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Pain Management: Diabetes-Related Nerve Problems
Neuropathy, a common complication of diabetes, is damage to the nerves that allow you to feel sensations such as pain. There are a number of ways that diabetes damages the nerves, and they are all linked to blood glucose (sugar) being too high for a long period of time.
Diabetes-related nerve damage can be painful, but it isn't severe in most cases. There are two major types of diabetic neuropathy: peripheral and autonomic.
Peripheral Neuropathy
The areas of the body most commonly affected by peripheral neuropathy are the feet and legs. Nerve damage in the feet can result in a loss of foot sensation, increasing your risk of foot problems like ulcers. Therefore, proper skin and foot care should be practiced. Rarely, the arms, abdomen, and back may be affected.
Symptoms of peripheral neuropathy may include:
- Tingling
- Numbness (severe or long-term numbness can become permanent)
- Burning
- Pain
In most cases, symptoms will become less when blood glucose is controlled.
To prevent peripheral neuropathy:
- Check your feet and legs daily -- look for blisters, calluses, and cuts.
- Apply lotion if your feet are dry but avoid getting lotion in between your toes; this area should be kept dry.
- Care for your nails regularly. (Go to a podiatrist if necessary.)
- Wear properly fitting footwear. Some people with bony abnormalities may require custom shoes to redistribute pressure.
- People with claudication may require a referral to a doctor or surgeon who specializes in poor circulation.
- Control blood sugar, cholesterol and high blood pressure
- If you smoke, quit
Autonomic Neuropathy
Autonomic neuropathy most often affects the digestive system, especially the stomach, blood vessels, urinary system, and sex organs. To prevent autonomic neuropathy, you need to continuously keep your blood glucose levels well controlled.
Symptoms of neuropathy of the digestive system may include:
- Bloating
- Diarrhea
- Constipation
- Heartburn
- Nausea
- Vomiting
- Feeling full after small meals
- Frequent episode of labile blood sugar control
Treatments may include:
- Eat smaller meals
- Medicines
Symptoms of neuropathy of the blood vessels may include:
- Blacking out when you stand up quickly
- Increased heart rate
- Dizziness
- Low blood pressure
Treatments may include:
- Avoid standing up quickly
- Salt supplementation
- Medicines
- Wear special stockings
Symptoms of neuropathy of the male sex organs may include:
- Unable to have or maintain an erection (erectile dysfunction)*
- "Dry" or reduced ejaculations
Treatments include:
- Counseling
- Penile implant
- External erection maintenance device
- Penile injections
- Medicine
Impotence needs to be evaluated by your doctor. It may be caused by your medicines or factors other than diabetes.
Symptoms of neuropathy of the female sex organs may include:
- Decrease in vaginal lubrication
- Decrease in number of orgasms or lack of orgasm
Treatments include:
- Counseling
- Estrogen
- Vaginal creams
- Lubricants
Symptoms of neuropathy of the urinary system may include:
- Unable to completely empty bladder
- Increased urinary tract infections
- Bloating
- Incontinence (leaking urine)
- Increased urination at night
Treatments include:
- Medicines
- Self-catheterization (inserting a catheter into the bladder to release urine)
- Surgery
Reviewed by Certified Diabetes Educators in the Department of Patient Education and Health Information and by physicians in the Department of Endocrinology at The Cleveland Clinic.
WebMD Medical Reference provided in collaboration with the Cleveland Clinic
Pain Management Guide
ORENCIA® (abatacept) Important Safety Information
Indication and Usage
ORENCIA® (abatacept) is a prescription medicine that reduces signs and symptoms in adults with moderate to severe rheumatoid arthritis (RA), including those who have not been helped enough by other medicines for RA. ORENCIA may prevent further damage to your bones and joints and may help your ability to perform daily activities.
Important Safety Information About ORENCIA® (abatacept)
Before you receive treatment with ORENCIA, a lyophilized powder for intravenous infusion, you should tell your doctor about all your medical conditions, including if you:
- have any kind of infection even if it is small (such as an open cut or sore) or an infection that is in your whole body (such as the flu).
- have an infection that will not go away or a history of infections that keep coming back.
- have had tuberculosis (TB), a positive skin test for TB, or if you recently have been in close contact with someone who has had TB. If you get any of the symptoms of TB (a dry cough that doesn’t go away, weight loss, fever, night sweats), call your doctor right away. Before you start ORENCIA, your doctor may examine you for TB or perform a skin test.
- have or have had viral hepatitis. Before you use ORENCIA, your doctor may examine you for hepatitis.
- have a history of chronic obstructive pulmonary (lung) disease (COPD).
- are scheduled to have surgery.
- are allergic to any of the following ingredients in ORENCIA: abatacept, maltose, monobasic sodium phosphate, or sodium chloride for administration.
- recently received a vaccination or are scheduled for any vaccination.
- have diabetes and use a blood glucose monitor to check your sugar levels. The infusion of ORENCIA contains maltose, a sugar that can give falsely high blood glucose readings with some monitors on the day you receive your infusion. Your doctor may tell you to use a different way to monitor your blood sugar levels.
- are pregnant, planning to become pregnant, or are thinking about becoming pregnant. It is not known if ORENCIA can harm your unborn baby.
- are breast-feeding. You will need to decide to either breast-feed or receive treatment with ORENCIA, but not both.
- take any other kinds of medicine, including prescription and nonprescription medicines, vitamins, and herbal supplements.
- are taking other biologic medicines to treat RA such as: Enbrel® (etanercept), Humira® (adalimumab), Remicade® (infliximab), Kineret® (anakinra) or Rituxan® (rituximab). You may have a higher chance of getting a serious infection if you take ORENCIA with other biologic medicines.
Possible Side Effects of ORENCIA® (abatacept)
ORENCIA can cause serious side effects including:
- Serious infections. Patients receiving ORENCIA have a higher chance of getting infections including pneumonia, and other infections caused by viruses, bacteria, or fungi. Call your doctor immediately if you feel sick or get any of the following signs of infection: fever, feel very tired, cough, feel flu-like, or warm, red or painful skin.
- Allergic reactions. Allergic reactions can happen on the day of treatment or the day after receiving ORENCIA. Tell your doctor or get emergency medical help right away if you have hives, swollen face, eyelids, lips, tongue, throat, or trouble breathing.
- Cancer (malignancies). Certain kinds of cancer have been reported in patients receiving ORENCIA. It is not known if ORENCIA increases your chance of getting certain kinds of cancer.
- Vaccinations. You should not receive ORENCIA with certain types of vaccines. ORENCIA may cause some vaccinations to be less effective.
- Respiratory problems in patients with COPD. You may get certain respiratory problems more often if you receive ORENCIA and have COPD, including: worsened COPD, pneumonia, cough, or trouble breathing.
The more common side effects with ORENCIA are headache, upper respiratory tract infection, sore throat, and nausea.
Please read the Patient Information in the Full Prescribing Information below.
ORENCIA is a registered trademark of Bristol-Myers Squibb Company.
All other trademarks are property of their respective companies.
TOPAMAX is approved for migraine prevention in adults only.
TOPAMAX is not used to stop a migraine after it starts.
IMPORTANT SAFETY INFORMATION
Serious risks associated with TOPAMAX include lowered bicarbonate levels in the blood resulting in an increase in the acidity of the blood (metabolic acidosis). Symptoms could include hyperventilation (rapid, deep breathing), tiredness, loss of appetite, irregular heartbeat or changes in the level of alertness. Call your doctor immediately if you get these symptoms. Your doctor may want to do simple blood tests. Chronic, untreated metabolic acidosis may increase the risk for kidney stones or bone disease.
Other serious risks include decreased sweating, increased body temperature, kidney stones, sleepiness, dizziness, confusion, difficulty concentrating, and increased eye pressure (glaucoma). Call your doctor immediately if you have any decrease in vision or eye pain. These problems can lead to blindness if not treated right away.
More common side effects are tingling in arms and legs, loss of appetite, tiredness, nausea, diarrhea, taste change and weight loss.
Tell your doctor about other medications you take. Please see full U.S. Prescribing Information.
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