Question

Diabetic Neuropathy (Nerve Damage)

How is diabetic neuropathy treated?

A Answers (2)

  • Amitriptyline and desipramine, which are antidepressant medications, can often reduce the pain and discomfort of peripheral neuropathies. The anticonvulsant drug gabapentin (Neurontin) may also be used to control any pain. To minimize any potential side effects of these medications, the initial dose may be small and then gradually increased over time if necessary. Some find relief when using capsaicin, a topical cream or ointment containing the ingredient that gives chili peppers their heat.

    To treat the diarrhea or constipation caused by autonomic neuropathies, over-the-counter anti-diarrheal medications or laxatives are often helpful. Tight stockings can keep blood from pooling in the legs, and people who experience orthostasis are advised to stand up slowly. Finally, Viagra is helpful for some men with diabetes-related erectile dysfunction, though it often does not work for impotence due to diabetic neuropathy.

    Neuropathies develop slowly and usually cannot be reversed.

  • ADarshan Shah, MD, Neurology, answered on behalf of NorthShore University HealthSystem
    The treatment of diabetic neuropathy is based on the type of neuropathy and the resulting symptoms.  As previously discussed, there are several types of diabetic neuropathy and the treatments are listed below.  It should be emphasized that these medications only treat the symptoms and do not slow or halt progression of diabetic neuropathy; that is best done through aggressive long term blood sugar control.
    1.  Sensorimotor polyneuropathy - gabapentin, pregabalin, antidepressants such as amitriptyline and duloxetine, and anticonvulsants such as lamotrigine are often used to control the prickly, burning, painful sensations.
    2.  Autonomic neuropathy - elastic stockings and medications such as fludrocortisone and midodrine are used to treat dizziness which comomonly occurs upon standing.  High fiber diet and medications which increase bowel motility are used to treat constipation.  Bladder dysfunction should be investigated further by an urologist.  Lastly, sildenafil (Viagra) and vardenafil (Levitra) are used to treat erectiel dysfunction.
    3.  Cranial neuropathy, as it results in double vision, is treated with a temporary eye patch.
    4.  Proximal neuropathy is treated with physical therapy and improves over 1-2 years.
    5.  Carpal tunnel syndrome, depending on the severity, is treated with wrist splints, steroid injections or sugery.    
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How is diabetic neuropathy diagnosed?