Diabetic Neuropathy medications & treatments

Medically reviewed by  Jamie Winn, PharmD

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Diabetic neuropathy affects up to half of the patients with type 1 and type 2 diabetes mellitus. It is the most common complication of diabetes. Although older patients are at an increased risk of diabetic neuropathy, it can affect people of any age. Approximately 8% of people over the age of 65 have symptoms of neuropathy. While neuropathy is common in diabetics, around 30% of people who receive chemotherapy and those with human immunodeficiency virus (HIV) report some degree of neuropathy.

What is diabetic neuropathy?

Diabetic neuropathy is a type of nerve damage that is a common complication of diabetes. High blood sugar levels can damage nerves in diabetics, typically in the legs and feet. Diabetic neuropathy is a progressive condition with symptoms getting worse over time. In addition to the nerve damage in your extremities, it can also cause problems with your digestive system, heart, and urinary tract.

Diabetic neuropathy causes

Although the exact cause of diabetic neuropathy is unknown, the following risk factors may contribute to this condition:

• High blood glucose levels. Diabetes is the leading cause of neuropathy in the U.S. Chronic high blood sugar can damage nerves and blood vessels, leading to serious complications.
• Lifestyle factors. Living an unhealthy lifestyle can contribute to your risk of this condition. High cholesterol and triglyceride levels, obesity, smoking, high blood pressure, and alcohol use can lead to nerve damage.
• Kidney disease. Kidney damage from diabetes can cause toxins to remain in circulation and cause nerve damage.
• Inherited factors. Some genetic mutations may make you more likely to develop neuropathic pain disorders than others.

How is diabetic neuropathy diagnosed?

To properly diagnose diabetic neuropathy, your doctor or healthcare professional will look at your symptoms, review your medical history, perform a physical exam, and run some tests.

Diabetic neuropathy symptoms

The symptoms of diabetic neuropathy will vary depending on the area that is affected. There are 4 main types of diabetic neuropathy that are classified based on the area of the nervous system it affects:

• Diabetic peripheral neuropathy. This is the most common form of diabetic neuropathy. It typically affects the peripheral nerves of your hands and feet. Some symptoms include numbness, tingling or burning sensations, extreme sensitivity to touch, muscle weakness, insensitivity to hot or cold temperatures, and sharp pain. It can also lead to serious foot problems such as ulcers, blisters, and infections.
• Autonomic neuropathy. This is the second most common type of neuropathy in diabetic patients. It is damage to the nerves that control your internal organs including your digestive system, sweat glands, sex organs, and cardiovascular system. Common symptoms include constipation, diarrhea, gastroparesis (indigestion, bloating), erectile dysfunction, vaginal dryness, increased heart rate, and urine leakage (incontinence).
• Proximal neuropathy. This is a rare form of neuropathy that is also known as diabetic amyotrophy. It tends to affect older adults and is present in about 1% of patients with type 2 diabetes. Proximal neuropathy typically affects nerves in the thighs, hips, buttocks, or legs on one side of your body. Symptoms include severe pain, weight loss, and muscle weakness.
• Focal neuropathy. Focal neuropathy, or mononeuropathy, affects individual nerves or a group of nerves, typically in your hand, head, torso, or leg. The most common type of focal neuropathy is carpal tunnel syndrome. Some common symptoms include pain, numbness, tingling in the affected area, double vision, eye pain, paralysis on one side of your face, and inability to focus your eyes.

In addition to the physical exam and review of symptoms, your health care professional may order specific tests to help confirm a diagnosis, including:

• Nerve conduction velocity test (NCV). This test measures and records the speed at which electrical signals pass through the nerves in your arms and legs.
• Needle electromyography. This test is usually performed along with an NCV. Electromyography measures electrical activity in your muscles while in use to determine if there is any disconnection between your nerves and muscles.
• Filament test. This is used to test the sensitivity in your feet. To perform this test, a nylon fiber (monofilament) is brushed over areas of your skin to check for any loss of sensation.
• Sensory test. A variety of sensory tests can be performed to check your muscle sensitivity to position, vibration, temperature, and light touch.
• Blood work. Your doctor may draw your blood to rule out other causes of nerve damage such as thyroid disease, kidney disease, and vitamin B12 deficiency.

The American Diabetes Association (ADA) recommends that you should be screened for diabetic neuropathy starting immediately after you have been diagnosed with type 2 diabetes or 5 years after a diagnosis of type 1 diabetes. Screening is recommended once a year thereafter.

What are some diabetic neuropathy treatment options?

There is no cure for diabetic neuropathy so the treatment goals will include slowing down the progression of the disease and relieving symptoms. This usually includes a combination of lifestyle changes and medications.

Medications

• Anticonvulsants. Medications used to treat seizures such as Lyrica (pregabalin) and Neurontin (gabapentin) are typically the first-line treatment for diabetic neuropathy pain management.
• Antidepressants. Certain antidepressants can help relieve nerve pain as a result of diabetes. The American Diabetes Association (ADA) recommends Cymbalta (duloxetine) as a first-line treatment. It belongs to a class of medication called serotonin and norepinephrine reuptake inhibitors (SNRIs). If you cannot take an SNRI or it doesn’t work, your doctor may try a tricyclic antidepressant (TCA) such as Pamelor (nortriptyline).
• Opioids. Although they are not typically used, your doctor may prescribe a strong pain reliever such as Nucynta ER (tapentadol) or Ultram (tramadol).
• Topical medications. Medications such as lidocaine and capsaicin come in various OTC and prescription formulations, such as creams and patches that can help with pain relief.

Complementary treatments

• Transcutaneous electrical nerve stimulation (TENS). TENS uses a low-level electrical current that is delivered through electrodes on your skin at or near the affected area(s) to reduce nerve pain.
• Other treatments. Acupuncture, massage, physical therapy, and occupational therapy may help improve your symptoms and quality of life.

What is the best medication for diabetic neuropathy?

The best medication for the treatment of diabetic neuropathy will depend on the individual’s specific medical condition, medical history, medications that the individual is already taking that may potentially interact with diabetic neuropathy medications, and the individual’s potential response to the treatment. It is advisable to always speak with your healthcare provider about the best medication for you. The table below includes a list of the most prescribed or over-the-counter medications and supplements approved by the Food and Drug Administration (FDA).

Best medications for diabetic neuropathy

Your healthcare provider will determine the right dosage based on your response to the treatment, medical condition, weight, and age. Other possible side effects may exist; this is not a complete list.

What are the most common side effects of diabetic neuropathy medications?

As with all medicines, those used for diabetic neuropathy will have some side effects, depending on the class you are taking. For oral medications used to treat diabetic neuropathy, the most common side effects include:

• Drowsiness
• Fatigue
• Nausea
• Dry mouth
• Headache
• Dizziness
• Constipation
• Blurred vision
• Impaired coordination
• Confusion

The topical medications commonly caused application site reactions such as redness, burning, and pain.

What are some home remedies for diabetic neuropathy?

To prevent diabetic neuropathy, you have to manage your diabetes by maintaining healthy blood sugar, blood pressure, and cholesterol levels. 

Diabetic neuropathy prevention

Some lifestyle changes and self-care measures that can help prevent diabetic neuropathy include:

• Monitor your blood sugar levels
• Take your diabetes and other medications as prescribed
• Keep your blood pressure and cholesterol under control
• Get regular physical activity
• Eat a healthy diet
• Quit smoking
• Avoid alcohol or limit it to 1 drink a day for women and 2 drinks for men
• Maintain good foot care, checking for sores or blisters, keeping your toenails clipped straight across, and wearing closed-toe, well-fitting shoes

Frequently asked questions about diabetic neuropathy

Can diabetic neuropathy be cured?

There is no cure for diabetic neuropathy. The best way to avoid it is to tightly manage your blood glucose levels. Once you are experiencing symptoms, your doctor will come up with a treatment plan that may include lifestyle changes and medications.

What are some complications of diabetic neuropathy?

If not managed properly, diabetic neuropathy can lead to serious complications such as:

• Foot sores, blisters, ulcers, and infections.
• Amputation of a limb. Approximately 86,000 Americans with diabetes lose a limb each year.
• Chronic urinary tract infections and incontinence.
• Sexual dysfunction.
• Gastrointestinal issues such as diarrhea, constipation, bloating, and indigestion.
• People with autonomic neuropathy may not recognize the signs of hypoglycemia.

When should I contact my doctor?

If you experience the following signs and symptoms, contact your healthcare provider:

• Burning, tingling, numbness, or muscle weakness in your hands or feet
• Extreme sensitivity to touch
• Foot sores or cuts that won’t heal
• Digestive or sexual dysfunction

Related resources for diabetic neuropathy

• Understanding neuropathy and your diabetes. American Diabetes Association
• Diabetic neuropathy overview. MayoClinic
• What is diabetic neuropathy? National Institute of Diabetes and Digestive and Kidney Diseases
• Diabetic neuropathy practice essentials. MedScape
• What is diabetic neuropathy? WebMD
• What to know about diabetic neuropathy. MedicalNewsToday
• Neuropathy symptoms and causes. Cleveland Clinic