Diabetic neuropathy: Diagnosis, treatment

The article is professionally consulted by Master, Doctor Huynh An Thien - Neurologist - Department of Medical Examination & Internal Medicine - Vinmec Danang International Hospital.

Diabetic neuropathy is damage to nerves throughout the body, caused by high blood sugar. The disease is diagnosed based on functional symptoms and there is no cure for diabetic neuropathy completely.

Doctors usually diagnose diabetic neuropathy by doing a physical exam and careful review of symptoms, as well as taking the patient's medical history. Specifically, you will be tested:
Strength, tension and muscle tone; tendon reflexes; Feel the touch and vibration of the tuning fork. At the same time, the doctor also performs specific tests to help diagnose diabetic neuropathy, such as:
Thread test: The doctor will brush a soft nylon thread (filament) over the areas of the diseased skin. multiplier to test the sensitivity to touch; Sensory testing: A non-invasive test that shows the nerve's response to vibration and temperature changes (hot/cold); Nerve conduction test: Measures the speed at which the electrical signals are conduction of the nerves in the hands and feet. This test is also commonly used in the diagnosis of carpal tunnel syndrome; Electromyography: This test measures electrical discharges produced by muscles and studies nerve conduction; Automated testing: Special tests that identify changes in blood pressure and ability to sweat as the patient performs different positions.

Diabetic neuropathy has no cure. The goals of treatment for diabetic neuropathy are:
Slow the progression of the disease; Pain relief; Complications control and rehabilitation.

Keeping blood sugar steady is key to preventing or delaying nerve damage. Good blood sugar management even improves some existing symptoms. Your doctor will work out a target blood sugar level for you based on your age, length of diabetes, and overall health.
Optimal blood sugar will vary from person to person. In general, the American Diabetes Association recommends the following blood sugar goals for most people with diabetes:
Between 80 - 130 mg/dL, or 4.4 - 7.2 mmol/L before meals eat; Less than 180 mg/dL (10.0 mmol/L) two hours after a meal. Some experts recommend lower blood sugar for most young people with diabetes, and higher for older adults at risk for complications from low blood sugar. Specifically, the commonly recommended pre-meal blood sugar level is:
Between 80 - 120 mg/dL (4.4 - 6.7 mmol/L) for patients 59 years of age or younger with no underlying medical conditions other; From 100 - 140 mg/dL (5.6 - 7.8 mmol/L) for patients aged 60 years or older or with heart, lung, or kidney disease. In addition, controlling blood pressure, maintaining a healthy weight, and getting regular physical activity are also important considerations to slow or prevent diabetic neuropathy from getting worse.

There are many prescription medications for diabetic neuropathy, but the effects will vary from person to person. Before trying any medication, consult with your doctor about the benefits and possible side effects to find the best option.
Prescription pain relievers include:
Antiepileptic drugs Some medications for seizure disorders (epilepsy) are also used to relieve nerve pain, such as pregabalin (Lyrica). Gabapentin (Gralise, Neurontin). Possible side effects are drowsiness, dizziness, and swelling.
Antidepressants Antidepressants also work to reduce nerve pain, even if you're not depressed. For example, tricyclic antidepressants that help relieve mild to moderate neuropathic pain include: amitriptyline, desipramine (Norpramin), and imipramine (Tofranil). Side effects can include irritability, dry mouth, and drowsiness.
Serotonin and norepinephrine reuptake inhibitors (SNRIs) are also an antidepressant that help with diabetic neuropathy, with fewer side effects. The recommended ones are duloxetine (Cymbalta) and venlafaxine (Effexor XR). Side effects include: nausea, drowsiness, dizziness, decreased appetite, and constipation.
Over-the-counter pain relievers Sometimes, antidepressants can be combined with anti-seizure medications and pain relievers, such as over-the-counter acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB) or patches topical pain reliever paste with anesthetic agent.

To manage diabetes complications, you will need the care of a variety of specialists from different fields. For example, urologists and cardiologists will help prevent or treat diabetic neuropathy.
Treatment will depend on the complications related to the neurological disease you have, specifically:
Urinary tract problems Some drugs affect bladder function, so your doctor may suggest stopping or changing the medication. Patients should follow a strict schedule of urinating or urinating for several hours, incorporating gentle pressure on the bladder area (below the abdomen). Self-catheterization is also a necessary method to make urine easier in the patient.
Digestive problems To relieve signs and symptoms, including indigestion, belching, nausea or vomiting, patients are advised to divide their meals and eat more often. Dietary changes, combined with certain medications, can help relieve abdominal pain, diarrhea, constipation, and nausea.
Low blood pressure when standing Treat orthostatic hypotension simply by making lifestyle changes, such as avoiding alcohol, drinking plenty of fluids, sitting correctly, or standing up slowly. Elevating the head of the bed 15 - 25cm helps prevent blood pressure disorders while sleeping. Certain medications may also be prescribed to treat orthostatic hypotension.
Sexual dysfunction Oral or injected medication can improve sexual function in some men with erectile dysfunction due to diabetic neuropathy, but requires a doctor's prescription. Mechanical vacuum devices can also increase blood flow to the penis. For women, vaginal lubricants can be used for support.

The following measures can help you feel better and reduce your risk of diabetic neuropathy:
Control your blood pressure: If you have high blood pressure and diabetes, you have a higher risk of complications. Try to keep your blood pressure within the acceptable range and have it checked at every regular check-up; Healthy food choices: A balanced diet with a wide variety of healthy foods – especially vegetables, fruits and whole grains, and ensuring the right portion sizes will help you maintain a healthy weight strong; Get active every day: Exercise helps lower blood sugar, improve blood flow, and keep your heart healthy. The American Diabetes Association recommends that all adults with diabetes get 150 minutes of moderate-intensity exercise per week. Gentle exercise is also a good way to relax after every 30 minutes of sitting in place. It is advisable to consult a physiotherapist before starting to exercise. If you have reduced sensation in your legs, certain types of exercise such as walking may be safer. If you have a foot injury or pain, do exercises that don't require you to put weight on your injured foot. Quit smoking: Exposure to secondhand smoke in any form increases the risk of poor circulation in the feet. If you are a smoker, ask your doctor for instructions on how to quit.

There are also many alternative treatments that can provide effective pain relief. However, you should consult your doctor before adopting any new therapy to avoid drug interactions. For diabetic neuropathy, you have several options:
Topical capsaicin cream: Relieves pain sensation. Side effects include burning and skin irritation; Alpha-lipoic acid: Powerful antioxidant that helps relieve symptoms of neuropathic pain; Acetyl-L-Carnitine: A nutrient that is both naturally produced by the body and added to oral supplements, which has the effect of reducing nerve pain; Transcutaneous Electrical Nerve Stimulation (TENS): Blocks pain signals from reaching the brain by placing tiny electrodes on the skin, which transmit electrical impulses to specific nerves; Acupuncture: Helps relieve neuropathic pain and usually has no side effects, but it takes persistence to do the therapy repeatedly to get results.

Preventing diabetic neuropathy is also a way to slow the progression of the disease, most importantly, take proper care of your feet. Diabetic neuropathy, although rarely fatal, can severely affect quality of life. Therefore, you should actively treat diabetes from the time of diagnosis. If you already have diabetes complications, you need care and support from your doctor as well as your family.
Currently, Vinmec International General Hospital has been and continues to deploy a screening package for diabetes and dyslipidemia to help detect prediabetes early, accurately classify diabetes type, build Develop a nutritional regimen, monitor and minimize the risks and complications caused by diabetes to organs in the body such as the nervous system, cardiovascular system....

Reference source: mayoclinic.org