Diabetic neuropathy is nerve damage caused by high blood sugar and is one of the most common complications in diabetic patients. Nerve damage can involve various organs throughout the body, such as the stomach and intestines, eyes, and sexual organs, leading to gastroparesis, diabetic retinopathy, and sexual dysfunction.

In addition to targeted drug therapy, such as gastric paralysis of sugar users will take gastrointestinal power enhancement drugs, there are four other types of drugs can help sugar users to ease the discomfort, to fight against neuropathy. Today, "ask the doctor" will give you a list of commonly used drugs for the treatment of diabetic neuropathy.

I. Vasodilator drugs

Another important cause of neuropathy is ischemia and hypoxia of nerve cells, so drugs that dilate blood vessels and improve microcirculation can increase the blood and oxygen supply to nerve cells and help them repair and regenerate.

1. Nimodipine

Nimodipine is the drug of choice for the treatment of diabetic neuropathy and belongs to the diphenhydramine class of antihypertensive drugs. It prevents a portion of calcium ions from entering cardiac muscle and vascular smooth muscle cells, attenuates vasoconstriction, decreases peripheral vascular resistance, increases nerve blood flow, and improves nerve conduction velocity.

Commonly used drugs:Nemeton (Nimodipine Tablets)

Dosage:60mg (2 tablets) each time, 6 times a day at least 4 hours between doses

Taking contraindications:The metabolites of nimodipine have toxic reactions, and should be used with caution in people with hepatic impairment; nimodipine can cause a decrease in blood pressure, and patients with hypertension should reduce or discontinue antihypertensive medications, or reduce the dose of nimodipine.

2. Ketone Theobromine

Already ketocorine can improve the deformation ability of red blood cells and white blood cells, tissue cell aggregation, thus improving microcirculation, but also inhibit the synthesis of thromboxane, play a role in dilating blood vessels.

Commonly used drugs:Bertone (Enteric-coated tablets with ketocorine)

dose: Oral 0.2~0.4g, 2~3 times a day

Taking contraindications:

• The drug may aggravate the drop in blood pressure to some extent when used in combination with antihypertensives, antidiabetic urine, and antiarrhythmic drugs, and sugar users should be aware of this;
• Patients who are applying warfarin for the treatment of blood clots and other diseases should reduce the dose of hashkone cacodylate;
• The metabolites of this peripheral vasodilator drug also improve vascular viscosity as well as vascular microcirculation.

3. Scopolamine

Scopolamine is an alkaloid extracted from scopolamine that relaxes smooth muscle, relieves vasospasm, improves microcirculation, and has some analgesic effects.

Commonly used drugs:Minsheng (Racemic Scopolamine Tablets)

Dosage:5~10mg each time, 3 times daily

Taking contraindications:Increased intracranial pressure, acute stage of cerebral hemorrhage, glaucoma, friends obstruction, intestinal obstruction, as well as prostate hypertrophy is prohibited.

II. Nutritional drugs

1. Methylvitamin B12

Long-term, high-dose use of metformin can lead to vitamin B12 deficiency, and a deficiency of this vitamin predisposes to diabetic neuropathy. Methylvitamin B12 is a coenzyme formed by the conversion of vitamin B12 that can help repair damaged nerves.

Commonly used drugs:Mecobalamin (Methylcobalamin Tablets)

Dosage and method of administration:Adults take 1 tablet (0.5mg) 1 time, 3 times a day with meals.

Contraindications to taking medication:Prolonged use of Micronutrients can cause hypokalemia, hyperuricemia and induce gout. It should not be taken by sugar patients without a confirmed diagnosis of neuropathy.

2. Epalrestat

Aldose reductase is increased in patients with chronic hyperglycemia, and this aldose reductase reduces glucose to sorbitol, which can cause nerve cells to swell and deform, thus causing neuropathy. Epalrestat, an aldose reductase inhibitor, can protect nerve cells by reducing aldose reductase activity.

Commonly used drugs:Tanglin (Epalrestat)

Dosage and method of administration:50mg each time, 3 times daily, orally before meals

Contraindications to taking medication:Urine may appear brownish red after taking Epalrestat, this is normal; use with caution if you have a history of allergy.

III. Pain management

Pain caused by neuropathy can seriously affect the patient's quality of life, so pain relief is a priority. The main medications commonly used clinically to relieve pain caused by neuropathy are as follows:

1. Pregabalin

Calcium channel modulators, as represented by pregabalin, are internationally recognized as first-line agents for the treatment of nerve pain.

Commonly used drugs:Lerica, Lerick.

Dosage and method of administration:50~100mg each time, 3 times daily

contraindication：

• Pregabalin is excreted exclusively in the urine and needs to be used in reduced doses in people with reduced renal function;
• Pregabalin, like other antiepileptic drugs, requires a gradual dose reduction before discontinuing the drug.

2. Amitriptyline

Amitriptyline is a tricyclic antidepressant, but is widely recommended for the treatment of neuropathic pain.

Commonly used drugs:Dongting (amitriptyline hydrochloride tablets), Changzhou Shiyao (amitriptyline hydrochloride tablets)

Dosage:Adults start at 25mg once, then increase to 150-250mg depending on condition and tolerance

Number of doses:2~3 times a day

Taking contraindications:Serious insufficiency of liver and renal function, prostatic hypertrophy, cardiovascular disease and elderly patients should be used with caution; during the period of taking the drug can not drive, operate equipment or work at heights, manic tendency should be immediately discontinued.

IV. Other drugs

opioid

Opioids are second-line therapeutic agents for the treatment of neuropathic pain, usually in combination with anticonvulsants or antidepressants. Opioids, like morphine, fentanyl and tramadol, are easily addicted and abused and are more tightly regulated in the country. Taking such drugs can produce discomfort such as nausea and constipation, and long-term use can lead to dependence.

Topical pain relief - capsaicin

Capsaicin, an alkaloid extracted from red chili peppers, can be applied 3 to 4 times a day to reduce pain. However, redness, tingling, and burning sensations can occur at the site of application.

The above content is edited and organized by "ask the doctor" for you, want to know more authoritative health knowledge, welcome to pay attention to us!

Diabetic neuropathic changes are mainly categorized as polyneuropathy, mononeuropathy and autonomic neuropathy. Their treatment is based on glycemic control and can be based on the use of nutritive neurotropic drugs, anti-oxidative stress and symptomatic treatment including a variety of analgesic drugs.

I. Treatment of causes

1、Aldose reductase inhibitor By inhibiting the sorbitol bypass, it prevents the deposition of sorbitol and fructose in the nerve tissue and prevents the reduction of inositol in the nerve tissue, preventing the demyelination of nerve segments and improving the nerve conduction velocity. Epalrestat is the only aldose reductase inhibitor currently on the market.

2、Antioxidant α-lipoic acid is known to be a natural antioxidant with strong effect of a vitamin, is currently commonly used in clinical treatment of drugs, which can scavenge oxygen radicals, inhibit peroxides, regeneration of antioxidant substances, and improve the speed of nerve conduction.

3、Nutritional nerve drugs Mecobalamin is an endogenous coenzyme B12, which can be directly transferred to the nerve cells, by promoting the synthesis of protein nucleic acid and phospholipids in the neurons, repairing the myelin sheath and regenerating the damaged areas of the axons, and improving the speed of nerve conduction, and it is widely used in the clinic. NGF can increase the number of surviving neurons, stimulate the development of neuronal envelope and dendrites, and have a protective effect on damaged neurons.

II. Symptomatic treatment

The main medications used to relieve diabetic peripheral neuropathic pain include the following:

1. Tricyclic antidepressants: amitriptyline, promethazine.

2, 5-HT and NE dual-channel reuptake inhibitors: duloxetine, venlafaxine.

3. Anticonvulsant drugs: gabapentin and pregabalin.

4. Analgesic drugs: opioid analgesic drugs.

5. Traditional Chinese medicine and other preventive and therapeutic measures: In clinical practice, drugs such as tanshinone, chuanchuan bowuzhizine, and acanthopanax can usually be used to improve the blood supply and alleviate the patient's symptoms. Chinese medicine fumigation, acupuncture and other means can also be used to improve symptoms.

bibliography

Yang Fan, Lian Fengmei. Progress of clinical research on diabetic peripheral neuropathy[J]. Medical Review, 2017,23(10):1991-1996.

Mou Yiming, Guo Daihong. Clinical Pharmacotherapeutics of Endocrine Metabolic Diseases [M], Beijing: People's Health Publishing House, 2017: 165.

The authoritative interpretation of Pharmaceutical Affairs, unauthorized reproduction, plagiarism will be punished.

Specialists answer the question, so pay attention to learn more!

Once an old patient took my hand and cried to me, that leg ah, no place to put, put everywhere uncomfortable, to the night burning fire ah! I also put it in cool water to soak it in the winter!

It was an old PLA soldier, who had been through guns and bullets, and had no tears even with shrapnel on his body, and could be seen

This neuropathy is truly torturous.

Diabetic neuropathy is a type of diabetic lesion, and it can be said that it is an extremely painful feeling for diabetic patients because it manifests itself in many forms, including numbness of the fingertips, pins and needles, tingling, burning, and some people may experience neuralgia, typical pain most often in the lower limbs, which usually exists at rest and is aggravated at night. In the presence of autonomic neuropathy, there is also unusual sweating, alternating diarrhea and constipation, making life very inconvenient.

The drugs currently used for the treatment of neuropathy include methylcobalamin, lipoic acid, epalrestat, prostaglandin, gabapentin and other drugs, which have different mechanisms of action and different sites of action, and play different effects.

Usually methylcobalamin is more widely used, with better adherence to medication, which facilitates long-term maintenance of treatment for patients. Lipoic acid needs to be administered intravenously, prepared before infusion, and protected from light for infusion, so it should be shielded from light with a dark colored bag when used. Epalrestat and gabapentin are more effective in the treatment of painful neuropathy. Prostaglandin is mainly used for ulcers, claudication, pain and sensory abnormalities caused by arterial occlusive disease.

However, these drugs need to be used early and persistently for a long time in order to benefit significantly. Therefore, early prevention is very important. Do a good job of prevention, strive for diabetes without complications, complications without gangrene, gangrene without amputation, early prevention, early treatment.

Diabetic peripheral neuropathy is the most common complication of diabetes.

Symptoms of diabetic neuropathy include burning body pain, pins and needles, or accompanied by abnormal sensations, which in many people can worsen at night. In some cases, the pain is aggravated by irritation from wearing clothes or socks or covers. Some patients may exhibit tingling sensations and sensory deficits. Long-term lesions can lead to increased mental burden and interfere with daily life, so early intervention is essential.

For early diabetic neuropathy some may not feel, can not be detected, so we must do a good job on weekdays to prevent diabetic neuropathy, the best way to prevent diabetic neuropathy is to control blood glucose, research has found that good blood glucose control, can make diabetic neuropathy risk decreased by more than 70%, in addition to controlling blood glucose, blood pressure, blood lipids and so on is also to do a good job of controlling.

For diabetic neuropathy, there are no better medications that can reverse the condition, and some medications only ease or slow the progression and severity of the disease.

For pain is more obvious, the patient has anxiety and depression and other symptoms, can choose Pregabalin, Gabapentin to relieve pain, some antidepressants such as sertraline, amitriptyline and so on can also be used in conjunction with the necessary, can reduce the patient's anxiety. Nutritional nerve drugs such as methylcobalamin and Epalrestat can also be chosen. Epalrestat can inhibit aldose reductase, so that glucose is converted to sorbitol to reduce (sorbitol can make nerve cells swell and deform to produce pain).

The etiology of diabetic peripheral neuropathy is complex, and the exact pathogenesis is inconclusive. According to the available literature, its pathogenesis may be related to a variety of factors, such as prolonged severe hyperglycemia and the oxidative stress damage, microangiopathy, metabolic disorders, neuroinflammatory damage, and vitamin nutritional disorders that it causes.

If the hyperglycemic state of a diabetic patient persists, glucose cannot be utilized normally, and the excess glucose will also be converted into sorbitol and stored in the nerve cells, which affects the normal conduction function of the nerves, thus causing diabetic neuropathy. This is one of the hypotheses about the pathogenesis of diabetic neuropathy.

In addition to active control of blood glucose, blood pressure, blood lipids, and lifestyle changes are the basis for controlling diabetic peripheral neuropathy, in addition to the treatment of diabetic peripheral neuropathy become drugs mainly include:

1. Anti-oxidative stress drugs:It protects vascular endothelial function by inhibiting lipid peroxidation, increasing blood flow to neurotrophic vessels, and increasing neural Na+-K+ -ATPase activity, and the commonly used drug is lipoic acid. Lipoic acid injection is administered intravenously or intravenously, adverse reactions are rare in clinical practice, and the drug should be stored under light.

2. Drugs to improve microcirculation:It can effectively improve the clinical symptoms of diabetic peripheral neuropathy by dilating blood vessels, improving the hypercoagulable state of blood and microcirculation, and improving the blood oxygen supply to nerve cells. Commonly used drugs include Beraprost Sodium, Pancreatic Kininogenase, Prostaglandin and proprietary Chinese medicines that activate blood circulation and remove blood stasis (e.g. Ginkgo Biloba Drops Pills, Compound Danshen Drops Pills). The dosage of Beraprost Sodium Tablet is usually taken orally after meals, and it is prohibited for pregnant women and patients with bleeding.

3. Drugs to improve metabolic disorders:By inhibiting the enzyme aldose reductase, which in turn inhibits the conversion of glucose to sorbitol, thereby improving the symptoms of neuropathy, the common representative drug is Epalrestat. The common use of Epalrestat is to be taken before meals; it is worth noting that after taking the drug, the urine may appear brownish-red in color, which is normal.

4. Nutritional and neuroprosthetic drugs:Active vitamin B12 preparations, commonly represented by the drug: methylcobalamin, can repair and nourish the nerves, improving signs, symptoms and nerve conduction velocity.

5. Pain medication:Currently recommended for analgesic treatment of diabetic neuropathy are antidepressants (e.g., amitriptyline), anticonvulsants (pregabalin, gabapentin), and opioid analgesics (e.g., tramadol). Pregabalin tablets should be taken from a small dose, if the pain is not relieved, the dose can be adjusted under the guidance of the doctor. Note that the elderly are prone to neurological adverse effects such as dizziness, blurred vision, tremor and drowsiness.

Neuropathy in diabetes is one of the common chronic complications, and the likelihood of neuropathy increases with the prolongation of the disease, which can accumulate both central and peripheral neuropathy, with peripheral neuropathy being more common.

Peripheral neuropathy in diabetes mellitus often manifests as bilateral limb pain, numbness, and tenderness, and type 2 diabetes mellitus is diagnosed when type 1 diabetes mellitus is screened at least annually for 5 years after diagnosis and the diagnosis can be made by;; clinical symptoms, physical examination, and neurophysiologic examination.

Diabetes may also cause autonomic (vegetative) neuropathy, resulting in upright hypotension, syncope, abnormal coronary artery diastolic function, myocardial infarction, cardiac arrest, or sudden death, as well as symptoms such as dysphagia, gastric upset, and sexual dysfunction.

What are the medications used to treat diabetic neuropathy?

1. The first treatment needed to prevent and treat diabetic neuropathy is to control blood sugar and keep it stable for a long time.

2. Drugs for neuropathy include methylcobalamin, nerve growth factor and other drugs that promote nerve repair, in addition to neurotrophic factor, inositol, gangliosides and linolenic acid.

3. Drugs such as beclomethasone sodium, cilostazol, and pancreatic kininogenase can improve microcirculation, and drugs such as lipoic acid can have an anti-oxidative stress effect.

4. If it causes neuropathic pain it can cause medications such as pregabalin and gabapentin.

Note: The above medications should be used under the supervision of a physician.

Thanks for reading and I hope my answer helps!

I am Dr. Yang Hao, specializing in the diagnosis and treatment of common and multiple diseases, chronic disease management, health science and technology.

Limited space can not cover everything, if you need to know more about medical knowledge, welcome to pay attention to "Dr. Yang Hao"!

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Diabetic neuropathy is a common complication of diabetes mellitus, and the clinical manifestations include several types, with distal symmetrical multiple peripheral neuropathies and autonomic neuropathies being the most common.

clinical manifestation

Distal symmetric polypoidal peripheral neuropathy is characterized by a slow onset, with distal limb sensory abnormality as the first symptom, which may present glove-like or sock-like sensory impairment, and early key reflexes may be reduced, especially in the lower limbs of both limbs. In addition, autonomic nerve damage is manifested by abnormal sweating, diarrhea, constipation, sexual dysfunction, dysuria, upright hypotension, and tachycardia at rest.

The treatment of diabetic neuropathy should, firstly, be directed at the etiology of the disease, actively controlling blood glucose and glycosylated hemoglobin, and keeping blood glucose stable, and secondly, directed at the pathogenesis of the disease, and there are a variety of drugs currently in clinical use, including

1 Drugs with anti-oxidative stress effects such as lipoic acid, the

2 Improvement of metabolic disorders with drugs such as the aldose reductase inhibitor, epalrestat (Tanglin).

3 Various medications to improve microcirculation, such as Kaiser (Prostadil), Beraprost sodium (Kena), cilostazol (Pedal).

4 Neurotrophic restorative drugs such as methylcobalamin (Mecobalamin), thiamine and other B vitamins.

5 Symptomatic therapeutic measures for neuralgia, such as amitriptyline, gabapentin, pregabalin, duloxetine, venlafaxine, and other antidepressants.

bibliography

Consensus on the Diagnosis and Treatment of Diabetic Peripheral Neuropathy (2013)