Having diabetes puts patients at risk of developing several other health issues, including neuropathy. Diabetic neuropathy is characterized by nerve damage, as well as symptoms of numbness and tingling, which can progress over time into burning sharp pain that can significantly and negatively impact a person’s quality of life. (5)
What is diabetic neuropathy?
People with diabetes often have difficulty controlling blood sugar levels. Over time, uncontrolled blood sugar or high blood sugar can lead to nerve damage directly and indirectly by impeding the small blood vessels that deliver oxygen and nutrients to nerves. When nerves are deprived of the oxygen and nutrients they need, they become damaged, which causes nerve pain and weakness. (13)
- Peripheral neuropathy, which is the most common form and affects nerves in the feet, legs, hands, and arms.
- Proximal neuropathy, which affects muscles in the upper legs, buttocks, and hips.
- Autonomic neuropathy, which can affect a wide range of body systems and functions including digestive, cardiovascular, lungs, eyesight, and others.
- Focal neuropathy, which develops suddenly and affects one specific nerve, most commonly in the hands, head, torso, and legs. (13)
Approximately 50% of people with diabetes develop peripheral neuropathy and about 30% will be diagnosed with autonomic neuropathy. (9) The most common form of focal neuropathy involves the nerve going to the wrist, which causes carpal tunnel syndrome in about 10% of people with diabetes. (13)
Diabetic neuropathy symptoms and complications
Symptoms of peripheral neuropathy vary dramatically among patients but can be described as stabbing, stinging, burning pain, and weakness with a paradoxical simultaneous numbness and intense sensitivity. (5)
Once diabetic neuropathy takes hold, it can be extremely debilitating. For example, patients with distal symmetric polyneuropathy (DSP), the most common form of peripheral neuropathy, have a 15-fold increase in the likelihood of a lower extremity amputation, a life-changing complication that can have both physical and mental quality of life ramifications. (5) In addition, patients with DSP can have significant balance problems and are two to three times more likely to fall than diabetes patients who do not have neuropathy. (2)
This makes proactive prevention and nerve protection even more paramount.
Diabetic neuropathy treatment
The best way to treat diabetic neuropathy is by controlling blood sugar. In addition, individuals with diabetes should follow these self-care strategies to reduce the risk of developing neuropathy and prevent it from progressing: (13)
- Avoid smoking.
- Eat a healthy whole foods, unprocessed diet specifically for diabetes. Eliminate or reduce alcohol consumption.
- Engage in regular physical activity.
- Focus on foot care, checking for problems every day. If issues arise, individuals should visit their healthcare providers immediately.
- Take medications as directed.
Presently there is no sure-fire way to reverse diabetic neuropathy. However, there are many ways to manage symptoms and slow its progression. In some cases, anecdotally, reversal may be achieved using a comprehensive approach that includes diet, lifestyle, and dietary supplements. A prescription medication may also be necessary. (5)
From a conventional standpoint, pregabalin (Lyrica) is often prescribed to treat diabetic neuropathy pain. In addition to pregabalin, the American Academy of Neurology also recommends topical capsaicin cream for pain. (4)
An integrative approach to diabetic neuropathic may also include supplemental nutrients, aromatherapy, and acupuncture.
Supplements for diabetic neuropathy
Nerves are like any other tissue in the human body; they require adequate nutrition to function properly and reduce the risk of damage. When it comes to supporting nerve health and getting some nerve pain relief, the nutrients outlined below may help.
Alpha-lipoic acid is an antioxidant that can decrease lipid peroxidation, reduce oxidative stress, and improve nerve blood flow. (14) In one study, patients with painful diabetic neuropathy who took 600 mg of alpha-lipoic acid for a period of 40 days reported reduced pain and enhanced overall quality of life. (1)
Vitamin B12 deficiency can damage the protective coating of nerves, known as the myelin sheath. Vitamin B12 supplementation may be beneficial in these cases, particularly in patients taking the pharmaceutical medication metformin, as this drug has been shown to deplete vitamin B12. Research has demonstrated a direct correlation between metformin-induced low B12 levels and increased diabetic nerve pain. (3) Based on the results of a 2018 cross sectional study, the researchers recommend B12 supplementation for patients taking metformin to help reduce the risk of neuropathy, as well as metformin-induced anemia. (17)
Similar to alpha-lipoic acid, vitamin E is an antioxidant and free radical scavenger. In addition to directly detoxifying free radicals, vitamin E also is involved in the recycling process that creates reduced forms of antioxidant vitamins and nutrients, including the regeneration of reduced glutathione. (14) A 2014 randomized controlled trial featuring 92 patients with diabetic neuropathy demonstrated that vitamin E supplementation administered over 12 weeks significantly reduced pain scores when compared to the control group. (15)
N-acetylcysteine (NAC) is another potent antioxidant. By reducing oxidative stress, animal studies have shown that NAC can help protect from nerve damage and alleviate pain. (10) A 2019 placebo-controlled clinical trial examined the effects of NAC when taken concomitantly with the pharmaceutical medication pregabalin. The study found that the NAC combination was more effective at reducing diabetic nerve pain compared to placebo. (8)
Disclaimer: The U.S. Food and Drug Administration (FDA) recently adopted a position prohibiting supplement manufacturers from marketing N-acetyl-L-cysteine (NAC) products as dietary supplements. At this time, all NAC products will remain available through the Fullscript catalog. Fullscript will be closely following the Council for Responsible Nutrition (CRN) and the FDA for guidance and will not be removing NAC from the catalog until it is mandated. Fullscript’s quality team is continuing to monitor this situation, and should any changes occur, Fullscript will promptly notify practitioners.
The bright yellow compound found in turmeric, known as curcumin, has been shown to positively influence health on many levels, so it’s not surprising that it may also benefit diabetic neuropathy. Animal studies show that curcumin can relieve diabetic nerve pain via various mechanisms, including its anti-inflammatory effects as it has been shown to downregulate proinflammatory markers associated with neuropathic pain. (12) Further studies are needed to confirm the benefits of curcumin for diabetic neuropathy in humans.
Omega-3 fatty acids
Omega-3 fatty acids, primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are critical to a broad range of body systems including the nervous system. A one-year pilot study featuring 40 type 2 diabetic patients with some degree of neuropathy showed that omega-3 fatty acids helped prevent nerve damage progression. (11) This is consistent with previous animal studies that demonstrated omega-3 fatty acids were protective against diabetic neuropathy by helping to preserve nerve structure and function. (16)
Essential oils for diabetic neuropathy
In addition to targeted nutrients, aromatherapy massage may be beneficial in alleviating pain. In a 2017 randomized controlled trial, aromatherapy massage with essential oils led to a significant reduction in neuropathic pain scores and a significant improvement in quality of life in patients with painful diabetic neuropathy. (7)
Acupuncture for diabetic neuropathy
Acupuncture has also been identified as a possible treatment for neuropathy. According to a 2017 systematic review and meta-analysis, acupuncture may be beneficial in the treatment of diabetic neuropathy as it has been shown to improve nerve conduction to help alleviate pain. However, the researchers concluded that more well-designed, larger trials are needed to confirm definitive benefits for the various types of neuropathy. (6)
The bottom line
When it comes to diabetic neuropathy, prevention is key. To avoid serious diabetic neuropathy complications, the best strategy is to employ a comprehensive approach that includes diet, lifestyle, specific dietary supplements, and prescription medications when necessary.
- Agathos, E., Tentolouris, A., Eleftheriadou, I., Katsaouni, P., Nemtzas, I., Petrou, A., Papanikolaou, C., & Tentolouris, N. (2018). Effect of α-lipoic acid on symptoms and quality of life in patients with painful diabetic neuropathy. The Journal of international medical research, 46(5), 1779–1790. https://doi.org/10.1177/0300060518756540
- Agrawal, Y., Carey, J. P., Della Santina, C. C., Schubert, M. C., Minor, L. B. (2010). Diabetes, vestibular dysfunction, and falls: analyses from the National Health and Nutrition Examination Survey. Otol Neurotol. 31(9):1445-50. https://www.ncbi.nlm.nih.gov/pubmed/20856157
- Alvarez, M., Sierra, O. R., Saavedra, G., & Moreno, S. (2019). Vitamin B12 deficiency and diabetic neuropathy in patients taking metformin: a cross-sectional study. Endocrine connections, 8(10), 1324–1329. https://doi.org/10.1530/EC-19-0382
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- Callaghan, B. C., Cheng, H. T., Stables, C. L., Smith, A. L., & Feldman, E. L. (2012). Diabetic neuropathy: clinical manifestations and current treatments. The Lancet. Neurology, 11(6), 521–534. https://doi.org/10.1016/S1474-4422(12)70065-0
- Dimitrova, A., Murchison, C., & Oken, B. (2017). Acupuncture for the Treatment of Peripheral Neuropathy: A Systematic Review and Meta-Analysis. Journal of alternative and complementary medicine, 23(3), 164–179. https://doi.org/10.1089/acm.2016.0155
- Gok Metin, Z., Arikan Donmez, A., Izgu, N., Ozdemir, L., Arslan, I. E. (2017) Aromatherapy massage for neuropathic pain and quality of life in diabetic patients. J Nurs Scholarsh, 49(4):379-388. https://www.ncbi.nlm.nih.gov/pubmed/28605119
- Heidari, N., Sajedi, F., Mohammadi, Y., Mirjalili, M., & Mehrpooya, M. (2019). Ameliorative Effects Of N-Acetylcysteine As Adjunct Therapy On Symptoms Of Painful Diabetic Neuropathy. Journal of pain research, 12, 3147–3159. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875491/
- Izenberg, A., Perkins, B. A., Bril, V. (2015). Diabetic neuropathies. Semin Neurol, 35(4):424030. https://www.ncbi.nlm.nih.gov/pubmed/26502765
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- Li, Y., Zhang, Y., Liu, D. B., Liu, H. Y., Hou, W. G., & Dong, Y. S. (2013). Curcumin attenuates diabetic neuropathic pain by downregulating TNF-α in a rat model. International journal of medical sciences, 10(4), 377–381. https://doi.org/10.7150/ijms.5224
- National Institute of Diabetes and Digestive and Kidney Diseases. (2018, February). What is diabetic neuropathy. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/what-is-diabetic-neuropathy
- Oyenihi, A. B., Ayeleso, A. O., Mukwevho, E., & Masola, B. (2015). Antioxidant strategies in the management of diabetic neuropathy. BioMed Research International, 2015. https://www.hindawi.com/journals/bmri/2015/515042/
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- Zalaket, J., Wehbe, T., & Jaoude, E. A. (2018). Vitamin B12 deficiency in diabetic subjects taking metformin: a cross sectional study in a Lebanese cohort. Journal of Nutrition & Intermediary Metabolism, 11, 9-13. https://www.sciencedirect.com/science/article/pii/S2352385917302657