Diabetic peripheral neuropathy (DPN) can be a challege and take a toll on your quality of life. That's because this type of diabetes-related nerve damage can cause numbness and tingling in your feet and legs.
The condition can progress to damage nerves in other parts of your body. In time, you may lose the ability to feel foot injuries which can mean not treating cuts, burns, or bruises right away. If left untreated, DPN can lead to serious complications.
The good news is that with treatment, and regular foot inspection, you can stop the progression and damage that this painful condition can cause. Learn more about possible diabetic peripheral neuropathy treatments and how they might work for you.
What Is the Treatment for Diabetic Peripheral Neuropathy?
DPN treatment plans usually focus on four main areas of your health. Your treatment aims to keep your feet healthy and prevent more nerve damage. Finding the right treatment plan that best fits you is key.
Learning about the types of nerves and how DPN impacts your health is a great way to start.
With sensory nerve loss, your doctor will review your symptoms and how serious they are.
Can Blood Glucose Control Help With DPN?
Keeping your glucose levels under control is one of the most important things you can do to keep your DPN from getting worse. About half of people with diabetes also have DPN, especially if they've had diabetes for several years.
How does diabetic peripheral neuropathy happen?
Your nerves can be damaged in many ways. But when blood glucose stays too high for many years, small blood vessels can get damaged.
These small blood vessels provide oxygen and nutrients to your nerves. The lack of oxygen and nutrients can damage your nerves, leading to DPN.
You may feel DPN symptoms start with a burning pain or a "pins and needles" feeling in your feet. As the nerve damage gets worse, you may lose other sensations in your skin and feet.
How does my doctor decide on a blood glucose target?
After reviewing your medical history and tests, your doctor helps you decide the best target range for your blood glucose based on your:
- Age
- Overall health
- Other medical conditions
- History of low blood sugar (hypoglycemia)
- Diabetes type and how long you've had the condition
- Medications and lifestyle
Next, your doctor will tailor your treatment to help you achieve your blood glucose goal:
- Type 1 diabetes. You may need to adjust your insulin shots or use an insulin pump.
- Type 2 diabetes. Your doctor may prescribe more medicine or insulin shots.
When blood glucose levels improve, some of your DPN symptoms may also improve.
DPN Foot Care
Without healthy nerves in your feet, you might not feel a wound or injury on your foot with DPN. Left untreated, foot wounds can get infected, and you may need surgery to remove your foot (amputation) if it gets serious.
But there are ways to keep your feet healthy with DPN. You and your doctor will design a treatment plan to help you catch and treat injuries early to prevent complications.
Get your doctor to examine your feet?
Your doctor will do a foot exam at least once a year, depending on your type of diabetes:
- Type 1 diabetes. You'll get a foot exam every year, starting five years after your diabetes diagnosis.
- Type 2 diabetes. You'll get a foot exam each year, starting after your diabetes diagnosis.
This is a great time to ask about any other foot problems, too. You can ask them about:
- Claw or hammer toes
- Sores, pressure injuries, or ulcers
- Rocker-bottom feet, also called Charcot neuro‑osteoarthropathy
- Foot drop or problems walking
Your doctor will review your risk and may suggest shoe inserts, toe spacers, or special-fitting shoes to help. In some cases, your doctor may suggest that you see another specialist.
What happens during a DPN foot exam?
Your doctor will check your foot muscles, bones, and blood flow during your DPN foot exam.
How can I keep my feet healthy with DPN?
Between exams, you can help your feet stay healthy:
- Keep your feet clean and dry.
- Moisturize your feet to prevent cracking.
- Wear clean, dry socks.
- Wear cushioned shoes that fit.
- Avoid being barefoot.
When you're sitting, try to put your feet up to raise the blood flow to your feet. You can also try wiggling your toes for a few minutes throughout the day. You can also do daily foot exams.
What do I check during my daily foot exam?
Check your feet each day — especially between your toes.
You can also keep your feet moisturized. This cuts down on your risk of dry, cracked skin, which can easily get cut.
Which Medications Help With DPN?
There are several medications that are also used to treat neuropathy pain, or nerve pain. Severe nerve pain can interrupt your life, affect your sleep, and even lead to anxiety and depression.
About a quarter of people who have diabetic peripheral neuropathy have nerve pain – doctors call the condition painful DPN. If you have painful DPN, your doctor may prescribe several medications to help ease your pain.
Here are some medications that your doctor may prescribe.
Pregabalin (Lyrica)
Take this medicine according to your doctor’s instructions. Possible side effects can include:
- Dizziness
- Sleepiness
- Confusion
- Foot and ankle swelling
- Weight gain
Duloxetine (Cymbalta)
You take this medication once daily with food. Side effects can include:
- Nausea
- Dizziness
- Lower appetite
- Constipation
Gabapentin (Gralise, Neurontin)
This anti-seizure medication is taken by mouth up to three times a day. Your doctor may prescribe this with a tricyclic antidepressant. Possible side effects may include:
- Dizziness
- Confusion
- Drowsiness
- Headache
Tricyclic antidepressants
Medications called tricyclic antidepressants include amitriptyline (Elavil), desipramine (Norpramin), and nortriptyline (Aventyl, Pamelor). Studies show that low doses may help relieve DPN pain. You'll take them at bedtime and side effects can include:
- Dry mouth
- Insomnia
- Headache
- Fatigue
- Dizziness
- Constipation
Before taking these medications, talk to your doctor if you have heart disease. These medicines can impact your heart health. Also tell your doctor if you're taking duloxetine before starting tricyclic antidepressants – they may interact.
Even with medication, you may still have pain with DPN. Your doctor may suggest topical treatment and spinal cord stimulation (SCS). SCS is a small implanted device which sends electrical impulses to interrupt the pain signals and helps ease your DPN symptoms.
How Topical Medications Help With DPN
Your doctor may suggest a topical medication, such as lidocaine or capsaicin, to ease your pain. These medicines are available as a patch, which you can apply to painful areas.
The lidocaine patch releases medication (5% lidocaine) slowly over several hours into the area.
The capsaicin patch contains the main ingredient in chili peppers. It also works to treat nerve pain and can work well, but you can get redness, pain, and itching where you put it on your skin. So don't apply the patch on any areas of skin that damaged.
Other Treatments for Diabetic Peripheral Neuropathy
For some people, adding alternative treatments to blood sugar control, medications, and lifestyle changes might help with DPN-related pain.
Talk to your doctor before you try any of these treatments. They can help you decide how alternative therapy fits in your DPN treatment plan.
Acupuncture for nerve pain
A therapist places very fine needles into your skin to stimulate your nerves. Some studies show that acupuncture may help relieve nerve pain, but you may need more than one treatment to get relief. Larger studies are needed to confirm this.
Alpha-lipoic acid (ALA) supplements
This is an over-the-counter dietary supplement used in studies to lower diabetic neuropathy pain. ALA may also affect blood sugar levels and how your body uses insulin. More research is needed to see if ALA works for DPN pain over the long term.
Omega-3 and vitamins C, D, and E
Research is limited, but some studies suggest that certain nutrients can lessen your DPN symptoms:
- Omega-3 fatty acid
- Vitamin C
- Vitamin D
- Vitamin E
Ask your doctor if any of these supplements might work for you.
Transcutaneous electrical nerve stimulation (TENS)
You can get this treatment in your doctor's office, at physical therapy, or at home. Small electrode stickers are placed on your skin. A battery-operated device sends tiny electrical impulses into the area to stimulate nerve pathways. It's safe and painless, although you may feel a slight tingle. Some studies show it can help relieve nerve pain.
Four Lifestyle Changes to Slow DPN
Along with medications, simple lifestyle changes can help you control your symptoms and prevent further nerve damage.
Eat healthy foods
Eating foods like whole grains, fruits, vegetables, and lean meats can help you maintain a healthy body weight. These foods also can help you keep your blood sugar level on target.
If you need ideas for meal planning or meal choices, ask to see a dietitian or nutritionist on your diabetes care team.
Physical activity
The American Diabetes Association recommends at least 150 minutes of moderate to vigorous exercise per week. This can be a brisk walk, at least three times per week.
They also recommend muscle strengthening at least two days a week. Skip any high-impact activities like running. This is really key if you have less feeling in your legs because of DPN.
Ask your doctor or physical therapist which exercises are best for your DPN. They may also suggest exercises that work on flexibility and balance.
Quit smoking
Smoking affects blood flow and can raise your risk of foot problems and amputation. Even cutting back can help.
Talk to your doctor about a cessation program – there are lots of free programs to help you quit.
Limit alcohol
Drinking alcohol can cause more nerve damage and make your DPN symptoms worse. Cut back or stop altogether.
If you have alcohol use disorder, support is available. Talk to your doctor about your drinking habits; they can help you get the right support.
Who's on My DPN Care Team?
Your health care team can include a range of specialists who can help you control your blood glucose.
These doctors can help you manage your pain and prevent further nerve damage, too. Each doctor plays a key role in helping you slow the progression of DPN.
Will Treatment Prevent DPN From Getting Worse?
Sticking to your treatment plan can help you keep your DPN from getting worse. Here are some tips to slow down your DPN:
- Keep your blood glucose within your target range.
- Do daily foot checkups and let your doctor know about any changes right away.
- Lower DPN pain, tingling, and other symptoms by taking medications as prescribed.
- When taking medications for DPN, be patient. Symptoms like numbness and stabbing pains often improve with treatments.
Complications to watch for
Diabetic peripheral neuropathy can come with some complications if it goes untreated or progresses. Some of the most serious ones can mean:
- Foot drop, leading to problems walking and a higher risk of falls
- Serious blood vessel damage in your lower limbs, causing gangrene
- Infections deep in your feet like an abscess, cellulitis, or osteomyelitis
These complications are serious and may require antibiotics, hospitalization, or surgery. If you notice any problems during your treatment, call your doctor right away. Catching complications early can help prevent serious problems.
Speaking up about foot injuries and reporting any new redness can help you prevent complications.
Is Diabetic Peripheral Neuropathy Reversible?
Although you can't reverse nerve damage, you can treat DPN symptoms and ease your pain. Work with your doctors on these health goals to help keep your DPN from progressing:
- Keep your blood glucose levels on target.
- Stick with your foot care routine to prevent injury and stay ahead of complications.
- Take your medications as directed to manage your pain.
- Make healthy diet choices and stay physically active to support your glucose levels.
Focusing on these four health areas can help you manage your symptoms, prevent further damage, and avoid serious foot issues with DPN.
Show Sources
Photo Credit: iStock/Getty Images
SOURCES:
UpToDate: "Overview of management of diabetes-related food disease," "Diabetic neuropathy (Beyond the Basics)," "Glucose monitoring in diabetes (Beyond the Basics)," "Patient education: Preventing complications from diabetes (Beyond the Basics)."
Mayo Clinic: "Diabetic neuropathy types: Symptoms tell the story," "Peripheral neuropathy," "Diabetic Neuropathy," "Tramadol (oral route)."
National Institute of Diabetes and Digestive and Kidney Diseases: "What Is Diabetic Neuropathy?"
Journal of Diabetes & Metabolism: "Painful Diabetic Peripheral Neuropathy: Presentations, Mechanisms, and Exercise Therapy."
American Diabetes Association: "Peripheral Neuropathy."
Western Reserve Hospital: "Effective Strategies for Diabetic Neuropathy: Early Signs and Expert Treatment."
Cleveland Clinic: "Peripheral Neuropathy."
CDC: "Your Feet and Diabetes," "Preventing Diabetes-Related Amputations."
Diabetes & Metabolism Journal: "Pharmacological and Nonpharmacological Treatments for Painful Diabetic Peripheral Neuropathy."
Diabetes Care: "Psychosocial Care for People With Diabetic Neuropathy: Time for Action."
Frontiers in Neurology: "Acupuncture for painful diabetic peripheral neuropathy: a systematic review and meta-analysis."
CPT: Pharmacometrics & Systems Pharmacology: "Enhanced Sensitivity to Tramadol in Diabetic Neuropathic Pain Compared to Nerve Compression Neuropathies: A Population PK/PD Model Analysis."
