From the Guidelines
Managing diabetic neuropathy at home requires a multifaceted approach that prioritizes blood sugar control, pain management, and lifestyle modifications to improve quality of life and reduce morbidity and mortality. The most recent and highest quality study, 1, recommends optimizing glucose control to prevent or delay the development of neuropathy, and optimizing blood pressure and serum lipid control to reduce the risk or slow the progression of diabetic neuropathy.
For pain relief, the American Academy of Neurology recommends gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers as initial pharmacologic treatments for neuropathic pain in diabetes, as stated in 1. Specifically, medications such as gabapentin (300-1200mg three times daily), pregabalin (50-300mg twice daily), duloxetine (60-120mg daily), or amitriptyline (10-150mg at bedtime) may be prescribed by a doctor if over-the-counter options like acetaminophen, NSAIDs, or topical treatments such as capsaicin cream (0.075%) are insufficient.
Daily foot care is essential and includes:
- Inspecting feet for injuries
- Washing and drying them thoroughly
- Moisturizing (but not between toes)
- Wearing comfortable shoes
- Never walking barefoot Regular gentle exercise, such as walking or swimming for 30 minutes most days, can improve circulation and may reduce pain, as suggested in 1. Additionally, limiting alcohol consumption and quitting smoking are crucial, as both worsen neuropathy. A balanced diet rich in B vitamins, particularly B12, can support nerve health, and considering alpha-lipoic acid supplements (600mg daily) may help reduce symptoms, as mentioned in 1. For nighttime discomfort, using a bed cradle to keep sheets off sensitive feet can provide relief. If worsening symptoms, new areas of numbness, or foot injuries that don't heal occur, it is essential to contact a healthcare provider promptly.
From the FDA Drug Label
The efficacy of the maximum recommended dose of pregabalin for the management of neuropathic pain associated with diabetic peripheral neuropathy was established in three double-blind, placebo-controlled, multicenter studies with three times a day dosing, two of which studied the maximum recommended dose The efficacy of duloxetine delayed-release capsules for the management of neuropathic pain associated with diabetic peripheral neuropathy in adults was established in 2 randomized, 12-week, double-blind, placebo-controlled, fixed-dose trials in adult patients having diabetic peripheral neuropathic pain (DPNP) for at least 6 months
Diabetes Neuropathy Management at Home:
- Medications: Pregabalin 2 and duloxetine 3 are effective for managing neuropathic pain associated with diabetic peripheral neuropathy.
- Key Points:
- Pregabalin: three times a day dosing, maximum recommended dose effective in clinical studies.
- Duloxetine: 60 mg once daily or 60 mg twice daily, statistically significant improvement in endpoint mean pain scores.
- Home Management: Patients can manage their diabetes neuropathy at home by taking their prescribed medications, such as pregabalin or duloxetine, as directed by their healthcare provider.
From the Research
Diabetes Neuropathy Management at Home
- Management of diabetes neuropathy at home involves a combination of pharmacological and non-pharmacological treatments, as well as lifestyle modifications 4, 5, 6.
- Pharmacological treatments for painful diabetic neuropathy include duloxetine, gabapentin, amitriptyline, and pregabalin, which can provide adequate pain reduction, but may have side effects such as drowsiness, dizziness, and dry mouth 7, 4, 8.
- Non-pharmacological treatments, such as exercise and neuromodulation with spinal cord stimulation or transcutaneous electrical nerve stimulation, may also be effective in reducing pain, but require further study 4, 6.
- Lifestyle modifications, including glycemic control, lifestyle modifications, and foot care, are essential for preventing and managing diabetic neuropathy 4, 5.
- Early diagnosis and periodic, objective monitoring of medication response are critical to ensure effective management of diabetic neuropathy 4, 6.
Treatment Options
- Amitriptyline, pregabalin, and duloxetine are commonly prescribed drugs for the treatment of painful diabetic peripheral neuropathy, with amitriptyline showing more favorable findings with tolerable side effects 7.
- Pregabalin and duloxetine have been compared in observational studies, with duloxetine showing greater effectiveness in treating diabetic peripheral neuropathic pain, but with more side effects 8.
- Other treatment options, such as acupuncture, alpha-lipoic acid, acetyl-L-carnitine, cannabidiol, and onabotulinumtoxinA, require further study in patients with diabetic peripheral neuropathy 4.
Home Care
- Patients with diabetic neuropathy can take steps to manage their condition at home, including monitoring their blood sugar levels, exercising regularly, and practicing good foot care 5.
- It is essential for patients to work with their healthcare provider to develop a personalized treatment plan that includes a combination of pharmacological and non-pharmacological treatments, as well as lifestyle modifications 4, 6.