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Neuropathy is nerve damage caused by chronic high blood sugars in diabetes. This nerve damage can result in pain, particularly in the extremities such as the legs and feet. Over time this pain can subside and be replaced with numbness, as nerve damage becomes nerve cell death.
Sometimes neuropathy is not accompanied by pain, if the nerves damaged influence such things as how well your stomach and intestines clear the food you eat through your system. In this circumstance, a condition called gastroparesis develops, and the symptoms can include abdominal discomfort, nausea, vomiting, bloating or other problems. Nerve damage in other areas of the body can result in such things as incomplete emptying of the bladder, incontinence, or sexual dysfunction. Damage to nerves that regulate blood flow and blood pressure can result in significant blood pressure drops when sitting or standing, causing a person to feel light-headed or even faint.
If you begin to show signs of neuropathy, the most important first thing you can do to try to prevent further damage is to make sure your blood sugars are under as good control as possible. Sometimes improving blood sugar control can lead to increased pain initially, but may eventually decrease pain or other symptoms of neuropathy over time. Improved blood sugar control can also help to prevent further damage. Nerves do not re-grow however, so once pain is replaced with numbness, the nerves are dead and the numbness will not go away.
Frequently people with painful neuropathy find the discomfort very difficult to tolerate. Some patients find some relief from this nerve damage or neuropathy by keeping blood sugars as closely controlled as possible, getting regular exercise and keeping their weight under control. Doctors may suggest drugs such as aspirin, acetaminophen (Tylenol), or drugs containing ibuprofen. Using these non-narcotic pain relievers consistently throughout the day — rather than waiting until nighttime when symptoms can become more severe — also seems to help if pain is the major symptom.
Surprisingly, clinicians have found that certain antidepressants may be helpful and can take the edge off the pain of neuropathy as well. This doesn't mean that your doctor thinks you are depressed! Rather, it seems that the medications block the pain. Patients take them at night, and they have the effect of helping patients tune the pain out. Antidepressants can take several weeks to become effective, so patients should give these drugs a month before deciding whether they are helpful or not.
Today, one of the most commonly used and effective medications to help with the pain caused by neuropathy is called Neurontin (gabapentin capsules). An additional advantage of Neurontin is its relative lack of side effects.
Also, a topical cream (capaicin) is now available and may help relieve the pain of neuropathy, clinicians believe, by blocking nerve signals. An analgesic ointment such as Ben Gay may also help.
Patients should avoid taking narcotic painkillers for neuropathy, as they do not work very well for neuropathy, and will lead to addiction.
Some patients have experienced success with other forms of pain management — biofeedback, meditation, hypnosis, acupuncture, etc. A person should feel free to try any safe, non-drug approach to pain relief. What may not work for one person may work really well for someone else.
While physicians have found some medications and other treatments that help ease these painful symptoms for some people, prevention continues to be the key. Hemoglobin A1c readings should ideally be at 7.5, or even at 7.0 or below. Those that are consistantly near or above 8 percent cause concern that any diabetes complication, including neuropathy, may develop.
See also:
What does an A1c mean?
How do I prevent complications from diabetes?
Are complications inevitable?
More on neuropathy
Find more information about diabetes complications in The Joslin Guide to Diabetes available from the Joslin Online Store.
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