What is the best medicine for diabetes to prevent peripheral neuropathy?

First of all, let’s be honest. There is no “best” drug for preventing diabetic peripheral neuropathy in clinical practice. All medication plans are based on your blood sugar control, duration of disease, and body tolerance. There is no magic pill.

Last week, I met a 62-year-old Aunt Zhang in the outpatient clinic. She has been diabetic for 7 years. I heard from fellow patients in the community that methylcobalamin is a "magic medicine" for preventing numbness in the feet. I bought it and took it for almost a year. As a result, last month, my toes started to feel numb every day. Even wearing slippers felt like wearing thick socks. I came over to check the glycosylated hemoglobin 7.9%. Normally, my fasting blood sugar often floats above 9. I told her that if you let high sugar soak your nerves every day, it's like soaking a wire in acid water for a long time. Sooner or later, the outer insulation will be corroded. No matter how much methylcobalamin you take, it can't make up for it.

In fact, the core foundation of preventing peripheral neuropathy is always sugar control. If you stabilize fasting blood sugar at 4.4-7.0mmol/L, do not exceed 10mmol/L two hours after a meal, and control glycated hemoglobin within 7%, you can reduce the risk of peripheral neuropathy by more than 60%. The metformin, glycolic acid, or insulin you usually take are essentially the most effective "preventive drugs."

Of course, this does not mean that everything will be fine if you control your sugar. If you have been ill for more than 5 years and occasionally experience tingling in your toes or crawling ants, or have been found to have high homocysteine, doctors will usually prescribe some nerve-nutrition drugs. The most commonly used drug is methylcobalamin, which is active vitamin B12 and can help repair the sheath outside the nerve. If you are still not relieved after taking it for more than 3 months, you may need to add folic acid and vitamin B6 together. Some patients have poor microcirculation and their feet are always cold in winter. Some patients will also be prescribed pancreatic kallikrein to improve the blood supply around the nerves, which is equivalent to "water pipes" for the nerves. Only by supplying nutrients can they survive.

Nowadays, many people recommend α-lipoic acid, saying that it has good antioxidant effects and can prevent lesions. This is indeed controversial in clinical practice. Some studies say that it can reduce the oxidative damage to nerves caused by high sugar. Some studies believe that the preventive effect on Asian people is not obvious, and some people will experience mild gastric reflux and dizziness after eating it. It is not suitable for everyone.

I have met too many patients who ask about "the best medicine" as soon as they come in, and then turn around and buy imported "neuroprotective health products" that cost hundreds of dollars a bottle. When you take them apart, the ingredients are nothing more than B vitamins, which are not as good as the medicines in the hospital that cost a few dollars a bottle. If you really want to prevent pathological changes, don't focus on medicine first. First, do a solid job of monitoring your blood sugar every day. If you have nothing to do, touch your feet to see if you feel numb or numb. Do a regular neurological screening every year. It is more reliable than any "magic drug".