Diabetic Peripheral Neuropathy

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Diabetic Peripheral Neuropathy

About Diabetic Peripheral Neuropathy

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Overview

Diabetic nerve pain -- also known as diabetic neuropathy— is a common complication of diabetes. People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness—loss of feeling—in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs. About 60 to 70 percent of people with diabetes have some form of neuropathy.

People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat and blood pressure and those who are overweight.

Common Symptoms

Symptoms depend on the type of neuropathy and which nerves are affected. Some people with nerve damage have no symptoms at all. For others, the first symptom is often numbness, tingling, or pain in the feet. Symptoms are often minor at first, and because most nerve damage occurs over several years, mild cases may go unnoticed for a long time. Symptoms can involve the sensory, motor, and autonomic—or involuntary—nervous systems. In some people, mainly those with focal neuropathy, the onset of pain may be sudden and severe. 

Symptoms of nerve damage may include:

  • numbness, tingling, or pain in the toes, feet, legs, hands, arms, and fingers
  • wasting of the muscles of the feet or hands
  • indigestion, nausea, or vomiting
  • diarrhea or constipation
  • dizziness or faintness due to a drop in blood pressure after standing or sitting up
  • problems with urination
  • erectile dysfunction in men or vaginal dryness in women
  • weakness

Symptoms that are not due to neuropathy, but often accompany it, include weight loss and depression.

What Causes It?

The causes are probably different for different types of diabetic neuropathy. Researchers are studying how prolonged exposure to high blood glucose causes nerve damage. Nerve damage is likely due to a combination of factors:

  • metabolic factors, such as high blood glucose, long duration of diabetes, abnormal blood fat levels, and possibly low levels of insulin
  • neurovascular factors, leading to damage to the blood vessels that carry oxygen and nutrients to nerves
  • autoimmune factors that cause inflammation in nerves
  • mechanical injury to nerves, such as carpal tunnel syndrome
  • inherited traits that increase susceptibility to nerve disease
  • lifestyle factors, such as smoking or alcohol use

Am I at Risk?

About half of the 24 million people with diabetes in the U.S. will suffer from neuropathy at some point, and the incidence increases over time. About 20 percent of the people with diabetic neuropathy have nerve pain to varying degrees.

What Medicines Are Available?

The first treatment step is to bring blood glucose levels within the normal range to help prevent further nerve damage. Blood glucose monitoring, meal planning, physical activity, and diabetes medicines or insulin will help control blood glucose levels. Symptoms may get worse when blood glucose is first brought under control, but over time, maintaining lower blood glucose levels helps lessen symptoms. Good blood glucose control may also help prevent or delay the onset of further problems. As scientists learn more about the underlying causes of neuropathy, new treatments may become available to help slow, prevent, or even reverse nerve damage.

As described in the following sections, additional treatment depends on the type of nerve problem and symptom.

Pain Relief

Doctors usually treat painful diabetic neuropathy with oral medications, although other types of treatments may help some people. People with severe nerve pain may benefit from a combination of medications or treatments and should consider talking with a healthcare provider about treatment options.
Medications used to help relieve diabetic nerve pain include:

  • tricyclic antidepressants, such as amitriptyline, imipramine, and desipramine (Norpramin, Pertofrane)
  • other types of antidepressants, such as duloxetine (Cymbalta), venlafaxine, bupropion (Wellbutrin), paroxetine (Paxil), and citalopram (Celexa)
  • anticonvulsants, such as pregabalin (Lyrica), gabapentin (Gabarone, Neurontin), carbamazepine, and lamotrigine (Lamictal)
  • opioids and opioid-like drugs, such as controlled-release oxycodone, an opioid; and tramadol (Ultram), an opioid that also acts as an antidepressant

Duloxetine and pregabalin are approved by the U.S. Food and Drug Administration specifically for treating painful diabetic peripheral neuropathy

People do not have to be depressed for an antidepressant to help relieve their nerve pain. All medications have side effects, and some are not recommended for use in older adults or those with heart disease. Because over-the-counter pain medicines such as acetaminophen and ibuprofen may not work well for treating most nerve pain and can have serious side effects, some experts recommend avoiding these medications.

Treatments that are applied to the skin—typically to the feet—include capsaicin cream and lidocaine patches (Lidoderm, Lidopain). Studies suggest that nitrate sprays or patches for the feet may relieve pain. Studies of alpha-lipoic acid, an antioxidant, and evening primrose oil suggest they may help relieve symptoms and improve nerve function in some patients.

Are They Safe?

Some of the drug treatments for diabetic nerve pain carry Black Box Warnings on the package insert.  Black Box Warnings are the  FDA’s highest-level of warning regarding potentially fatal side-effects.  Together with your doctor, it’s important to review the potential harms and benefits of the drug you choose to treat your nerve pain.

Are There Over-the-counter Options?

Other treatment options include creams or patches on your skin for burning pain and over-the-counter pain medicines.

Are There Non-drug Options?

Non-drug options are: 

  • physical therapy, which helps with muscle weakness and loss of balance
  • relaxation exercises, such as yoga
  • special shoes to fit softly around sore feet or feet that have changed shape

Stopping smoking and drinking alcoholic beverages also may help with symptoms. A device called a bed cradle can keep sheets and blankets from touching sensitive feet and legs. Physical therapy may help relieve pain in some people. Treatments that involve electrical nerve stimulation, magnetic therapy, and laser or light therapy may be helpful but need further study. 

Sources

"Diabetic Neuropathies: The Nerve Damage of Diabetes."  National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.  Published November, 2013.  

"Preventing Diabetes Problems:  Keep Your Nervous System Healthy."  National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.  Published May, 2014

"Using Anticonvulsants to Treat Bipolar Disorder, Nerve Pain, and Fibromyalgia." Consumer Reports Best Buy Drugs.  Published July 2011.

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