Because there are several forms of neuropathy, the treatment will vary according to the systems affected and the symptoms. Treatment of the underlying condition is a priority. In the case of diabetes, this includes controlling glucose (blood sugar).

Keeping glucose within the physician-prescribed range may help prevent or delay the onset of neuropathy. Studies have shown that patients with type 1 diabetes who controlled their glucose (glycohemoglobin A1C below 7 percent) reduced their risk of peripheral neuropathy by 60 percent. Improving glucose control may cause increased pain at first. With time, however, a more stable glucose level will result in less pain and fewer neuropathy symptoms. Better control of glucose means better health.

Preventive treatment of diabetic neuropathy may also include:

• Proper diet and weight control
  
  
• Good skin care and foot care
  
  
• An exercise program to build strength and control glucose
  
  
• Avoidance of smoking, because the damage to circulation increases the risk of foot problems and other disorders
  
  
• Restriction of alcohol, because alcohol is a nerve toxin and can interfere with glucose control
  
  
• Control of high blood pressure
  
  
• Close monitoring of diabetes by medical professionals

The second focus of treatment for diabetic neuropathy is relief of symptoms. Although symptoms vary greatly, pain is one of the most common complaints. The U.S. Food and Drug Administration (FDA) has approved two drugs for relief of diabetic nerve pain: pregabalin (Lyrica), an anticonvulsant (seizure medication) that is also used to treat fibromyalgia and post-shingles pain, and the antidepressant duloxetine (Cymbalta), a serotonin and norepinephrine reuptake inhibitor (SNRI).

The American Society of Pain Educators and Johns Hopkins University School of Medicine released in 2006 what they called the first definitive consensus guidelines for treating diabetic nerve pain. As first-line treatments, they recommended duloxetine, pregabalin, controlled-release oxycodone (an opioid) and tricyclic antidepressants.

The FDA has advised that antidepressants and anticonvulsants may increase the risk of suicidal thinking in some patients. Possible side effects of pregabalin include weight gain, blurry vision and dizziness, and the FDA advises diabetic patients to monitor their skin because pregabalin causes skin sores in animals. According to the FDA, people should not take duloxetine if they have uncontrolled narrow-angle glaucoma, have serious liver or kidney disease (e.g., diabetic nephropathy), are taking monoamine oxidase inhibitors (a class of antidepressants) or are taking triptans (migraine drugs).

Other medications sometimes recommended by physicians to ease the pain of diabetic neuropathy include other anticonvulsants, other opioids (narcotic painkillers), local anesthetics such as lidocaine and anti–inflammatories such as aspirin.

Analgesic creams, such as those containing capsaicin, may be rubbed on the skin to reduce pain in a muscle or joint. These creams contain ingredients that can produce a hot, cold or numbing sensation to calm the nerve endings and lower discomfort. Research has suggested that supplements of an antioxidant called alpha lipoic acid and an amino acid derivative called carnitine may ease diabetic nerve pain.

Researchers are conducting clinical trials of several medications that may one day be available to treat diabetic neuropathy or its complications, such as foot ulcers. Several studies have suggested that an investigational class of drugs called aldose reductase inhibitors may reduce diabetic nerve damage.

Treatment for other symptoms of neuropathy may include:

• Medications for any infections, digestive or blood pressure problems
  
  
• Medications or other treatments for sexual dysfunction
  
  
• Continence training, biofeedback, medications or other treatments for bladder or bowel problems, such as overactive bladder
  
  
• Physical therapy
  
  
• Adaptive equipment to help with motor or sensory problems
  
  
• Splints or braces for conditions such as carpal tunnel syndrome or Charcot foot
  
  
• Nutritional supplements
  
  
• Psychological counseling for emotional difficulties

If noninvasive treatments fail, surgery may be recommended in some cases, such as nerve decompression for peripheral neuropathy or foot surgery for Charcot arthropathy.

Patients may also wish to ask their physician about electronic light energy units, such as monochromatic infrared energy (MIRE), that can be used in clinics or at home. Studies into the effectiveness of such treatments for diabetic neuropathy have produced mixed results.

Neuropathy can be a serious complication in diabetes, leading to pain, weakness and failure with body systems. It is important for all patients with diabetes to prevent complications and to continue to have their neuropathy monitored by medical professionals.

Gene therapy might one day lead to prevention or a cure. Clinical trials are investigating whether manipulating genes may prevent, halt or reverse diabetic neuropathy.