Diabetes can cause nerve damage, or diabetic neuropathy. Diabetic neuropathies affect various parts of the body or organ systems such as the heart, reproductive organs and the digestive system. Approximately 70 percent of diabetic patients are affected with diabetic neuropathies, according to 2009 information from the National Diabetes Information Clearinghouse. This condition commonly present with loss of sensation to touch, tingling, muscle weakness and severe pain. Treatment consists of combination therapeutic modalities such as physical and alternative therapies, education, pain management and medications.
Types of Neuropathies
The different types of diabetic neuropathies can help determine the most appropriate and effective treatment and medications. These types of neuropathies include peripheral, proximal, focal, autonomic and proximal neuropathy. Each type of neuropathy affects different systems and areas of the body. For example, peripheral affects legs, feet, arms; proximal affects thighs and hips; focal affects localized regions of nerves, targeting a specific area on the body; autonomic affects the blood pressure, cardiovascular, digestive and renal functions. Patients in the early acute phases of painful neuropathies are treated with tight blood sugar glucose management and over-the-counter pain medications such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDS).
Characteristics of Insulin Medications
Control and tight management of the glycemic and blood sugar levels in diabetes is vitally important to prevent and control the progression of nerve damage to the body's internal organ systems and musculature. It is important to constantly monitor blood glucose and to take insulin and diabetic medications. There are different types of insulin, oral and injectables with different mechanism of actions for lowering blood sugar levels. The characteristics of insulin are onset time, peak time and duration--the time the drug continues to work lowering blood glucose. Rapid acting, short acting, intermediate and long acting insulin medications are classified according to these characteristics.
Neuropathic Pain Management
Several types of pain medications are used to treat diabetic neuropathies such as over-the-counter NSAIDs or acetaminophen. Topical analgesic creams, for example, capsaicin cream, can be used for temporary relief of pain. For chronic severe nerve pain, prescription medications are used to manage the neuropathy such as antiarrhythmics, anticonvulsants, or antidepressants. Opiate drugs, like OxyContin, are also used as combination therapy for pain management. Muscular pain is common in peripheral neuropathies and is treated with muscle relaxants and physical therapy.
Gastrointestinal Neuropathies
Diabetic neuropathies can affect the gastrointestinal system causing gastroparesis and symptoms such as belching, indigestion, vomiting and nausea. In severe cases, prescription medications are used to treat the symptoms. For example, metoclopramide and cisapride are used to reduce nausea and vomiting, and to speed up digestion in the stomach; antacids reduce and regulate acid secretions from the stomach; and erythromycin aids in digestion. Antibiotics, such as tetracycline, can be used to treat diarrhea and problems with the bowel.
Alternative Therapies
Symptoms of diabetic neuropathies can be managed in combination with adjunctive modalities such as herbal and supplements medicine, holistic and osteopathic medicine. Common alternative medications for peripheral neuropathies are alpha-lipoic acid, capsaicin and methylcobalamin. Natural organic therapies include herbs like St. John's wort or bitter lemon, vitamin E, folic acid, omega-3 fatty acids, magnesium and chromium. Always consult your medical doctor before starting any type of alternative or complementary therapies.
References
- Primary Care Diabetes; A survey of treatment practices in diabetic peripheral neuropathy; P. CJ, et al; November 2009
- Amercian Diabetes Association; Living with Diabetes; Insulin Basics
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); NIH; Diabetic Neuropathies; February 2009
