Diabetic Neuropathy Treatment

The treatment is based on the types of diabetic neuropathy 

1. Peripheral neuropathy treatment

• Manage pain with standard analgesics
• Maintain HbA1c below 7%
• Avoid tobacco and narcotics
• Localised pain can be managed with topical capsaicin, antidepressants (duloxetine, amitriptyline, imipramine, desipramine, venlafaxine), anticonvulsants (carbamazepine, gabapentin, phenytoin), or antiarrhythmic drug mexilitine (oral lidocaine).

2. Proximal neuropathy treatment

• Manage joint pain with standard analgesics
• Maintain HbA1c below 7%
• Avoid tobacco and narcotics
• Local pain can find relief with topical capsaicin and lidocaine patches
• Manage pain with antidepressants (duloxetine, amitriptyline, imipramine, desipramine, venlafaxine), anticonvulsants (carbamazepine, gabapentin, phenytoin), or opiods (oxycodone, tramadol)
• Complementary therapies like acupuncture, physical therapy and TENS (Trans cutaneous electrical nerve stimulation) have been shown to be helpful in some cases

3. Autonomic neuropathy treatment

• Encourage small frequent feeds with liquids, soft foods and low fibre. Avoid high fat foods and carbonated beverages.
• Maintain HbA1c below 7%
• Medications are used for symptomatic relief such as erythromycin or dopamine antagonists (metoclopramide); antidiarrheal medications (loperamide and diphenoxylate), and bile salt sequestrants (cholestyramine). Bowel infections should be referred to a gastroenterologist or treated with broad spectrum antibiotics such tetracycline or cephalosporin. 

4. Focal neuropathy

• Symptomatic palliation
• Maintain the HbA1c below 7%
• Prevent onset and/or slow progression clinical neuropathy with regular follow-ups and disease monitoring
• Reassess symptoms every 3-4 months and a yearly follow up for clinical evidence of diabetic neuropathy. In Type 1 diabetics it is within 5 years of diagnosis unless burning and loss of sensations were present at the time of diagnosis. 
• Annual neurological screening with medical history and examination that includes sensory, motor, reflex and autonomic responses and a complete foot examination.