Overview

Diagnosis

Diabetic neuropathy is diagnosed through a physical exam, a review of symptoms, and a medical history evaluation. During the examination, healthcare professionals assess muscle strength, tone, and reflexes, as well as how sensitive the body is to touch, temperature, pain, and vibration.

Additional tests help confirm the diagnosis and determine the extent of nerve damage:

  • Filament testing: A soft nylon fiber is brushed against the skin to check for sensitivity.

  • Sensory testing: Evaluates nerve responses to vibration and temperature changes.

  • Nerve conduction studies: Measure how quickly electrical signals move through nerves.

  • Electromyography (EMG): Records electrical activity in muscles to identify nerve or muscle damage.

  • Autonomic testing: Monitors blood pressure, heart rate, and sweating to check autonomic nerve function.

Treatment

There is no permanent cure for diabetic neuropathy, but treatment focuses on slowing disease progression, relieving pain, managing complications, and improving daily function.

Slowing Disease Progression

The most effective way to prevent or delay nerve damage is to maintain stable blood sugar levels. Proper diabetes management may improve current symptoms and prevent new ones.

Recommended blood sugar targets generally include:

  • Between 80 and 130 mg/dL before meals

  • Less than 180 mg/dL two hours after meals

  • An A1C level of 7.0% or lower for most adults

Lifestyle measures to slow disease progression include:

  • Keeping blood pressure under control

  • Maintaining a healthy body weight

  • Engaging in regular physical activity

Relieving Pain

Pain management depends on the individual’s response to medication. Commonly prescribed options include:

  • Anti-seizure medications: Drugs such as pregabalin or gabapentin can reduce nerve pain but may cause drowsiness or swelling.

  • Antidepressants: Tricyclic antidepressants like amitriptyline or nortriptyline may help, though side effects include dizziness or dry mouth. Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine or venlafaxine, are also effective and may have fewer side effects.

  • Topical treatments: Lidocaine patches or gels may help control localized pain.

Managing Complications and Restoring Function

Depending on which nerves are affected, different specialists may assist with treatment.

  • Urinary issues: Timed urination, changes in medication, or the use of catheters can help manage bladder control.

  • Digestive problems: Eating smaller, low-fat meals can ease symptoms such as bloating and nausea caused by gastroparesis.

  • Low blood pressure on standing: Increasing fluid intake, avoiding alcohol, and sleeping with the head elevated can help stabilize blood pressure. Compression garments may also be beneficial.

  • Sexual difficulties: Medications or mechanical devices can improve function in men, while lubricants may help women.

Self-Care

Healthy daily habits can reduce the impact of diabetic neuropathy and improve overall wellbeing.

  • Keep blood pressure and blood sugar within recommended ranges.

  • Eat a balanced diet rich in fruits, vegetables, and whole grains.

  • Exercise regularly with guidance from your healthcare professional.

  • Avoid smoking to improve circulation and healing.

  • Check your feet daily for sores or injuries if you have reduced sensation.

Alternative Medicine

Some complementary treatments may help relieve pain when used alongside standard care. Always consult a healthcare professional before starting any alternative therapy.

  • Capsaicin cream: May reduce pain but can cause temporary skin irritation.

  • Alpha-lipoic acid: A natural antioxidant that may improve nerve pain in some cases.

  • Acetyl-L-carnitine: A supplement that may support nerve health.

  • TENS therapy: Uses mild electrical impulses to block pain signals.

  • Acupuncture: May help relieve chronic nerve pain after several sessions.

Coping and Support

Managing diabetic neuropathy can be emotionally challenging. Support groups and counseling can help individuals adjust to lifestyle changes and cope with chronic symptoms. Talking to therapists, support networks, or organizations like the American Diabetes Association can provide valuable guidance.

Preparing for Your Appointment

Patients are often referred to an endocrinologist or neurologist for further evaluation. Preparing ahead can make your visit more effective.

  • Write down your symptoms and when they began.

  • Record your blood sugar readings.

  • Bring a list of all medicines and supplements you take.

  • Note any lifestyle changes or stress factors.

  • Prepare a list of questions about diagnosis, treatment, and long-term management.

Common questions to ask include:

  • What type of neuropathy do I have?

  • What treatment options are best for my symptoms?

  • How can I manage pain effectively?

  • Will better blood sugar control improve my condition?

  • What lifestyle changes should I focus on first?

Request an appointment

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