Drugs for preventing neuropathy in diabetes

Currently, there are no specific drugs specifically designed to “100% prevent diabetic neuropathy.” All clinical drugs used to prevent neuropathy play an auxiliary role in reducing the risk of onset and delaying the progression of early damage on the basis of strict blood sugar control. It is recognized that the commonly used drugs include alpha-lipoic acid, pancreatic kallikreinogenase, and methylcobalamin. There is no absolute “first choice” and must be selected based on individual blood sugar conditions, disease course, and body response.

Last week I went out to the outpatient clinic and met a 38-year-old diabetic patient. He has been diabetic for 7 years and his glycemia has been around 8.5%. He posted a short video saying that lipoic acid can prevent neuropathy. I bought it and took it for three months. I still feel that my feet are numb from time to time. An electromyogram showed that the nerve conduction velocity has slowed down slightly. He also wondered, "Didn't I take all the preventive medicines?" In fact, the problem was not with the medicine at all, but with his blood sugar not reaching the standard. His nerves were exposed to a high-sugar environment every day, and no protective agent he took could stop the damage.

If you really want to say that the one with the most evidence-based evidence is alpha-lipoic acid. For example, a high-sugar environment will produce a lot of "destructive molecules" oxygen free radicals, which are specialized in gnawing at the outer envelope of nerve cells. Lipoic acid is equivalent to putting a protective shield on nerve cells, and it can also clear out the destructive molecules that have penetrated. It was used particularly early in Europe. Many studies have proven that long-term consumption can reduce the risk of neuropathy by about 30%. However, it is not suitable for everyone. People who are allergic to sulfur should not touch it. A few people will feel a little dizzy and nauseated for the first few days after eating it, but it will usually subside in a few days.

In addition to antioxidants, there is also a class of drugs that aim to "supply blood" to nerves, such as pancreatic kallikrein. In order for nerve cells to work normally, they rely entirely on the supply of nutrients from the surrounding capillaries. Long-term high sugar levels will clog the capillaries and prevent nutrients from being delivered through them. If the nerves are starved for a long time, problems will naturally occur. Pancreatic kallidinogenase unblocks the channels of these capillaries. Once the pathways are opened, nutrients can keep up, and the resistance of the nerves will naturally become stronger. This medicine is very mild. I have rarely seen any serious side effects among the patients I have come into contact with. It is suitable for people with diabetes who usually have cold hands and feet and always feel the soles of their feet fluttering when walking.

Speaking of which, we have to mention the most controversial methylcobalamin. Two groups of doctors have been arguing for many years about whether to take it regularly. One group thinks that there is absolutely no need to take it regularly. Methylcobalamin is active vitamin B12. If you eat normally, there will be no problem with digestion and absorption. The B12 supplement from meat, eggs, and milk is completely enough. However, supplementing indiscriminately may increase the metabolic burden, and a few people will develop rashes and diarrhea. The other group thinks If you have been suffering from diabetes for more than 5 years, even if you don’t have any symptoms, you can still take it in small doses, because nerve damage progresses quietly. By the time you feel numbness and pain, more than 30% of the damage has often been done. Taking supplements in advance is equivalent to "adding a nutritious meal" to the nerves, which does no harm. My own experience is that if you usually eat a lot of vegetarian food, or have taken metformin for more than 3 years (metformin can affect B12 absorption), even if you have no symptoms, you can check your serum vitamin B12 level. If it is low, supplement it. If it is not low, there is no need to eat blindly.

Many people also ask whether oryzanol and ordinary vitamin B1 can be eaten. It is not impossible, but the evidence-based evidence for these two types is not that sufficient. They are auxiliary. If you feel comfortable after eating it and there are no side effects, it is okay to eat some, but don’t regard it as the main force.

Oh, by the way, don’t buy the “miraculous nerve repair medicine” and “sugar foot preventive health care products” that are so popular on the market. Last year, a 62-year-old aunt heard from patients in the community that there was an “imported nerve repair hormone” and she would never get sugar foot after taking it. Xiao Tenwan bought half a year's supply and took it for two months. His blood sugar, which was under good control, suddenly shot up to 17, and his feet began to feel numb. When he went to the hospital for a check, he found that there were no active ingredients in the health product, and a lot of powdered sugar was added. Instead, he developed early-stage neuropathy. The gain outweighed the gain.

After all, don’t put all your hope in “preventing neuropathy” on medicines. If you drink milk tea and eat dishes heavy in oil and salt, your blood sugar will rise and fall. Even if you take all the preventive medicines, you can’t prevent nerve problems. In fact, many times life intervention is more effective than taking medicine. Soak your feet in warm water of about 37℃ every night, wear loose soft-soled shoes, don't walk barefoot, cut your nails without cutting the nail grooves, and touch your feet every day to see if you feel cold or tingling. If you do these little things well, it will be much more effective than spending a lot of money on health care products or taking random medicines.

Medicine has always been an auxiliary. Controlling blood sugar, blood pressure, and blood lipids within the target range is the most effective "preventive medicine."