Management     By Dr. Steven J. Dolgoff

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Richard Bedlack, MD, PhD
Activity Medical Director Associate Professor of Neurology Duke University School of Medicine Durham, NC

Managing Diabetic Neuropathy Requires Treating the Underlying Disease

Treatment of Neuropathic Pain in Type 2 Diabetes

Optimal management of diabeticuneuropathies requires that clinicians understand that long-term control of blood sugars and reduction of cardiovascular risk factors is the cornerstone of treatment, both for diabetes and for diabetic neuropathy. Clinicians who properly treat the underlying diabetes have a better chance of reducing neuropathy and its accompanying symptoms, as opposed to regimens that simply address the neuropathy symptoms.

Nonpharmacological Treatment Options

Lifestyle Modifications

Diet and exercise have been shown to promote cutaneous reinnervation and improve pain in diabetic neuropathy patients. Patients should be counseled on the benefits of weight loss, tobacco cessation, and the effects of alcohol on diabetic neuropathy.

The Importance of Foot Care

Once a patient has diabetic neuropathy, foot care becomes crucial for preventing ulceration, infection, and amputation. At each visit, the physician should examine the patientís feet to detect evidence of neuropathy or early lesions, as well as skin breaks, red or callused areas, decreased pedal pulses, delayed capillary refilling, bony deformities, and protective sensation.