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Treatment

Treatment of diabetic neuropathy focuses on:

  • Tighter control of blood glucose

  • Pain relief

  • A regular exercise program to burn glucose and build muscle strength

  • Avoiding smoking

  • Medications to treat autonomic problems and prevent bladder infections

  • Physical therapy

  • Meticulous care of the feet

Healthy eating and regular exercise can keep blood sugar under control in some people with diabetes. For others, treatment with one or more medication or with insulin may be needed.

To relieve the pain of peripheral neuropathy, your doctor may first prescribe acetaminophen (Tylenol) or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or naproxen.

There are many other medications available to reduce nerve pain. These include:

  • Low doses of tricyclic antidepressant medications, such as

    • amitriptyline (Elavil)

    • nortriptyline (Aventyl, Pamelor)

    • desipramine (Norpramin)

  • Gabapentin (Neurontin)

  • Pregabalin (Lyrica)

  • Duloxetine (Cymbalta)

  • Carbamazepine (Tegretol)

Your doctor may also recommend that you rub on a pain-relieving cream containing capsaicin. In more severe cases, doctors may prescribe narcotic medicines.

If you have gastroparesis, eating small, frequent meals low in fat and fiber. Your doctor may prescribe metoclopramide (Reglan) to help the stomach empty.

There are many available treatments for constipation and diarrhea.

To help relieve constipation, drink plenty of fluids and exercise regularly. You also can take:

  • fiber

  • stool bulking and softening agents such as:

    • psyllium (Metamucil, Konsyl)

    • methylcellulose (Citrucel)

  • stool lubricants such as:

    • docusate sodium (Colace)

  • enemas

Use laxatives sparingly. Overuse may lead to dependence and make constipation worse.

For diarrhea, your doctor may prescribe:

  • fiber

  • bulking agents (which help to change liquid stool into a soft solid stool)

  • loperamide (Imodium)

If you have poor emptying of the urinary bladder, your doctor will help you minimize medicines that could contribute to the problem of incomplete bladder emptying. Catheters can be used to empty the bladder when neuropathy is severe. Bladder infections requiring antibiotics commonly occur in people with abnormal bladder function.

For erectile dysfunction (impotence), your doctor may prescribe:

  • sildenafil (Viagra)

  • vardenafil (Levitra)

  • tadalafil (Cialis)

Other possible treatments for erectile dysfunction include:

  • A vacuum cylinder with a hand pump

  • Injections into the penis of a drug that promotes erections

  • A penile implant.

Dizziness when standing can be treated by drinking more fluids. Medicines that increase your body salt and water can also help.

If peripheral neuropathy affects your feet, you should:

  • Wash your feet every day and make sure you dry between the toes.

  • Carefully check your feet for any cuts, sores or swellings.

  • Wear soft, clean socks and well-fitting shoes.

  • Never go barefoot.

  • Cut your toenails straight across to avoid ingrown toenails.

  • Never try to remove calluses or warts yourself. Always show them to your doctor.

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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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