The Doctor-Approved Guide to Diabetic Neuropathy Treatments

News

Daisy Bernstein

Date: 19.12.2017

Start with this blood sugar level guide to help manage your diabetes, because the adage that an ounce of prevention is worth a pound of cure rings true when it comes to diabetic neuropathy, says Caroline Messer, MD, an endocrinologist at Lenox Hill Hospital in New York City. High blood sugar increases the risk of all diabetes side effects including painful nerve damage, and that’s what leads to diabetic neuropathy treatment. “Keeping blood sugar—glucose—under tight control can help stave off nerve damage and pain,” she says. This means eating a careful diet, regular monitoring plus medications. “We can treat blood sugar with insulin or add on new classes of blood sugar-lowering drugs to bring glucose down to where it should be.” Preventing the condition requires the same lifestyle changes that you’d make for diabetes in general, including quitting smoking and keeping weight in the normal range, adds Gary W. Jay, MD, a clinical professor of neurology at the University of North Carolina at Chapel Hill. “Once you develop the pain, however, it’s not going to get better without treatment.”

Diagnosing diabetic nerve pain

What is diabetic neuropathy? The first symptom tends to be numbness and pain in your hands and feet, and this pain feels and acts differently than other types of pain. “It feels like burning electrical impulses are shooting through your feet and legs, and it is often symmetrical,” Dr. Messer says. Some people report numbness or pins and needles, she says. It also tends to occur at rest not during activity. By contrast, peripheral artery disease (PAD)—which also travels with diabetes—is worse with activity. “Establishing the proper diagnosis will help determine the best course of treatment for diabetic neuropathy,” she says. Your doctor will take a thorough history, conduct a physical exam and possibly order nerve conduction studies or perform other tests to see how well your nerves function, she explains. Don’t miss these key facts about diabetic neuropathy.

Anti-seizure drugs

The newest guidelines from the American Diabetes Association recommend the anti-seizure drug pregabalin (Lyrica) as one of the first-line diabetic neuropathy treatments. Exactly how anti-seizure medications soothe nerve pain is not 100 percent understood, but they may interfere with the overactive transmission of pain signals sent from damaged nerves. Lyrica is not the only anti-seizure drug available, but it is the only one that is specifically approved by the U.S. Food and Drug Administration (FDA) for diabetic nerve pain. “Lyrica has been better studied specifically for diabetic nerve pain whereas gabapentin [another anti-seizure medication] has been studied in neuropathy in general,” Dr. Jay says. Lyrica does come with a much higher price tag, which is why other anticonvulsants such as gabapentin (Neurotin) may be tried. There may also be some natural remedies worth trying for diabetic nerve pain.

Antidepressants

Antidepressants may reduce nerve pain in addition to the depression that tends to travel with the pain. Sometimes individuals will need more than one diabetic neuropathy treatment to get ahead of the burning and numbness. “Once you are on a therapeutic level of one drug such as Lyrica, it can take as long as eight weeks to see how well it is working,” Dr. Jay says. “If the pain was a 7 out of 10 and then it is a 4 or 5 after six weeks on the drug, it may be enough for some people, but others may need more relief.” In these cases, Dr. Jay would add Cymbalta (duloxetine), an antidepressant that is specifically approved for diabetic nerve pain. The ADA guidelines back up this approach, and suggest that Cymbalta can also be a first-line therapy for diabetic nerve pain. “I add some Cymbalta and, if the patient can tolerate it and isn’t having any side effects, we titrate them to the right dose,” he says. Some people may develop stronger side effects than others with Cymbalta, such as dry mouth, constipation, and nausea. If the side effects are troublesome, other options include tricyclic antidepressants: While not specifically approved for diabetic nerve pain, this older class of drugs may offer some benefit. But they have their own share of side effects, including excessive sleepiness. The good news? Scientists may be on the road to making antidepressants work faster.

This material was prepared specially for the WORLD HEALTH NEWS project by journalist Daisy Bernstein.

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