Diabetic Neuropathy - Ask The Pharmacist

Dec 24, 2014
The specialist pharmacists in the Express Scripts Diabetes Therapeutic Resource Center® counsel patients on managing diabetes and neuropathy resulting from the disease.
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  • Diabetes

Nearly half of all patients with diabetes suffer from near-debilitating pain in their extremities – hands and feet. The pain is a symptom of diabetic peripheral neuropathy (DPN).

Diabetes is one of the most common causes of nerve damage and can affect the nerves that control movement and sensations in arms and legs, as well as those nerves that regulate heart rate, digestion, blood glucose, perspiration and sexual function. It can, in fact, affect any nerve in the body, irreparably decreasing, altering or destroying its function.

The specialist pharmacists in the Express Scripts Diabetes Therapeutic Resource Center® counsel patients on managing diabetes and neuropathy resulting from the disease.

Risk Factors for DPN

DPN is the most common form of diabetic neuropathy and is more common in patients with certain risk factors or coexisting conditions including:

  • Smoking
  • Excessive alcohol consumption
  • High cholesterol
  • High blood pressure
  • Peripheral vascular disease

However, the most important risk factor seems to be total hyperglycemic exposure. This means that diabetes patients with the longest history of poor glycemic control, including older patients or those with a long duration of diabetes, are most likely to suffer from this possibly devastating quality of life issue.

Early Screening

It is recommended that all patients be screened for diabetic neuropathy starting at diagnosis of Type 2 diabetes and five years after diagnosis of Type 1 diabetes. Patients should be retested annually.

Early recognition and appropriate management of neuropathy in patients with diabetes is important because a number of treatment options are available that can help significantly improve quality of life. In addition, as many as half of all diabetes patients with DPN may have no symptoms of neuropathy, putting them at risk for injuries resulting from loss of pain or pressure sensations. This is especially true for the feet of patients with diabetes in whom trauma may cause skin breakdown, ulceration and infection that could lead to amputation and even death.

Identifying at-risk patients as early as possible and providing education about the need for daily foot inspection and regular self-care can dramatically reduce the risk of debilitating complications. Comprehensive foot-care programs have been shown to reduce amputations by as much as 45% to 85%.

Treating DPN

There are no specific treatments currently available that can effectively reverse nerve damage. However, it is possible to both reduce painful symptoms and slow the progression of diabetic neuropathy. This requires a two-pronged approach: symptom relief and therapy to slow the progression of neuropathy. Tight and stable blood glucose control is the most important as it has been shown to decrease both the progression of neuropathy as well as painful symptoms. However, if patients have poor control of their blood sugar, and then quickly normalize their blood-glucose levels, the painful symptoms may actually worsen for a few days before they improve.

Medication Options

Medications can help relieve diabetic nerve pain. Commonly used oral medications include amitriptyline, imipramine, lamotrigine, gabapentin, pregabalin and duloxetine. Some of the medications used to treat diabetic neuropathy are classified by the U.S. Food and Drug Administration as antidepressants or anticonvulsants. While these medications can help relieve symptoms, their use can pose challenges depending on coexisting conditions. Patients should consult with their physician or specialist pharmacist.

Patients often experience worse pain from diabetic neuropathy in the evenings. These medications can help reduce the pain, as well as provide a mild sedative effect further enabling the patient to fall asleep.

Topical medications, such as capsaicin and lidocaine, also can help with managing diabetic neuropathy-related pain.

Lidocaine is an anesthetic available as a patch that may be worn for 12 hours at a time, numbing the area to which it is applied.

Capsaicin is derived from chili peppers and is available in cream form. When routinely applied, three to four times a day, it depletes pain transmitters in nerve endings, thereby decreasing painful sensations. Since capsaicin can irritate the eyes and mucous membranes, application is best done while wearing disposable gloves.

Studies suggest that alpha-lipoic acid, an over-the-counter antioxidant, may help relieve painful symptoms and possibly improve nerve function.

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