Diabetes Health Center

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Autonomic neuropathy-which affects nerves that regulate internal functions-can affect digestion, urination, sweating, sexual function, blood pressure, and other involuntary body functions. Some symptoms of autonomic neuropathy can be hard to manage, but others respond well to treatment:

• Mild constipation. Eating small, frequent meals that are high in fiber and low in fat may help.
• Frequent diarrhea. Eating foods that are high in fiber may help. You may need medicines that slow the rate at which digested food and waste travel through the intestines, or you may need antibiotics such as tetracycline, amoxicillin, or metronidazole.
• Mild gastroparesis. This is a condition that causes the stomach to empty very slowly. It may get better if you eat small, frequent meals that are low in fiber and fat. Medicines that help the stomach empty more quickly may also be needed. Controlling blood sugar levels may reduce symptoms of gastroparesis.
• Abnormal sweating. If you sweat a lot, try to avoid intense heat and humidity. If you sweat severely while eating certain foods, anticholinergic medicines may help. But these medicines have side effects that may sometimes be more troublesome than the abnormal sweating. Botulinum toxin (Botox) injections may also help.⁵ If you don't sweat enough, you can use moisturizers to help with dry or cracked skin. Drinking more water can prevent overheating. Try to avoid places that are very hot or very cold.
• Lack of awareness of low blood sugar level. This is also called hypoglycemia unawareness. You can adjust your insulin and allow your blood sugar levels to be a little bit higher than the target range. Usually it is recommended that you keep your A1c in a target range.
• Urinary problems. Urinary problems can be treated with antibiotics for urinary tract infections and medicines to improve bladder control.
• Sexual problems. Your doctor may suggest using medicines or devices to improve erections. Or you may need nonprescription lubricants and estrogen creams for vaginal dryness. For more information, see sexual problems.
• Blood pressure problems. Blood pressure problems can be treated with medicines and by wearing support stockings (also called compression stockings).

Ongoing treatment

Ongoing treatment for diabetic neuropathy includes making sure your blood sugar levels stay tightly controlled within a narrow target range. You also need to practice wise health habits such as seeing your doctor regularly, controlling your blood pressure, getting regular exercise, limiting or avoiding alcohol, and not smoking. Also, take good care of your feet so that foot sores and other foot problems do not develop. For more information, see:

Diabetes: Taking Care of Your Feet.

Other treatment is tailored to your specific symptoms and the type of diabetic neuropathy that you have.

Many people who have peripheral neuropathy-which affects nerves that supply sensation and touch-have mild to severe pain in specific parts of their bodies. Treatment can reduce pain and improve physical functioning, mood, and mental well-being and may include:

• Medicines such as nonprescription pain relievers or creams to relieve pain. The most common medicines used to treat symptoms of diabetic neuropathy include anticonvulsant drugs such as pregabalin and gabapentin, tricyclic antidepressants, and the antidepressant duloxetine hydrochloride.
• Complementary therapies such as acupuncture. Acupuncture has not been well studied as a treatment for diabetic neuropathy. But some studies show that it may help with pain.
• Physical therapy such as exercises, stretching, and massage. If you are told to use heat or ice, be careful. Neuropathy makes it hard for you to feel changes in temperature.
• Transcutaneous electrical nerve stimulation (TENS), which is a type of therapy that reduces pain by applying brief pulses of electricity to nerve endings in the skin.