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Raj Singh MD
September 9, 2023

Diabetic neuropathy treatments

Diabetic neuropathy treatments

Today will be discussing the topic of Diabetic neuropathy treatments or diabetic nerve disease

As the incidence of diabetes and prediabetes is increasing diabetic neuropathy is becoming an increasing problem.

The main issue with diabetic neuropathy is a loss of sensory function, so patients have limited ability to perceive certain sensations such as temperature, vibration and pressure. Patients may also notice unsteadiness especially with eyes closed

Diabetic neuropathy is a chronic debilitating disease that causes symptoms such as numbness and weakness from damage to nerve fibers. Over time patients may also experience symptoms of symptoms of pain from abnormal and damaged nerve fibers. Symptoms tend to be common in the toes and feet and often get worse at night

The important question is why does this happen. So let us take a look at the underlying pathophysiology

Our body is constantly repairing our damaged nerves, in patients with diabetic neuropathy the damage is happening at a much accelerated rate and our body is not able to keep up. So if you have diabetic neuropathy that generally means that you have an imbalance between nerve damage and nerve repair. As seen in this image, Nerve fibers are surrounded by schwann cells. These cells have their own microcirculation and have a high metabolic requirement.

In patients with uncontrolled diabetes, the tissues are over saturated with abundant amounts of glucose, this extra glucose gets converted to a molecule called acetyl coenzyme A. This molecule later gets converted to acylcarnitines.

It is these acylcarnitines that are thought to be toxic to Schwann cells and may be responsible for the symptoms of diabetic neuropathy. So in simple terms not only that these nerve cells are starving, and at the same time they also are surrounded by these toxic molecules which leads to significant and often irreversible damage to nerve fibers

Once a diagnosis of diabetes is established it may take several years for diabetic neuropathy to develop. In certain individuals if they have high risk factors the symptoms may appear much sooner.

Let's look at some of the Risk factors for developing diabetic neuropathy

Uncontrolled diabetes:

of course this is the big one, if your blood glucose is out of control the disease may progress much rapidly. We also know that when blood glucose is brought under control at a rapid rate by using insulin therapy, the neuropathy can worsen initially and may cause significant pain and discomfort. This particular condition is from inflammation caused by rapid changes in glucose levels and is called treatment induced neuropathy or insulin neuritis.


BMI is directly related to diabetic neuropathy, this is thought to be secondary to insulin resistance caused by obesity, Hypercholesterolemia: especially low HDL levels correlate with increased risk of neuropathy.

High blood pressure:

Uncontrolled high blood pressure can cause further spasm and damage to the neural microcirculation and may restrict blood flow to the nerve fibers and schwann cells

let’s us dive into some of the potential treatment and preventative options

Pain management

There are several medications that can be used to improve the symptoms of pain

Several antidepressant such as duloxetine, amitriptyline can reduce pain

Duloxetine is typically started at 30 mg a day and must be taken on a full stomach to reduce nausea

Gabapentin and pregabalin ( Lyrica) are also extremely effective in reducing pain.

if your already overweight I do not recommend pregabalin as this can cause significant weight gain

Other medications can be capsaicin cream or lidocaine patch

Some studies have mentioned acupuncture as an effective therapy however data is lacking.

Let us look at Nonprescription based approach:

Strict control of blood glucose is essentially important to prevent and improve diabetic neuropathy. It is possible that once the treatment for diabetes is started, the neuropathy may worsen like we discussed before. This condition however is rare and is called insulin neuritis or treatment induced neuropathy.

Diabetic neuropathy treatments

B12 supplementation:

B12 deficiency is common in patients with diabetic neuropathy, sometimes this deficiency can be made worse by starting a patient on metformin.

So if you are taking metformin, its a really good idea to take B12 or B complex supplementation.

Injectable therapies:

Alpha lipoic acid

This is one of my favorite injections to improve nerve pain this is a powerful antioxidant can reduce inflammation in the nerves, Monthly injections are typically required

Glutathione injections

another powerful antioxidant to reduce inflammation in the nerve fibers

NAD injections

Resets cellular metabolism and provides rapid source of energy at the cellular level

So that was a brief overview of diabetic neuropathy, will be discussing diabetic autonomic dysfunction in another video

Here is what I recommend to help improve your diabetic neuropathy

Control your diabetes

Reduce insulin resistance: this can be accomplished by healthy lifestyle, losing weight and nutritional supplementation. Avoid excessive amounts of insulin as this can make insulin resistance worse

Lose weight

Stop smoking

Improve your HDL levels by taking omega-3 twice a day

Alpha lipoic acid injections

Glutathione injections

NAD injections.

B12 or B complex supplementation

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