This is one of the most important questions my patients ask, and the honest answer is that it depends on the stage at which neuropathy is identified and addressed. In the very early stages, when glycaemic control is improved substantially and sustained, some degree of nerve function recovery is possible. The nerve fibres that have been damaged but not yet lost can partly recover when the metabolic insult driving the damage is removed. However, nerve fibres that have been destroyed do not regenerate, which means that established, advanced neuropathy cannot be reversed: the goal becomes stabilisation and prevention of further progression. This is the clinical argument for early detection. A patient with early tingling and pins and needles who achieves sustained excellent glycaemic control may stabilise or partially improve. A patient who presents with established numbness and whose nerve conduction studies show significant fibre loss is at a stage where the realistic aim is preventing further damage, not recovering what has been lost. The most effective treatment for diabetic neuropathy at every stage is the best achievable blood glucose control, because it is the elevated glucose that drives the ongoing nerve damage, and addressing it is the intervention that most consistently changes the trajectory.
Written by Dr. Santosh Kumar PK, Master's in Diabetes Management (Middlesex University), PGD Clinical Cardiology and PGD Endocrinology (Royal College of Physicians, UK), Consultant Physician and Cardio-Diabetologist, Chirayu Multispeciality Clinic, Kasturi Nagar, Bengaluru. Phone: +91 9164442266.
