Living with Diabetic Neuropathy: Treatment Options and Self-Care Tips

Although it is not always possible to prevent diabetes-related peripheral neuropathy (DPN), the best way to slow its progression, as shown in the large Diabetes Control and Complications Trial (DCCT), is to closely manage diabetes. We will discuss various treatment options, including medications, healthy eating, and other lifestyle factors that are available if DPN develops.

What Treatment Options Are Available For DPN?

If DPN does develop, medications can decrease the burning, tingling sensations, and pain that might be present. Medications that may be prescribed include Neurontin (gabapentin) or Lyrica (pregabalin), both of which are used for pain and seizures. Cymbalta (duloxetine), used for chemical balance in the brain, may be used to help with pain associated with DPN. While these medications can be effective, it may take several weeks of adjustments to find the right dose. If you are prescribed these medications, you should be aware that they can be somewhat sedating. Other drugs that may be effective include medications used for mood disorders, such as venlafaxine (Effexor), nortriptyline (Pamelor), or amitriptyline (Elavil), but they may have side effects at higher doses and especially with older age.

Topical treatments such as capsaicin or lidocaine that can be spread on the skin or used as a patch can help relieve localized pain but can cause skin irritation, burning, and redness at the application site. Capsaicin, available as a cream, gel, lotion, or ointment, reduces the neurotransmitter that signals pain at the affected nerves. It is applied to the painful areas 3 to 4 times per day. Be sure to avoid touching your eyes or other areas of your body while applying capsaicin. Also, avoid sniffing or inhaling near capsaicin. You should contact your doctor immediately if you experience severe irritation or if side effects bother you or don’t go away. It is important to discuss capsaicin use with your doctor prior to using it if you have high blood pressure or have had recent heart problems, stroke, or other vascular problems. QUTENZA is a prescription brand of capsaicin that is used to treat DPN. It must be applied by a healthcare provider and should never be applied or removed by the patient.

Ice baths can also provide some level of pain relief. When pain management is not achieved, a person should be referred to a neurologist or pain specialist. According to the American Diabetes Association (ADA), the use of any opioid for pain management carries the risk of addiction and should be avoided.

Several newer treatments for pain have recently been approved by the FDA for intractable pain, or pain that is difficult to manage and isn’t relieved with medication. Spinal cord stimulators are a new form of therapy and will be discussed more fully in the next article in this series.

Neuropathy is a very active area of research to identify new and effective treatments. Future advancements include nerve growth factor treatments, which are being studied to determine if they may help repair nerve damage over time. If you are experiencing any of the symptoms of neuropathy, be sure to inform your diabetes care team and work with your team to determine what diagnostic tests need to be done and what treatment course might be best for you. While there is no cure or treatment for DPN, there are ways to manage the pain that may accompany it.

How Does What I Eat Impact DPN?

As discussed in the previous article, careful diabetes management, including maintaining stable blood glucose levels, is crucial for managing DPN. A healthy, balanced eating plan, rich in whole grains, vegetables, and lean proteins helps stabilize glucose and manage diabetes. Be sure to avoid high-sugar foods or other foods that lead to blood glucose spikes, as these spikes can contribute to inflammation and worsen nerve damage. Monitoring your glucose, especially before and after meals, or using a continuous glucose monitor, can help gauge your individual response to foods and eating patterns. It is important to work with a registered dietitian nutritionist (RDN) to design an eating plan that works best for you and your circumstances. It turns out that the same eating plan that helps your diabetes and your heart will also help your nervous system’s health. The focus is on what you can (and should) eat instead of what you should not eat! Overall, an eating pattern rich in plant-based foods and low in animal fats and saturated fats is best.

The Mediterranean eating pattern, so named after the eating habits of those living near the Mediterranean Sea, is often recommended. Researchers report that this plant- and seafood-based eating pattern may help reduce the risk of heart disease and other diabetes complications, such as DPN.

The Mediterranean eating pattern includes:

• Colorful vegetables and fruits.
• Nuts such as almonds, cashews, and walnuts.
• Seafood as your primary meat source.
• Healthy fats like olive oil instead of butter.
• Whole grain bread, cereals, and pasta.
• Plenty of herbs and spices added to your food to lower your salt intake and add nutrients.
• Moderate amounts of yogurt, cheese, and eggs.

A general recommendation to help with portion sizes is to fill one half of your plate with non-starchy vegetables, one quarter with a lean protein choice such as seafood, and the final quarter with a whole grain. A serving of fruit and possibly low-fat dairy on the side completes the meal.

What Are Some Of The Best Nutrients And Foods That Can Help With Nerve Health?

• Magnesium helps stabilize nerve cells and relax the nervous system. Foods that contain magnesium include raw nuts, pumpkin seeds, quinoa, beans, and peas.
• B vitamins support nerve function, neurotransmitter production, and overall neurological health. Fish, poultry, meat, eggs, dairy products, leafy green vegetables, beans, and peas are all good sources of B vitamins. Many cereals and some breads have added B vitamins. Vitamin B-Complex includes B6, B12, and B1, all of which are essential for nerve function and repair. These vitamins can reduce nerve pain and enhance sensory perception.

• Vitamin B12: Found in sardines, salmon, tuna, mackerel, and cod, Vitamin B12 is crucial for nerve regeneration.
• Vitamin B1: Green peas, black beans, and lentils are great sources of Vitamin B1, which helps prevent nerve damage.
• Vitamin B6: Tuna and salmon are rich in Vitamin B6, which plays a role in neurotransmitter production and nerve health.

• Omega-3 fatty acids, found in fish oil, fatty fish such as salmon, and flaxseeds, help reduce inflammation and develop healthy nerves. Fish oil can also help treat neuropathy, relieve pain, and reduce muscle soreness.
• Alpha-lipoic acid, found in green leafy vegetables, helps relieve neuropathic pain and improve nerve regeneration.
• Antioxidants neutralize free radicals that can harm cells and cause them to mutate. Antioxidants like CoQ10 and acetyl-l-carnitine can help prevent or reverse nerve damage. Berries and leafy greens are foods that are rich in antioxidants. Some of the best fruits for nerve health include apples, berries, oranges, and grapes. These fruits contain flavonoids like quercetin, which have anti-inflammatory properties that can soothe neuropathy pain and promote nerve healing.
• Monounsaturated fatty acids are healthy fats found in avocados, nuts, seeds, olive oil, peanut oil, sesame oil, and canola oil. They help protect nerve cells in the brain and improve blood flow and blood pressure.

Keeping a food diary helps you see what foods and eating patterns affect your symptoms. Over time, this can guide the best food choices and eating plan for you.

What Other Lifestyle Factors Are Important For People Living With DPN?

• Regular physical activity is key to improving circulation and managing blood glucose. Low-impact exercises like swimming, cycling, and walking are ideal for women with DPN.
• Weight management helps reduce strain on nerves and improves mobility. Work with your diabetes care team, including your RDN, to discuss options for healthy weight management.
• Quit smoking and limit alcohol intake to prevent further damage to nerves and blood vessels. Ask your diabetes care team for resources to help in quitting smoking or managing alcohol intake if needed.
• Foot care should include daily inspections for injuries and wearing properly fitted shoes to avoid ulcers and infections. Also, be sure to ask your diabetes care team to check our feet during healthcare appointments.

How Do I Check My Feet At Home?

The ADA recommends that all people with diabetes, regardless of age or duration of diabetes, should check and take care of their feet as part of their daily routine. This includes inspecting your feet regularly, including checking between your toes and the surfaces of your foot looking for cuts, sores, blisters, corns, calluses, or any redness. Podiatrists recommend the following steps for a regular foot care routine:

• Use a mirror to see the bottoms of your feet and make sure there are no cuts or ulcerations that would need immediate attention to ensure they don’t worsen. If necessary, ask someone in your household to help you inspect your feet.
• Wash your feet regularly, making sure the water is not too hot (not more than 90-95 degrees F), and be sure to dry them well.
• Rub a small amount of lotion or cream on the tops and bottoms to keep skin healthy, but do not put lotion or cream between your toes, an area more prone to fungal infections.
• Smooth corns and calluses gently. Talk with your diabetes care team or a podiatrist about how to deal with corns and calluses if they are frequent or problematic.
• Trim toenails straight across with a toenail clipper, preferably after bathing, when nails are softer and easier to cut. Don’t cut too close, avoid breaking any skin, and file any sharp ends. If you have reduced sensation or can’t see or reach your toenails to cut them, seek the help of a podiatrist.
• Wear well-fitting, closed-toe shoes. Choose lightweight shoes that cushion the feet, distribute pressure evenly, and have a broad and square toe box, such as walking or athletic shoes. Break in new shoes slowly. If an existing foot problem has caused a deformity in one or both of your feet, therapeutic shoes that are custom molded to relieve pressure may be recommended.
• Avoid walking barefoot or without shoes. Wear socks with breathable fabrics that draw sweat away from your skin (cotton and special acrylic fibers are fabrics that “wick” sweat). There are socks designed for people with diabetes, including socks that can monitor the temperature of your feet.
• Protect feet from temperatures that are too hot or cold. Wear shoes if the surface you walk on will be hot. Use sunscreen on your feet to avoid sunburn. In cold weather, keep your feet away from heaters and open fires, and use socks and lined boots to keep your feet warm when outside.
• Get up and move regularly, or at least wiggle your toes and roll your ankles around. Keep blood circulation flowing by elevating your feet rather than letting them dangle or rest on the floor.

Make sure you always have your feet checked when you see your diabetes care team. They should do a simple test in the office to check for numbness or pain. To be sure they don’t forget, take off your shoes and socks while you are waiting. See the previous article for more on what to expect with a comprehensive foot exam.

While diabetic peripheral neuropathy can be challenging, proactive and comprehensive management offers the best chance to alleviate symptoms and prevent progression. From carefully chosen medications to a balanced, nutrient-rich eating plan and lifestyle changes, there are many tools to help you manage DPN effectively. Working closely with your healthcare team can empower you to find the right treatments for your needs, stay vigilant about self-care, and make choices that support your nerve health and overall well-being. With the right approach, you can continue to live well and actively reduce the impact of DPN on your daily life.

Learn more about the Medtronic spinal cord stimulator.

References:

American Diabetes Association Professional Practice Committee. 12. Retinopathy, neuropathy, and foot care: Standards of Care in Diabetes—2024. Diabetes Care 2024;47(Supp. 1):S231-S243.

Martin CL, Albers JW, Pop-Busui R for the DCCT/EDIC Research Group. Neuropathy and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study In Special Collection: DCCT-EDIC Special Article Collection , DCCT/EDIC 30th Anniversary Summary Findings Diabetes Care 2014;37(1):31–38 https://doi.org/10.2337/dc13-2114

El Soury M, Fornasari BE, Carta G, Zen F, Haastert-Talini K, Ronchi G. The Role of Dietary Nutrients in Peripheral Nerve Regeneration. Int J Mol Sci. 2021 Jul 10;22(14):7417. doi: 10.3390/ijms22147417. PMID: 34299037; PMCID: PMC8303934. National Institutes of Health (NIH) (.gov) https://www.ncbi.nlm.nih.gov › articles › PMC8303934

About the Author

Janice MacLeod, MA, RD, CDCES, FADCES,  is a diabetes-cardiometabolic consultant and thought leader in digital health and chronic condition management. Janice began her career as a diabetes-focused dietitian and certified diabetes care and education specialist at Carilion Clinic in Roanoke, VA and later at the University of Maryland in Baltimore, MD. More recently, Janice led clinical advocacy at Medtronic and Companion Medical and has served in clinical leadership roles with Welldoc and Johnson and Johnson. She is past chair of the Academy of Nutrition & Dietetics Diabetes Practice Group and has been elected to the Association of Diabetes Care and Education Specialists Board of Directors (2024-2027). Janice has authored multiple publications and developed numerous programs on diabetes nutrition, digital health, and practice transformation.  Her passion is developing business-savvy solutions leveraging technology to transform care.