Many patients with diabetes develop numbness, tingling, pain, or weakness in their hands or feet, a condition called diabetic neuropathy. Diabetic neuropathy refers to symptoms and signs of neuropathy, or nerve damage, as a result of diabetes. There are many other reasons for nerves to be damaged or harmed. An important clue that often distinguishes diabetic neuropathy from other forms of neuropathy is that the nerve damage is symmetrical. This means the nerve damage is similar on both sides, for instance, both feet.  If the nerve of only one side of the foot or arm is damaged, then the neuropathy is likely to be from another source, such as a nerve entrapment.

While good control of blood sugar levels is known to lower the risk of diabetic neuropathy, new research suggests that there are other measures diabetes patients can take. In particular, by maintaining a healthy weight, quitting smoking, and receiving treatment for high blood pressure, those with diabetes may reduce the risk of diabetic neuropathy.

Natural Diabetic Neuropathy treatment
Pharmaceutical medications for the treatment of diabetic neuropathy don't seem to offer a cure for the condition. There are certain supplements that may play a role in reducing the risk or severity of diabetic neuropathy and provide an alternative diabetic neuropathy treatment. There's still much to be learned about the effectiveness of these supplements in terms of diabetic neuropathy treatment, and if they do work, what dosages are ideal. In the meantime, if you have diabetes or diabetic neuropathy, you may discuss with your doctor following a healthy diet, and perhaps the following herbal and nutritional options. For diabetic neuropathy, alpha lipoic acid is a crucial nutrient.
   If your doctor decides to use more than one supplement at a time, use lower dosages since combining them can cause side effects such as overstimulation and insomnia. In fact, try one supplement at a time for a week to become familiar with it before combining it with another supplement.

Alpha Lipoic Acid is one if the most important nutrients to consider for diabetes. Alpha Lipoic acid has been evaluated for blood sugar control, and it may also be considered in diabetic neuropathy and kidney disease. A dose of 20 to 50 mg daily appears to be appropriate and a cautious way to begin treatment. Alpha lipoic acid is more effective when treatment is started early before the diabetic neuropathy has progressed to a late stage. You can buy an Alpha-Lipoic acid supplement online.

Acetyl-L-carnitine is helpful in the treatment of diabetic neuropathy. An acetyl l-carnitine dose of 100 to 300 mg a few times a week may be tried. Higher doses can cause overstimulation. Occasionally carnitine may also be tried. You can buy an Acetyl-l-Carnitine supplement online.

Benfotiamine has been evaluated in diabetic neuropathy with positive results.

B vitamins could be helpful, perhaps combined with gabapentin (Neurotin).

Ginkgo Biloba - Dr. Susanne Koeppen, from the University of Essen in Germany, and colleagues randomly assigned 60 diabetic patients with neuropathy to ginkgo biloba extract, folate, both agents, or placebo. All three active treatments were superior to placebo, with the best effect seen with the combination of folate and ginkgo biloba extract.

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Diet and Diabetic Neuropathy
In patients with impaired glucose tolerance-related neuropathy, diet and exercise counseling leads to cutaneous reinnervation and improved pain response.

Alpha lipoic acid and diabetic neuropathy
Alpha-lipoic acid may improve symptomatic diabetic polyneuropathy.
Neurologist. 2007 May;13(3):164-7. Tang J, Wingerchuk DM, Crum BA, Rubin DI, Demaerschalk BM. Department of Neurology, Mayo Clinic Rochester, Rochester, MN, USA.
Oral alpha lipoic acid may improve neuropathic symptoms in diabetic distal symmetric polyneuropathy. A single modestly valid RCT demonstrated that 600 mg was an effective and well-tolerated dose.
   Comments: For long term use, I think a much lower dose is appropriate, perhaps 100 mg of alpha lipoic acid or 50 mg or R lipoic acid.

Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial.
Diabetes Care. 2006 Nov;29(11):2365-70. FRCPE, Deutsche Diabetes-Klinik, Deutsches Diabetes-Zentrum, Leibniz-Institut an der Heinrich-Heine-Universitat, Auf'm Hennekamp 65, 40225 Dusseldorf, Germany.
The aim of this trial was to evaluate the effects of alpha lipoic acid (ALA) on positive sensory symptoms and neuropathic deficits in diabetic patients with distal symmetric polyneuropathy (DSP). In this multicenter, randomized, double-blind, placebo-controlled trial, 181 diabetic patients in Russia and Israel received once-daily oral doses of 600 mg (n = 45) (ALA600), 1,200 mg (n = 47) (ALA1200), and 1,800 mg (ALA1800) of ALA (n = 46) or placebo (n = 43) for 5 weeks after a 1-week placebo run-in period. The primary outcome measure was the change from baseline of the Total Symptom Score (TSS), including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet. Secondary end points included individual symptoms of TSS, Neuropathy Symptoms and Change (NSC) score, Neuropathy Impairment Score (NIS), and patients' global assessment of efficacy. RESULTS: Mean TSS did not differ significantly at baseline among the treatment groups and on average decreased by 4.9 points (51%) in ALA 600, 4.5 (48%) in ALA 1200, and 4.7 (52%) in ALA 1800 compared with 2.9 points (32%) in the placebo group. The corresponding response rates (>/=50% reduction in TSS) were 62, 50, 56, and 26%, respectively. Significant improvements favoring all three alpha lipoic acid groups were also noted for stabbing and burning pain, the NSC score, and the patients' global assessment of efficacy. The NIS was numerically reduced. Safety analysis showed a dose-dependent increase in nausea, vomiting, and vertigo. Conclucsion : Oral treatment with alpha lipoic acid for 5 weeks improved neuropathic symptoms and deficits in patients with DSP. An oral dose of 600 mg once daily appears to provide the optimum risk-to-benefit ratio.
   Dr. Sahelian comments: My preference would be to use 50 mg of R alpha lipoic acid rather than 600 mg. Too high a dose can cause side effects and insomnia, and perhaps heart palpitations. R lipoic acid at 50 mg is equivalent to 100 mg of regular lipoic acid.

Diabetic neuropathy, alpha lipoic acid or Gabapentin?
Switching from pathogenetic treatment with alpha-lipoic acid to gabapentin and other analgesics in painful diabetic neuropathy: a real-world study in outpatients.
J Diabetes Complications. 2008 Aprril Ruessmann HJ; on behalf of the German Society of out patient diabetes centres AND (Arbeitsgemeinschaft niedergelassener diabetologisch tätiger Ärzte e.V.). Heinz-Jürgen Ruessmann, President AND, Wilhelminenstr. 22, 46537 Dinslaken, Germany.
In this retrospective real-world study, we aimed to evaluate whether switching from the treatment option alpha-lipoic acid to drugs for symptomatic treatment of diabetic neuropathic pain such as gabapentin would be associated with changes in efficacy, safety, and cost-effectiveness. A cohort of 443 diabetic patients with chronic painful diabetic neuropathy were treated with alpha-lipoic acid 600 mg qd orally for a mean period of 5 years. After stopping this treatment, 293 patients were switched to gabapentin (600-2400 mg/day), while 150 patients remained untreated because of no acute symptoms. In the untreated group, 110 (73%) patients developed neuropathic symptoms as soon as 2 weeks after the end of treatment with alpha-lipoic acid. In the group started on gabapentin, 131 (45%) patients had to stop taking the drug due to intolerable side effects. Among the patients treated with gabapentin 132 (45%) were responders on an average dose of 1200 mg/day, whereas 161 (55%) were nonresponders at gabapentin doses up to 2400 mg/day. These patients required an alternative treatment which consisted of pregabalin, carbamazepine, amitriptyline, tramadol, or morphine as monotherapy or in combination. The daily costs for alpha-lipoic acid were considerably lower than those for gabapentin or several frequently used drug combinations. In conclusion, switching from long-term treatment with alpha-lipoic acid to central analgesic drugs such as gabapentin in painful diabetic neuropathy was associated with considerably higher rates of side effects, frequencies of outpatient visits, and daily costs of treatment.

Symptom of Diabetic Neuropathy
The symptoms of diabetic neuropathy are many. Some of the earliest symptoms include numbness and tingling in feet. Strangely, some people notice few or no symptoms, while others are significantly disabled. Symptoms of diabetic neuropathy are sometime mild in the beginning, and since the damage to nerves occurs over a period of several years, mild cases may go unnoticed for a long time. Additional diabetic neuropathy symptoms include abnormal sensations in the hands and feet, diarrhea, constipation, vertigo or dizziness, and impotence. Impotence occurs because the nerves supplying the penis become numb.

Types of Diabetic Neuropathy
Doctors classify diabetic neuropathy into four categories: peripheral, autonomic, focal, proximal, and peripheral since the nerve damage in each region causes different symptoms. 
     Autonomic neuropathy causes changes in digestion, bowel and bladder function, sexual response, and perspiration. It can also affect the nerves that serve the heart and control blood pressure. Autonomic neuropathy leads to gastrointestinal symptoms of diarrhea or constipation.
     Focal neuropathy is due to the sudden weakness of one nerve, or a group of nerves acting in a specific area, causing muscle weakness or pain. Any nerve in the body may be affected.
    Proximal neuropathy causes pain in the thighs, hips, or buttocks and leads to weakness in the legs. Contrast this with peripheral diabetic neuropathy which causes either pain or loss of feeling in the toes, feet, legs, hands, and arms. Peripheral diabetic neuropathy pain can be managed by pain medicines and other drugs.

Treatment of Diabetic Neuropathy pain
The traditional treatment for diabetic neuropathy pain is with analgesics, non-steroidal anti-inflammatory drugs such as ibuprofen or naproxyn, antidepressants, and anticonvulsants. The treatment of autonomic neuropathy is symptomatic. A new treatment for diabetic neuropathy is a drug called Lyrica.
     There are several conditions besides diabetes that can cause neuropathic pain. Neuropathic pain may be caused by abnormalities of structural lesions in the peripheral or central nervous system. Many common diseases, such as postherpetic neuralgia, trigeminal neuralgia, spinal cord injury, cancer, stroke, and degenerative neurological diseases may produce neuropathic pain.

Diabetic Neuropathy Medication or Drug
Treatment of peripheral diabetic neuropathic pain with medicine is evolving. Various drugs have been tried and recently gabapentin ( Neurontin ) and morphine combined have lead to better analgesia at lower doses of each drug than either as a single agent, with constipation, sedation, and dry mouth as the most frequent adverse effects.
     Pregabalin ( Lyrica, Pfizer ) is a GABA analog with similar structure and actions to gabapentin. It has antiepileptic, analgesic and anxiolytic activity. Pregabalin is indicated for the management of neuropathic pain associated with diabetic neuropathy and post-herpetic neuralgia.

Intensive Insulin Therapy for Diabetic Neuropathy
Several years after participating in a clinical trial of intensive diabetes therapy, patients assigned this treatment still showed improvements in neuropathy symptoms. The study involved 1,257 subjects who were enrolled in the Diabetes Control and Complications Trial who were randomly assigned to receive intensive or conventional diabetes therapy. The intensive approach involved at least three injections of insulin per day, while the conventional approach involved no more than two. After being followed for an average of 6.5 years, all of the subjects were encouraged to use the intensive therapy. The patients were then evaluated annually for neuropathy and other complications.The group initially assigned to receive intensive therapy had a lower prevalence of neuropathy than those who began with conventional therapy: 17 percent vs. 28 percent. Signs and symptoms of diabetic neuropathy were also less common in the first intensive therapy group, even though patients' blood sugar levels were comparable to those seen in the conventional therapy group. The relationship between blood sugar control and neuropathy suggests that intensive therapy has a durable effect on neuropathy similar, similar to what has previously been reported for diabetic retinopathy and diabetic nephropathy. Diabetes Care February 2006.

Other Causes for Neuropathy
Besides diabetes, neuropathies  may also occur due to the following reasons: autoimmune and inflammatory, toxic, neuropathies associated with plasma cell dyscrasias, and paraneoplastic neuropathies.

Diabetic Neuropathy Treatment Research Update
Acetyl-L-carnitine improves pain, nerve regeneration, and vibratory perception in patients with chronic diabetic neuropathy: an analysis of two randomized placebo-controlled trials.
Diabetes Care. 2005 Jan;28(1):89-94. Sima AA, Calvani M, Mehra M, Amato A; Acetyl-L-Carnitine Study Group. Department of Pathology, Wayne State University School of Medicine, Detroit, Michigan
We evaluated frozen databases from two 52-week randomized placebo-controlled clinical diabetic neuropathy trials testing two doses of acetyl-L-carnitine (ALC): 500 and 1,000 mg/day t.i.d. Intention-to-treat patients amounted to 1,257 or 93% of enrolled patients. Efficacy end points were sural nerve morphometry, nerve conduction velocities, vibration perception thresholds, clinical symptom scores, and a visual analogue scale for most bothersome symptom, most notably pain. The two studies were evaluated separately and combined. RESULTS: Data showed significant improvements in sural nerve fiber numbers and regenerating nerve fiber clusters. Nerve conduction velocities and amplitudes did not improve, whereas vibration perception improved in both studies. Pain as the most bothersome symptom showed significant improvement in one study and in the combined cohort taking 1,000 mg ALC. CONCLUSIONS: These studies demonstrate that ALC treatment is efficacious in alleviating symptoms, particularly pain, and improves nerve fiber regeneration and vibration perception in patients with established diabetic neuropathy and may provide an alternative diabetic neuropathy treatment.

Treatment of peripheral diabetic neuropathic pain with gabapentin alone or combined with vitamin B complex. preliminary results.
Proc West Pharmacol Soc. 2004;47:109-12.
Neuropathic pain is a syndrome that affects around 1% of population. This condition can be severely disabling and traditional analgesics are sometimes useless against this type of pain. Several adjuvants such as the anticonvulsive agent gabapentin - Neurontin - have been used to treat diabetic neuropathy with several degrees of effectiveness, but it is characterized of a high incidence of dizziness, somnolence and ataxia. Previously we have found a functional synergistic interaction after co-administration of gabapentin and B vitamins by using a neuropathic pain model in the rat. In order to evaluate the efficacy of gabapentin and B vitamins in the treatment of diabetic neuropathy in humans we carried out a comparative trial. In this study are presented preliminary results from 6 patients assigned to two groups: group A (n=3) received gabapentin, and group B (n=3) received gabapentin plus B vitamins. In both groups, the dose was increased at weekly intervals, and characteristics of pain and some parameters of quality of life were assessed. Both treatments significantly reduced pain and improved quality of life in the patients. Dizziness was the main adverse event observed in both groups. Data suggest that the combination of gabapentin and B vitamins could be an alternative treatment for diabetic neuropathic patients.

Acetyl-L-carnitine in the treatment of diabetic neuropathy. A long-term, randomized, double-blind, placebo-controlled study.
De Grandis D, Minardi C. Department of Neuroscience, Ospedale Civile, Rovigo, Italy.
Drugs R D. 2002;3(4):223-31.
To assess the efficacy and tolerability of acetylcarnitine versus placebo in the treatment of diabetic neuropathy, mainly by evaluating the effects of treatment on electrophysiological parameters and pain symptoms. This was a multicentre (n = 20), randomised, double-blind, placebo-controlled, parallel-group study. PATIENTS: 333 patients meeting clinical and/or neurophysiological criteria for diabetic neuropathy were enrolled. Patients were randomised to treatment with acetyl-L-carnitine or placebo. Acetylcarnitine (or placebo) was started intramuscularly at a dosage of 1000 mg/day for 10 days and continued orally at a dosage of 2000 mg/day for the remainder of the study (355 days). The main efficacy parameter was the effect of treatment on 6- and 12-month changes from baseline in nerve conduction velocity (NCV) and amplitude in the sensory (ulnar, sural and median) and motor (median, ulnar and peroneal) nerves. The effect of treatment on pain was also evaluated by means of a visual analogue scale (VAS). Among the 294 patients with impaired electrophysiological parameters at baseline, those treated with LAC showed a statistically significant improvement in mean NCV and amplitude compared with placebo. The greatest changes in NCV (at 12 months) were observed in the sensory sural nerve (7 m/sec in the acetylcarnitine group vs +1.0 m/sec in the placebo group), sensory ulnar nerve (+2.9 vs +0.1 m/sec, respectively) and motor peroneal nerve (+2.7 vs -0.2 m/sec), whereas the greatest changes in amplitude were recorded in the motor peroneal nerve (+2.2 vs +0.1 mV). After 12 months of treatment, mean VAS scores for pain were significantly reduced from baseline by 39% in acetylcarnitine-treated patients compared with 8% in placebo recipients. acetylcarnitine was well tolerated over the study period. Acetylcarnitine was effective and well tolerated in improving neurophysiological parameters and in reducing pain over a 1-year period. acetylcarnitine is, therefore, a promising treatment option in patients with diabetic neuropathy.

Diabetic Neuropathy Treatment emails
Q. Would lipoic acid be a good medication for painful non diabetic peripheral neuropathy?
     A. There have been a few studies that showed alpha lipoic acid to be helpful in diabetic peripheral neuropathy, but I have not come across studies evaluating alpha lipoic acid in non diabetic neuropathy.

Q. Could natural supplements offer a natural cure for diabetic neuropathy?
     A. It's hard to say. Perhaps if caught in the early stages, natural supplements, along with a strict diet and blood sugar control could reverse the condition and offer a diabetic neuropathy cure or healing, but there's still much to be learned.

Q. Why does diabetic neuropathy cause more problems in the foot as opposed to the hand?
     A. The answer is simple. The lower extremity is longer than the upper extremities, and hence nerves to the feet are longer since they need to reach from the spinal cord to the tip of the toe of the foot. When peripheral diabetic neuropathy occurs, the feet are the first to suffer the damage.

Q. I found your information on SAM-e quite interesting. I have been taking 200 mg of SAM-e twice daily for several months. I have found it to boost my energy level and diminishing my mild depression. I note you connect SAM-e with repair of myelin sheath of nerve endings which fascinates me. I have "idiopathic small fiber peripheral neuropathy" - all tests for usual causes of peripheral neuropathy negative. I am otherwise a fairly healthy 74-year-old male (ran the Comcast Marathon in 2002). I am experiencing progressive numbness, which started with tingling of the soles of both feet in year 2000. Now the tingling/numbness has progressed to encompass my entire body. Numb scalp, numb face, fingers, hands, forearms, feet, legs, thighs, buttocks. EMGs (three of them over three years) show little or no muscle degeneration, just mild degeneration of nerve endings (myelin sheath). Now if SAM-e builds myelin sheath, shouldn't my taking 400 mg daily (empty stomach am and pm) have had some effect at reversing the degeneration of myelin sheath and restoring feeling? Should I combine the SAM-e with B-complex vitamins and other supplements? Should I increase dosage of SAM-e? I have been tested regularly and the results always show no vitamin deficiencies over the past six years. I follow quasi-vegetarian diet, no dairy, very little sugar, no coffee, no alcohol, no smoking, no white starches, no junk food. Mainly fresh fruits and vegetables, nuts and beans, some salmon, sardines, catfish, and chicken breast (all baked or roasted, never fried). I am slightly overweight (199 pounds at 5 feet, 10 1/2 inches in height). I walk a lot daily, but have not been running regularly since 2002 because the long distance running seemed to have increased the numbness. MRIs (three of them) and many x-rays show no damage to spine, no central nerve problems. SAM-e has given me great energy, I have progressed from taking steps one at a time (due to unreliable knee joints) to running up the stairs without any pain. I am hoping SAM-e will rebuild my small fiber nerves and reverse the peripheral neuropathy.

Q. I am suffering from diabetes since 1995. I am on tablets. From Dec 2005 I had developed with Diabetic NEUROPATHY PROBLEM. MY FAMILY DOCTOR IS gave me Lyrica 75 MG. FROM JAN 2006 MY PENIS GETTING THINNER and when erection time my penis is having abnormal bend. Therefore my penis is not straight to do intercourse. I have a difficulty to do the intercourse. Do you thing this problem is due to the Diabetic neuropathy.?
     A. This is something to ask your doctor.

Q. I am a 58 yr old female who was recently diagnosis with diabetic neuropathy poor circulation (burning, tingling and coldness on bottom of feet not all the time). I work in the medical industry and I don't want to take prescribed medication I rather take supplements. Presently I am taking Vit-B12 , omega, flaxseed I keep myself active by walking 3 miles daily do Pilates / Yoga not as often, always on top of the foods I eat. I have been reading into other type of supplements that would help for patients that have diabetes. I came across your website and the supplements that others recommended you have them on the Diet Rx pill. My question is, will this supplement also help the neuropathy or is there another supplement that would help.
   A. Diet Rx has excellent antioxidant herbs and nutrients, including acetyl-l carnitine and alpha lipoic acid that may help diabetic neuropathy but we can't say since, as of December 2007, we don't have any reports from users of this product regarding diabetic neuropathy. However, when people eat less, their blood sugar is not as high and perhaps, over the long run, this could help blood sugar control and better nerve sensation. You can discuss with your doctor other options listed on this page.