippers to protect the feet. Make sure your shoes fit well and that your toes can move freely when you put them on. 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.
If you are eligible for U.S. Senior and Disability Health Insurance (Medicare), this insurance can reimburse you for at least one pair of shoes per year. For more information, talk to your doctor or diabetes advocate.