Treatment Options:

1. Prevention

The American Diabetes Association (ADA) recommends getting an A1C test at least twice per year. Proactively check your feet for anything unusual, such as ulcers, infections, and improper circulation

2. Proper blood sugar control

One of the most important preventions and treatment options for diabetic neuropathy is maintaining your blood sugar levels within their target range. Although A1C targets are different for each individual, the ADA recommends having an A1C less than 7% or less than 154 mg/dL, 80-130 mg/dL prior to a meal, and less than 180 mg/dL 1-2 hours after a meal.

3. Medication

Pain relief medications like ibuprofen, acetaminophen, and naproxen, are available over-the-counter. Your doctor can prescribe other pain relief medications such as anti-seizure medication and antidepressants. Skin patches or creams containing lidocaine can also help reduce pain associated with diabetic neuropathy.

4. Acupuncture

Acupuncture can help relieve pain with no side effects, but it may require several sessions to prove effective.

5. Lifestyle changes

Eat a balanced diet, and stop using tobacco products. The ADA recommends 150 minutes per week of moderate-intensity exercise, but talk to your doctor about what exercise regimen is best for you.

6. Massage

Massaging your feet can help stimulate blood flow and encourage good circulation. Use a tennis or massage ball, your hands, or an electrical foot massager for self-massages.

7. Transcutaneous electrical nerve stimulation (TENS)

‘This device uses electrical impulses to prevent pain signals from reaching the brain. These devices are common in physical therapy offices and are available online for at-home use.

Symptoms

Symptoms can be minor at first and gradually become more severe, or they can be sudden and severe. The symptoms you experience will depend on what type of diabetic neuropathy you experience. Many symptoms disappear without treatment within a few weeks to a few months but talk to your doctor if your pain lasts longer or becomes more severe over time.

• Peripheral Neuropathy: numbness, reduced ability to feel pain, increased sensitivity to touch, tingling/burning sensation, muscle weakness, foot pain
• Autonomic Neuropathy:  hypoglycemia unawareness, bladder/bowel problems, decreased sexual response, increased heart rate even when at rest, bladder problems
• Radiculoplexus neuropathy (also known as diabetic amyotrophy, femoral neuropathy, or proximal neuropathy): usually on one side of the body – severe pain in the hip, thigh, leg, butt, difficulty standing, 
• Mononeuropathy (also known as focal neuropathy) difficulty focusing, aching behind one eye. 

Diagnostic Tests

Your doctor will perform a physical exam to check your overall muscle strength and tone, reflexes, and sensitivity to touch and vibration. The ADA recommends your doctor performs an annual foot exam. Your doctor may send you to specialists such as urologists or cardiologists to prevent, monitor, and treat complications of neuropathy or side effects of your medication. 

They may order tests such as:

• Autonomic testing
• Filament testing
• Electromyography
• Nerve conduction testing
• Quantitative sensory testing

Types 

• Peripheral neuropathy: most common – affects the legs and feet first, then the hands and arms
  • This is the most common type of diabetic neuropathy
  • Symptoms gradually develop and often worsen at night 
• Autonomic neuropathy: affects the autonomic nervous system, which controls the heart, bladder, stomach, intestines, sex organs, and eyes
• Radiculoplexus neuropathy:  affects the thighs, hips, buttocks, legs and can affect the abdominal/chest area
  • More common in older adults and those with Type 2 Diabetes
• Mononeuropathy: nerve damage to the face, torso, or lower extremities
  • More common in older adults
  • Symptoms often disappear without treatment within a few weeks to months

Causes

While the exact cause is unknown, current research indicates that prolonged exposure to higher than normal glucose levels damages the body’s nerves, and high levels of triglycerides are associated with the development of nerve damage.

While anyone with diabetes can develop neuropathy, some risk factors include:

• Drinking alcohol
• High blood sugar levels or uncontrolled blood sugar
• High cholesterol levels
• Obesity or being overweight
• Smoking or tobacco usage

Facts

As many as 50% of people with diabetes have some form of neuropathy, and you may experience more than one type of neuropathy. The most important thing is to keep your blood sugar within your target range and remain proactive in documenting any symptoms and reducing your risk of developing neuropathy.