A 3-Step Diabetic Treatment Plan
By Dr. Steven J. Dolgoff

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A 3-Step Plan for Diabetic Neuropathy Treatment

By Rebecca Buffum Taylor

If you have diabetes, you may already have experienced the nerve pain called diabetic neuropathy. If so, diabetic neuropathy treatment is important.

Some symptoms are obvious: pain in your feet. But more subtle signs of neuropathy are just as critical to notice - and to treat.

"We ask whether people are having unusual tingling or numbness," says Dace L. Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle. Those symptoms are signs of possible nerve damage, and are just as important as nerve pain.

Nerve pain and damage in your hands or feet is called peripheral neuropathy. But diabetic nerve damage can be the culprit behind a host of other problems - from erectile dysfunction to diabetic diarrhea.

The good news? Tight glucose control can help reduce your risk of complications such as diabetic neuropathy, says the American Diabetes Association (ADA). Nerve damage caused by diabetes generally occurs over years and is due to a prolonged high blood sugars, as well as other factors. Everything you're already doing to manage your diabetes will go a long way toward managing diabetic neuropathy and protecting the health of your nerves.


Step 1: Get Your Blood Sugar Under Control

The experts all agree: the first step in treating diabetic nerve pain is to bring your glucose levels under control. Here are the most effective tactics to help.


Use your glucose meter.

How good have you really been - honestly - with checking your glucose throughout the day as your doctor has advised? Commit to those minimum times - and consider checking more often. "We suggest that people get a better picture of what's happening to their blood sugar levels throughout the day," says Trence. "Sometimes that can be helpful, particularly if the person hasn't been checking that frequently."


Meet your target.

While individual blood glucose goals may vary, the National Diabetes Information Clearinghouse (NDIC) gives these general guidelines:

 before meals: 90 - 130 mg/dL

 1 to 2 hours after starting a meal: less than 180 mg/dL

Your doctor may have advised different numbers for you, based on your symptoms of nerve pain and other diabetes complications. Always follow your doctor's specific advice on the glucose goal that's right for you.


Eat right.

A diet that helps treat nerve pain is really no different than a good, healthy, balanced diet, says Trence. "The emphasis is really on blood sugar control," she says. A good diet outlines what to eat, when to eat, how much to eat, and allows for healthy snacks. While it's not always easy to watch everything you eat, remember that every bite counts when it comes to good glucose control.

Be active and exercise.

The ultimate goal? Try to be active for 30 minutes on most days. Exercise helps to lower your blood sugar, so it's an indirect way to help manage diabetes complications like nerve pain - and help keep your blood pressure and blood fats under control. Make sure to talk with your doctor before starting an exercise program. High impact exercises may not be right for you if you've lost sensation in your feet.

But there's some flexibility in what counts as exercise - and you can begin with simple things. "Don't park [your car] right by the door," says Trence. "Park farthest out and walk in. Use the stairs when you can. Make sure your groceries are packed in several bags, because that means more trips from the car."

Take the A1c test.

This is a key double-check, along with your glucose meter, that shows whether you're controlling your blood sugar over time. The A1c test is a simple blood test that measures the average amount of glucose in your blood for the previous 2 to 3 months, and the NDIC recommends taking it at least twice a year. But you can do it more often. "Most of us are really believing it should be done every 3 to 4 months," says Trence. "It's such a powerful piece of information to have, to complement a patient's own blood sugars."

Strict blood sugar control means an average level of A1c of less than 7%. If your test results are higher than 8%, you may want to rethink - and discuss with your doctor - how you're managing your diabetes. An A1c higher than 7% means that you have a greater chance of eye disease, kidney disease, and nerve damage.

Consider your diabetes medications.

"Sometimes, the blood sugar just has not achieved the target that is ideal," says Trence, "so we switch therapies to get better control." A side benefit may be relief from nerve pain. In a recent study in Diabetes Care, published by the ADA, people who used insulin injections for strict glucose control were less likely to get neuropathy. And those on an intensive regimen of taking insulin 3 or more times a day lowered their chances of tingling, burning, and other symptoms of neuropathy by 64% - a significant benefit.

Step 2: Treat Your Nerve Pain

These days, you have many options to soothe diabetic nerve pain, depending on your symptoms and their severity.

Ask about self-care.

Warm baths and frequent walks, for some people, can relieve mild symptoms of peripheral nerve pain. Ask your doctor if baths and walks are safe for you, since they could interfere with healing if you have cuts or sores in your feet. Wear shoes that fit well and allow your toes to move.

Ask about pain medications.

Pain can be a tricky symptom to control, so it may take time to find the right treatment for you. Cymbalta and Lyrica are the only FDA-approved medications for the treatment of painful diabetic neuropathy; however, your doctor might suggest other treatments that can be effective for pain control:

 - Creams or gels made from lidocaine, a topical anesthetic, or from capsaicin, made from crushed chili peppers.

 - Over-the-counter pain relievers such as aspirin, Advil, and Motrin.

 - Prescription-strength nonsteroidal anti-inflammatory drugs (NSAIDs)

 - Narcotics

 - Antidepressants such as Amitril, Norpramin or Tofranil.

 - Antiseizure medications such as Dilantin, Tegretol, Neurontin or Lamictal

 - Or other medications block or reduce the release of chemicals that cause pain to be transmitted.

 Try other therapies.

Acupuncture works to treat nerve pain for some people, says Trence, as does anodyne therapy, a treatment that uses infrared light to soothe pain, usually done in a physical therapy office.

"[Vitamin] B-12 actually can work," says Trence. "The problem is that if you take too much of it, it can cause its own neuropathies."

Surgical decompression of multiple peripheral nerves (called the Dellon procedure) is an alternative method for treating diabetic neuropathy.

Step 3: Try to Sidetrack More Damage

Once your nerve pain is under control, there are steps you can take to try to delay further damage to your nerves.

 - Keep close daily control of your glucose, and avoid big swings in blood sugar.

 - Keep exercising regularly and eating right.

 - Lose weight if you need to, since excess weight puts more pressure on painful feet.

 - Take special care of your feet - a sore spot for many people, since nerve damage is so common in the feet.