Managing Diabetic Neuropathy with Type 2 Diabetes

High blood sugar, suspected to be the cause of diabetic neuropathy, can damage the nerves themselves or the blood vessels that supply the nerves with critical oxygen and nutrients, explains Ruchi Mathur, MD, an endocrinologist and director of the Diabetes Outpatient Teaching Education Center at Cedars-Sinai in Los Angeles. And, once the damage progresses, it can cause even more serious complications.

Multiple types of neuropathy are associated with diabetes, including peripheral, sensory, motor, and autonomic. “Different types of neuropathies can cause different symptoms, and the location of the neuropathy can also play a role in the symptoms seen,” says Dr. Mathur.

Preventing Diabetic Neuropathy

Once a nerve is damaged, reversing that damage isn’t possible, says Mathur. For that reason, she emphasizes taking preventive measures to lower the chances of developing diabetic neuropathy in the first place.

If you’re on medication to help manage type 2 diabetes, start by taking it exactly as prescribed. Schedule regular checkups according to your doctor’s advice, and don’t skip them. Report any changes in your health that develop between regular checkups.

Then, look at lifestyle changes you may be able to make to help keep your blood sugar and blood pressure steady. You’ll also want to keep your triglycerides in check. “People with high levels of triglycerides in addition to high blood sugar levels are more at risk for neuropathy,” says Mathur. Her recommendations:

• Get regular exercise, including both cardiovascular and resistance training.
• Stick to a healthy diet that includes fruits and vegetables that are high in fiber and healthy fats.
• Limit the amount of simple carbohydrates you consume.
• Cut way back on alcohol, or stop drinking it altogether.
• Quit smoking, as it has a negative impact on blood flow and getting nutrients and oxygen to the nerves.

Treating Diabetic Neuropathy

Because there’s no known cure for diabetic neuropathy, the best course of action is to find ways to treat the pain, manage other complications, and slow the progression of the nerve damage. Your treatment plan will depend on the specific complications you are experiencing. Talk to your doctor about which medication options would be best for you.

Medication

Medications for diabetic neuropathy: These treatments work in three distinct ways.

• They slow the progression of nerve damage by controlling blood sugar.
• They relieve nerve pain.
• They treat the other complications that can arise from neuropathy.

According to the American Diabetes Association, the most common drugs prescribed to control blood sugar and help slow the progression are:

• Metformin
• DPP-4 inhibitors
• GLP-1 and dual GLP-1/GIP receptor agonists
• SGLT2 inhibitors
• Sulfonylureas
• Thiazolidinediones

These drugs all work to maintain healthy levels of blood sugar. Most are taken orally, while GLP-1 and dual GLP-1/GIP receptor agonists (with the exception of oral semaglutide) are injected.

Pain medications: Options for treating diabetic neuropathy pain are available both over the counter and by prescription. With OTC, people sometimes find success with pain relievers such as ibuprofen and acetaminophen, although it’s still important to talk to a doctor about how often and how much to take these.

Moving into prescription medications, two types have been found to help lessen discomfort and pain from diabetic neuropathy, says Mathur. The first are anti-seizure medications, also known as anticonvulsants, such as Neurontin and Horizant. Originally used to treat people with epilepsy, they have also been found to calm overactive nerves. Antidepressants can also be effective for easing mild-to-moderate nerve pain.

Medications for neuropathy complications: Depending on the type of neuropathy you have, you can also experience bladder and digestive issues, low blood pressure, and sexual dysfunction. Your doctor may prescribe medications that treat each of these complications.

“There are specific therapies for autonomic neuropathies, such as those that affect the gut and cause nausea and vomiting,” Mathur says.

To address issues with libido or sexual function, your doctor may prescribe a PDE5 inhibitor, such as Viagra or Cialis.

Surgery

“Surgical intervention may be an option for neuropathy that has led to deformities of the foot and other joints,” Mathur says. These surgeries can range from simple bunion surgery to complex foot reconstruction.

There is also promising research around nerve decompression surgery to relieve pressure on nerves. A review published in August 2022 in Plastic and Reconstructive Surgery — Global Open concluded that nerve decompression in the legs reduced pain and significantly lowered the risk of ulcers and amputations.

Alternative Therapies

Alternative approaches may offer additional avenues for relief.

• Biofeedback: According to Mathur, some data suggests that biofeedback — a way to learn to control your body’s functions — and meditation techniques can improve neuropathy symptoms and help with pain management. A study published in March 2021 in the Turkish Journal of Physical Medicine and Rehabilitation found that patients with chronic nerve pain saw a significant decrease in both pain and cortisol (the stress hormone) levels using biofeedback therapy.
• Acupuncture: A review published in the Journal of Diabetes Science and Technology found that acupuncture significantly reduced pain in diabetic neuropathy patients who were treated once a week for 10 weeks.
• Meditation: In the same review, meditation was also found to help significantly reduce daily pain for at least 24 hours.
• Low-level laser therapy:  Red light therapy involves shining a red light on painful areas to provide short-term relief.

It’s important to keep in mind that these treatments are considered complementary therapies, meaning they should be used in conjunction with conventional methods, such as medication and surgery, if needed.

As with any chronic condition, these medications and treatments aren’t a replacement for your healthcare team. You should be seeing your primary care physician and an endocrinologist regularly to ensure your blood sugar levels are under control. If you experience any new symptoms, such as tingling or pain in your extremities, dizziness, diarrhea, constipation, sexual issues, or a cut or sore on your foot that won’t heal, talk to your doctor.