Diabetic Neuropathy: What Is It And Can It Be Reversed?

What is Diabetic Neuropathy?

Diabetic neuropathy is the medical term for nerve damage caused by diabetes. People with type 1 diabetes, type 2 diabetes, and gestational diabetes can develop diabetic neuropathy, which most often progresses over several years. 

Neuropathy is one of the most common diabetes complications. It occurs due to high blood glucose (sugar) levels in the blood, which leads to nerve damage. People with long-standing diabetes are at a higher risk of developing diabetic neuropathy, especially if it’s not well-managed. Managing diabetes by taking medications as prescribed and maintaining a healthy lifestyle can prevent nerve damage, slow its progression, and reduce the risk of other complications.

Can Neuropathy Be Reversed?

 Unfortunately, it is not clear whether neuropathy can be reversed or completely cured. While injured nerve cells usually do not regenerate, it is possible to reverse neuropathy if treatment begins early enough. Additionally, if diabetes is well-managed, the symptoms of diabetic neuropathy can be controlled to prevent further deterioration.

Early diagnosis and treatment of diabetes can prevent further complications such as nerve damage and organ damage. In other words, diligent diabetes management can lower the risk of developing neuropathy and prevent diabetic neuropathy from getting worse.

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Types of Diabetic Neuropathy

Diabetes can cause damage to nerves throughout the body, including:

• Peripheral neuropathy or nerve damage in the feet, legs, hands, and arms. This is the most common type of diabetic neuropathy.

• Autonomic neuropathy or damage to nerves that control the autonomic nervous system, such as heart rate, blood pressure, vision, digestive system, urinary bladder, sex organs, and sweat glands.

• Focal neuropathy or damage to a single nerve frequently involves nerves in the hands, legs, head, or trunk.

• Proximal neuropathy or nerve damage in the thigh, hip, or buttock, usually on one side. This is rare but can be disabling due to severe pain and weight loss.

Peripheral Neuropathy Symptoms

• Pain (this is typically a burning, stabbing, or shooting pain)

• Paresthesia (numbness, tingling, pins and needles sensations)

• Dysesthesia (abnormal sensations)

• Slow-healing wounds such as a foot ulcer or sore

• Muscle weakness, muscle twitching, muscle cramps

• Loss of sensation in the feet or other parts of the body (for example, not feeling any pain signals from ulcers or injuries)

• Changes in hair, skin, and nails

Other neuropathy symptoms may include:

• Loss of balance 

• Heat intolerance and excessive sweating

• Loss of bladder control, leading to urinary incontinence or urinary tract infections

• Lightheadedness, dizziness, or fainting due to damage to nerves that control blood pressure

• Digestive system effects like diarrhea, constipation, fecal incontinence, or a complication such as gastroparesis

• Problems with eating or swallowing

• Sexual dysfunction (erectile dysfunction) due to damage to small blood vessels and nerves in the sexual organs, which can affect blood flow

• Serious, even life-threatening symptoms, for example, difficulty breathing or irregular heart rhythms

Risk Factors For Diabetic Neuropathy 

Diabetes is the most common cause of peripheral neuropathy. Experts estimate that 30 million Americans have peripheral neuropathy or diabetic polyneuropathy. About 1 in 4 people with diabetes will develop peripheral neuropathy. Additional risk factors for diabetic neuropathy include: 

• Age over 40

• Obesity or excess weight

• Smoking

• Excessive alcohol use

• Hypertension (high blood pressure)

• Hypercholesterolemia (high cholesterol)

• Kidney disease

Other Causes of Neuropathy

Other medical conditions that can cause peripheral nerve damage include:

• Physical damage to nerves, for example, from surgery or injuries. 

• Autoimmune diseases like rheumatoid arthritis, lupus, Sjogren’s syndrome, and celiac disease.

• Infectious diseases like Lyme disease, shingles, botulism, diphtheria, and HIV.

• Alcohol use disorder.

• Vitamin deficiencies, such as vitamin B12 deficiency.

• Hypothyroidism (underactive thyroid gland).

• Vasculitis (inflammation of the blood vessels).

• Chronic liver disease.

• Chronic kidney disease.

• Monoclonal gammopathy of undetermined significance (MGUS).

• Certain cancers, such as lymphoma, multiple myeloma, or bone marrow cancers. 

• Charcot-Marie-Tooth disease and other hereditary neuropathies (genetic conditions that cause nerve damage).

• Guillain-Barré syndrome: a rare neurological disorder in which the body’s immune system attacks the peripheral nerves, causing paralysis.

• Amyloidosis: a group of rare disorders in which an abnormal protein called amyloid gets deposited in tissues throughout the body. 

Nerve Damage from Medication Side Effects

Certain medications can cause peripheral neuropathy as a side effect. For example:

• Chemotherapy drugs.

• Colchicine (used to treat gout).

• Long-term use of certain antibiotics, such as nitrofurantoin and metronidazole. 

• Antiepileptic drugs like phenytoin. 

• Antiarrhythmics like amiodarone.

• Thalidomide (used to treat multiple myeloma).

• Pyridoxine (Vitamin B6)

Is Neuropathy Reversible?

While injured nerve cells usually do not regenerate, it is possible to reverse neuropathy if treatment begins early enough. Additionally, there are many things you can do to prevent further damage. Managing diabetes and keeping blood glucose levels in check is the most important thing you can do to prevent further nerve damage. There are also effective treatments available to manage symptoms of painful diabetic neuropathy.

First-Line Treatment Options

Lifestyle Changes 

The first-line treatment option for diabetic neuropathy is better glycemic control (blood glucose control). This involves lifestyle changes such as: 

• Eating a healthy diet.

• Getting regular exercise.

• Maintaining a healthy weight.

• Stopping smoking. 

• Avoiding or limiting alcohol use.

Diabetes Management

Proper treatment of diabetes complications like peripheral neuropathy requires medication adherence (taking your diabetes medications as prescribed). This is important to slow progression and prevent further nerve damage. 

Your healthcare provider may recommend working with diabetes specialists such as a certified diabetes care and education specialist (CDCES) to manage high blood sugar levels and prevent complications. 

Medications for Diabetic Peripheral Neuropathy

Medications that can provide pain relief from nerve pain related to diabetes include:

• Pregabalin (Lyrica)

• Gabapentin (Neurontin)

• Antidepressants such as duloxetine (Cymbalta), venlafaxine (Effexor), and Amitriptyline (Elavil)

• Capsaicin patches

Other Treatments for Diabetic Neuropathy

Depending on the severity of your neuropathy and specific issues, your healthcare provider may recommend other therapies to improve nerve function and quality of life, such as:

• Physical therapy if you have muscle weakness.

• Occupational therapy to improve your ability to perform everyday tasks.

• Speech therapy if neuropathy affects nerves involved in swallowing or speaking.

• Complementary therapies like acupuncture.

• Nutrition consultation to help with healthy eating.

Experimental and Advanced Treatments

When standard treatments for peripheral neuropathy do not work, doctors sometimes offer advanced treatments such as:

• Transcutaneous electrical nerve stimulation (TENS), which uses tiny electrical impulses to block pain signals or change pain perception.

• Peripheral nerve blocks and injections of local anesthetics, corticosteroids, or opioids to reduce pain.

• Implantation of a spinal cord stimulator, a device that sends low-level electrical impulses to the spinal cord to relieve pain.

Managing Diabetic Neuropathy

Natural Pain Management Strategies

Some non-drug methods of managing diabetic neuropathy pain include:

• Heat or cold application. Use ice packs or heat packs for joint or muscle tissue issues. 

• Do gentle exercise, such as walking or swimming. 

• Spend time in nature and with loved ones. 

• Massage can help with relaxation and pain reduction. 

• Stress management with techniques like meditation, yoga, and deep breathing can help reduce pain. 

• Cognitive behavioral therapy (CBT) can help you learn to change how you think about pain. 

Nutrition and Exercise Interventions

The following measures can help to prevent further nerve damage and control pain from diabetic neuropathy:

• Make healthy food choices, such as fruits, vegetables, whole grains, lean proteins, and low-fat dairy. 

• Get moving. Aim for 150 minutes of moderate-intensity aerobic exercise each week and at least two days of strength training. Talk to your healthcare provider before starting any new exercise program. If you have decreased sensation in your feet due to nerve damage, work with a physical therapist to learn safe ways to exercise.

• Quit smoking. Tobacco use is linked to poor circulation and problems with wound healing. 

Regular Medical Screenings

Regular medical check-ups and screenings are essential for early diagnosis and interventions for diabetes and its complications. Experts at the National Institute of Diabetes and Digestive and Kidney Diseases recommend getting tested for diabetes if you have risk factors. The American Diabetes Association has a Risk Test you can take.

Prevention and Progression

Tips To Prevent Neuropathy Onset

The best way to prevent the onset of diabetes-related neuropathy is to prevent diabetes. The lifestyle changes mentioned above (healthy diet, exercise, quitting smoking) can lower your risk of diabetes.

Strategies To Stop Progression

If you have been diagnosed with diabetes, the best way to stop progression or further nerve damage is to keep your blood glucose levels under control. Experts at the Mayo Clinic recommend the following target range:

• Blood glucose between 80 and 120 milligrams per deciliter (mg/dL) before meals for people 59 years of age and younger and no other health conditions.

• Blood glucose between 100 and 140 mg/dL before meals for people 60 years of age and older or those with other medical conditions such as heart disease, lung problems, or kidney disease.

• Keeping your blood pressure within range (below 140/90 mmHg or within the target range determined by your doctor).

• Maintaining a healthful lifestyle with a well-balanced diet and consistent physical activity to stay at a healthy weight. 

• Avoiding smoking 

• Avoiding alcohol or sticking to minimal to moderate alcohol consumption 

FAQs on Diabetic Nerve Damage

What Is The Best Treatment For Diabetic Nerve Damage?

The best treatment for diabetic nerve damage is managing diabetes to keep blood glucose levels under control, which will lead to a reduction in neuropathy symptoms and prevent further damage.

At What A1c Does Neuropathy Start?

Studies have found that, on average, people with type 2 diabetes mellitus are at an increased risk of diabetes-related neuropathy after having an A1C of over 7% for three years or longer. 

How To Repair Nerve Damage Caused By Diabetes?

Nerve damage caused by diabetes cannot be repaired, and it is not usually reversible. However, you can prevent further damage to your nerves by following your doctor’s diabetes treatment plan and keeping blood glucose under good control.

What Is The First Line Treatment For Diabetic Neuropathy?

The first-line treatment for diabetic neuropathy is managing diabetes with lifestyle changes and/or diabetes medications. In addition, doctors can prescribe medications to manage neuropathic (nerve) pain, such as antidepressant drugs or anticonvulsants.

Does Diabetic Neuropathy Ever Go Away?

While injured nerve cells usually do not regenerate, it is possible to reverse neuropathy if treatment begins early enough. In other words, even though diabetic neuropathy may not completely go away, early intervention is crucial to prevent the development of nerve damage. Additionally, neuropathy symptoms can be managed by controlling your diabetes. Pain can be managed through medications and complementary therapies.

What Is The Life Expectancy of a Diabetic With Neuropathy?

The life expectancy of a diabetic with neuropathy depends on many factors, including the type and severity of neuropathy, the presence of other diabetes-related complications, age, and overall health status. 

The life expectancy of someone with diabetic neuropathy can vary significantly, and it is best to consult your healthcare providers for insights specific to your situation. 

While diabetes and related neuropathy are serious conditions, they can be effectively managed through medications, lifestyle changes, and complementary therapies such as meditation, acupuncture, art, and music therapy. 

Improving your overall health not only helps to reduce the risk of complications from diabetes but also enhances your general well-being. It is important to approach the treatment of diabetes and its related complications in a holistic manner, and your care team can give you support and resources to best manage your condition.

How To Stop Diabetic Neuropathy From Progressing?

The best way to stop diabetic neuropathy from progressing is to keep your blood sugar levels in the target range.

Has Anyone Reversed Diabetic Neuropathy?

There are no reports of anyone having reversed diabetic neuropathy with nerve regeneration. But while you cannot reverse neuropathy, there are ways diabetic patients can prevent the nerve damage from progressing. The damage to small blood vessels and nerves occurs from excess sugars in the blood of people with a medical history of diabetes. Keeping blood sugar under control is, therefore, the best way to slow the progression of diabetic neuropathy.

Read next: Is Type 2 Diabetes Reversible?