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The goal of treatment for patients with diabetic neuropathy is to alleviate symptoms and prevent progression of neuropathy. The treatment options for patients with diabetic neuropathy are similar to patients with nondiabetic peripheral neuropathy as discussed above. As is the case for peripheral neuropathy in general, treatment of diabetic neuropathy is primarily focused on controlling and reducing the severity of the symptoms.

Controlling blood glucose levels has traditionally been considered as critical for controlling the progression of diabetic peripheral neuropathy. While this has proven effective for type 1 diabetes, glucose control for people with type 2 diabetes appears to have only partial success, at best, in slowing the progression of peripheral neuropathy. For further information, please click on the following link: http://www.medifocus.com/abstracts.php?gid=NR021&ID=18227494

Drug therapy for pain management in patients with diabetic neuropathy is similar to that for other types of peripheral neuropathy and includes:

• Antidepressants

  • tricyclic antidepressants
  • selective serotonin reuptake inhibitors
  • atypical antidepressants

• Anticonvulsants

• Antiarrhythmics
• Narcotic analgesics
• Non-narcotic analgesics
• Topical agents

As noted previously, within the past few years, two newer drugs [pregabalin (Lyrica) and duloxetine (Cymbalta)] have received approval from the U.S. Food and Drug Administration (FDA) for the treatment of diabetic peripheral neuropathy. Treatments under investigation for diabetic peripheral neuropathy that target the underlying process of neuropathy (as opposed to the pain aspect) include:

• Alpha lipoic acid (also called thioctic acid)- this is used for diabetic peripheral neuropathy in many countries worldwide but has not been approved by the US Food and Drug Administration (FDA). A meta analysis of several studies published in 2004 indicated that treatment with alpha-lipoic acid significantly improved neuropathic symptoms with oral treatment for 4-7 months. For more information please click on the following link: http://www.medifocus.com/abstracts.php?gid=NR021&ID=16026113
• Aldose reductase inhibitors (e.g. tolrestat, fiderestat)
• Y-linolenic acid
• Human intravenous immunoglobulin
• Neurotrophic therapy with recombinant human nerve growth factor

Individuals suffering from large fiber diabetic neuropathy may require addition treatments such as:

• Exercise to increase muscle strength
• Gait training
• Orthoses
• Surgical reconstruction (if warranted)

Preventing trauma and damage to the foot is also critically important for patients with diabetic neuropathy. Patients should carefully examine their feet each night for signs of any breaks in the skin or signs of infection, such as redness and swelling. Consult your doctor as soon as possible if you notice any unusual changes or if your symptoms suddenly become more pronounced. Diabetics with symptoms of small fiber neuropathy must be especially careful to care for their feet on a regular basis. Suggestions include:

• Daily inspection of soles of the feet and area between the toes
• Use of padded socks
• Wearing well-fitting and supportive shoes
• Caution with exposure to heat
• Creams for dry or cracking skin
• Powder between toes after a bath or shower
• Keeping toenails carefully trimmed

Symptoms of diabetic autonomic neuropathy are treated individually, for example:

• For postural hypotension, patients should attempt to wear supportive clothing that increases blood circulation (e.g., body stocking). There are also some medications (e.g., clonidine, metoclopramide) which may be useful.