Diabetic Neuropathy: Diagnosis, Treatment, Prevention
Diabetic neuropathy is generally identified based upon your symptoms, your medical history and a physical exam. During the examination, your doctor is most likely to examine your muscle strength and tone, tendon reflexes, and sensitivity to touch, temperature and vibration.
Contents
Diagnosis
Your doctor may likewise conduct tests that include:
- Filament test. Level of sensitivity to touch might be tested using a soft nylon fiber called a monofilament.
- Nerve conduction research studies. This test determines how rapidly the nerves in your arms and legs perform electrical signals. It’s often used to diagnose carpal tunnel syndrome.
- Electromyography (EMG). Frequently performed together with nerve conduction research studies, electromyography determines the electrical discharges produced in your muscles.
- Quantitative sensory screening. This noninvasive test is used to assess how your nerves respond to vibration and changes in temperature.
- Autonomic screening. If you have symptoms of autonomic neuropathy, your doctor might ask for special tests to look at your blood pressure in different positions and assess your ability to sweat.
The American Diabetes Association recommends that all individuals with diabetes have an extensive foot test — either by a doctor or by a foot expert (podiatric doctor) — at least when a year. In addition, your feet should be checked for sores, split skin, calluses, blisters, and bone and joint abnormalities at every workplace go to.
Also read: Diabetic Neuropathy: Symptoms, Causes, Risk Factors
Treatment
Diabetic neuropathy has no recognized treatment. Treatment for diabetic neuropathy concentrates on:
- Slowing progression of the disease
- Relieving pain
- Managing complications and bring back function
Slowing progression of the disease
Regularly keeping blood glucose within a target variety can assist avoid or postpone the progression of diabetic neuropathy and might even improve some of the symptoms you currently have. Your doctor will figure out the best target variety for you based upon a number of factors, such as your age, the length of time you’ve had diabetes, and your total health and the presence of other medical conditions.
For lots of people who have diabetes, Mayo Clinic normally suggests target blood sugar levels that are:
- Between 80 and 120 mg/dL, or 4.4 and 6.7 mmol/L, for people age 59 and more youthful who have no other underlying medical conditions
- In between 100 and 140 mg/dL, or 5.6 and 7.8 mmol/L, for individuals age 60 and older, or those who have other medical conditions, such as heart, lung or kidney disease
To help slow nerve damage:
- Follow your doctor’s suggestions for excellent foot care
- Keep your high blood pressure under control
- Follow a healthy-eating plan
- Get lots of exercise
- Keep a healthy weight
- Stop cigarette smoking
- Avoid alcohol or, if drinking is allowed, drink just in moderation
Relieving pain
Several medications are used to ease nerve pain, however they do not work for everyone and many have side effects that must be weighed against the benefits they provide. There are likewise a variety of alternative therapies, such as capsaicin cream (made from chili peppers), physical therapy or acupuncture, that might help with pain relief. Physicians regularly use them in combination with medications, but some may be effective by themselves.
Pain-relieving treatments may include:
- Anti-seizure medications. Although drugs such as gabapentin (Gralise, Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Tegretol) are used to treat seizure conditions (epilepsy), they’re likewise prescribed for nerve pain. Side effects may include sleepiness, dizziness and swelling.
- Antidepressants. Tricyclic antidepressant medications, such as amitriptyline, desipramine (Norpramin) and imipramine (Tofranil), may provide relief for mild to moderate symptoms by interfering with chemical procedures in your brain that cause you to feel pain, however they also cause a number of side effects, such as dry mouth, sweating, weight gain, constipation and lightheadedness. For some individuals, antidepressants called serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta), can ease pain with less side effects. Possible side effects of SNRIs consist of queasiness, drowsiness, dizziness, reduced cravings and constipation.
Handling complications and bring back function
Particular treatments exist for a number of the complications of neuropathy, consisting of:
- Urinary tract problems. Antispasmodic medications (anticholinergics), behavioral techniques such as timed urination, and devices such as pessaries — rings placed into the vagina to prevent urine leak — may be practical in treating loss of bladder control. A combination of treatments may be most reliable.
- Gastrointestinal issues. To eliminate mild signs and symptoms of gastroparesis — indigestion, burping, nausea or vomiting — doctors suggest eating smaller sized, more-frequent meals, lowering fiber and fat in the diet, and, for many individuals, eating soups and pureed foods. Dietary modifications and medications might assist alleviate diarrhea, constipation and nausea.
- Low blood pressure on standing (orthostatic hypotension). This is often assisted with easy lifestyle procedures, such as preventing alcohol, drinking plenty of water, and sitting or standing slowly. Your doctor might advise an abdominal binder, a compression support for your abdominal area, and compression stockings. A number of medications, either alone or together, might be used to treat orthostatic hypotension.
- Sexual dysfunction. Sildenafil (Revatio, Viagra), tadalafil (Adcirca, Cialis) and vardenafil (Levitra) might enhance sexual function in some men, but these medications aren’t efficient or safe for everyone. Mechanical vacuum devices might increase blood circulation to the penis. Women may find relief with vaginal lubes.
Lifestyle and natural home remedy
These procedures can help reduce your risk of diabetic neuropathy:
- Keep your high blood pressure under control. Individuals with diabetes are most likely to have hypertension than are individuals who don’t have diabetes. Having both high blood pressure and diabetes greatly increases your risk of complications due to the fact that both damage your capillary and reduce blood circulation. Aim to keep your blood pressure in the range your doctor suggests, and make sure to have it checked at every office visit.
- Make healthy food options. Eat a well balanced diet that includes a variety of healthy foods — particularly fruits, vegetables and entire grains — and limit portion sizes to assist attain or maintain a healthy weight.
- Be active every day. Daily activity secures your heart and enhances blood circulation. It likewise plays a major function in keeping your blood glucose and blood pressure under control. The American Diabetes Association generally suggests about 30 minutes of moderate workout a day at least 5 times a week. If you have severe neuropathy and decreased feeling in your legs, your doctor may suggest that you participate in non-weight-bearing activities, such as cycling or swimming.
- Stop smoking. If you have diabetes and use tobacco in any type, you’re more likely than are nonsmokers with diabetes to pass away of cardiovascular disease or stroke. And you’re more likely to develop circulation issues in your feet. If you use tobacco, talk with your doctor about finding ways to stop.
Prevention
You can assist prevent or delay diabetic neuropathy and its complications by keeping your blood sugar level consistently well-controlled, taking great care of your feet and following a healthy lifestyle.
Blood sugar level control
Keeping your blood glucose tightly managed needs constant monitoring and, if you take insulin, regular doses of medication. However keeping your blood sugar level consistently within your target range is the best way to help avoid neuropathy and other complications of diabetes. Consistency is essential because shifts in blood sugar levels can accelerate nerve damage.
The American Diabetes Association recommends that people with diabetes have a blood test called the A1C test at least two times a year to find out your average blood sugar level for the past two to three months. If your blood sugar isn’t really well-controlled or you change medications, you might need to get checked more frequently.
Also read: Self-monitoring: Diabetes Home Tests
Foot care
Foot issues, including sores that don’t recover, ulcers as well as amputation, are a common issue of diabetic neuropathy. However you can prevent many of these issues by having a thorough foot exam a minimum of once a year, having your doctor check your feet at each office check out and taking good care of your feet at home.
To protect the health of your feet:
- Check your feet every day. Look for blisters, cuts, swellings, cracked and peeling skin, inflammation and swelling. Use a mirror or ask a friend or relative to help examine parts of your feet that are difficult to see.
- Keep your feet tidy and dry. Wash your feet every day with lukewarm water and moderate soap. Avoid soaking your feet. Dry your feet and in between your toes carefully by blotting or patting with a soft towel. Moisturize your feet thoroughly to prevent cracking. Avoid getting lotion between your toes, however, as this can encourage fungal development.
- Trim your toenails thoroughly. Cut your toenails directly throughout, and file the edges thoroughly so there are no sharp edges.
- Wear tidy, dry socks. Look for socks made of cotton or moisture-wicking fibers that do not have tight bands or thick joints.
- Use cushioned shoes that fit well. Constantly use shoes or slippers to protect your feet from injury. Make certain that your shoes fit correctly and allow your toes to move. A podiatrist can teach you how to purchase properly fitted shoes and to avoid problems such as corns and calluses. If problems do take place, your doctor can help treat them to prevent more-serious conditions. Even little sores can quickly develop into severe infections if left neglected. If you get approved for Medicare, your strategy may cover the cost of a minimum of one pair of shoes each year. Speak with your doctor or diabetes teacher for more details.
