Diabetic neuropathies may have no symptoms, but they usually cause tingling, numbness, pain and potentially complete loss of feeling. Neuropathy can lead to catastrophic results, including blindness or foot amputation. Prevention is the goal, but if you have diabetic neuropathy, it's important to obtain an accurate diagnosis and start treatment as soon as possible.
Definition
Diabetic neuropathy refers to nerve disorders that occur as a result of prolonged exposure to glucose in the blood. The nerve damage can happen anywhere in the body, but it most often strikes the feet. The National Diabetes Information Clearinghouse states that 60 to 70 percent of people with diabetes have some form of neuropathy.
Current Treatment
The first priority is to control blood glucose levels to prevent or delay neuropathy. Experts at the Mayo Clinic state that "intense blood glucose control may reduce the overall risk of diabetic neuropathy by more than 60 percent." If you have neuropathy, current treatments include diligent foot care, pain relief with a variety of medications, alpha-lipoic acid to relieve symptoms and improve nerve function, transcutaneous nerve stimulation (TENS) to relieve pain and alternative methods such as biofeedback or acupuncture to help reduce pain. Other symptoms associated with neuropathy--such as gastrointestinal problems, dizziness or urinary problems--are treated with lifestyle changes or medication.
Standard Medications
Current medications focus on pain relief using antidepressants, anticonvulsants and opioids. The antidepressant duloxetine (Cymbalta) and the anticonvulsant pregabalin (Lyrica) have been approved by the U.S. Food and Drug Administration specifically to treat painful diabetic neuropathy. Pain also can be relieved by applying capsaicin cream and lidocaine patches to the skin.
Future Medications
A medication called ruboxistaurin is being developed by Eli Lilly to treat diabetic retinopathy, a type of neuropathy that affects the eyes and leads to blindness. As of December 2009, ruboxistaurin was undergoing clinical trials and was not yet available to physicians.
Lacosamide, an anticonvulsant, began the FDA approval process in September 2008. It also is undergoing clinical trials to determine its effectiveness as a treatment for painful diabetic neuropathy. An article in the August 2009 issue of the "Journal of Pain" reported that lacosamide reduced pain and "may be a suitable treatment option for patients with diabetic neuropathic pain."
Surgery
Nerve decompression surgery has been used to treat other conditions such as carpal tunnel syndrome, but its application to diabetic neuropathy is relatively new. An article in the October 2006 issue of the "Annals of Plastic Surgery" reported that 90 percent of patients with diabetic neuropathy showed significant improvement in pain and function following surgical decompression.
The surgery was pioneered by Dr. A. Lee Dellon, professor of plastic surgery and neurosurgery at the Johns Hopkins University School of Medicine. Dellon states that decompression of nerves in the leg, ankle and foot can relieve the pain and ulceration of diabetic neuropathy in up to 80 percent of patients.
