Managing Diabetic Neuropathy: 7 Medication Plans for Pain, Numbness, and More

Diabetes Neuropathy is a common chronic complication of diabetes, mostly due to long term Hyperglycaemia Triggered by damaged nerve fibers (especially peripheral nerves and autonomic nerves), it is typically manifested by numbness and tingling in the hands and feet (pinprick-like, ant-crawling-like), hypoaesthesia (insensitive to hot and cold), dry skin, and in severe cases muscle weakness, foot ulcers, and even affects digestive and cardiovascular function. Medication needs to be controlled around “ Glycemia (basic), repair nerve damage, and relieve Neuralgia , Improve neurometabolism ”Expand, the following is a detailed explanation of 7 targeted drug regimens and key points of use to help you scientifically manage your condition.

1. 7 medication plans and applicable scenarios, symptomatic medication is the core

Diabetic neuropathy requires a two-pronged approach “hypoglycemic + nerve protection”. Different symptoms (mainly pain/mainly numbness/combined with autonomic nerve problems) correspond to different plans. It needs to be selected based on the location of nerve damage and symptom severity:

– Scheme 1: Diabetic peripheral neuropathy (mainly numbness of hands and feet)

Typical manifestations: history of diabetes for more than 5 years, symmetrical numbness of the hands and feet (starting from the toes and fingertips and gradually spreading to the calves and arms), accompanied by slow sensation (such as not knowing the water temperature when soaking feet), no obvious pain Electromyography Prompt “slowed conduction of peripheral nerves”.

Applicable stage: Mild nerve injury with numbness and hypoaesthesia as the main symptoms, need to improve neurometabolism and delay the progression of injury.

Medication combination: Methylcobalamin Tablets + epastat tablets

Efficacy: methylcobalamin (endogenous vitamin B12) promotes neuromyelination and repairs damaged nerve fibers; Epastat Inhibit Aldose Reductase (overactivation of this enzyme in hyperglycemia causes nerve damage), reduces nerve cell damage, and improves numbness.

Usage: Methylcobalamin 0.5 mg each time, 3 times daily, taken after meals; epasilastat 50 mg each time, 3 times daily, taken before meals (30 minutes apart from food to enhance absorption); take continuously for 3-6 months, review electromyography every 2 months (monitor nerve conduction velocity).

Note: Check the skin of the hands and feet daily (with or without damage, it is easy to ignore trauma due to hypoaesthesia); avoid wearing tight shoes and high heels (reduce foot compression damage); strictly control sugar (fasting blood glucose＜ 7.0 Mmol /L, 2 hours after the meal ＜10.0 mmol/L).

– Scheme 2: Diabetic peripheral neuropathy (predominantly severe pain)

Typical manifestations: persistent pain in the hands and feet (needle-like, cauterized or electroshock-like), increased pain at night (affecting sleep), increased pain when touching the skin (hyperalgesia), conventional analgesics (eg Ibuprofen )Poor effect, accompanied by irritability and sleep disorders.

Applicable stage: Moderate or severe neuralgia, which requires rapid pain relief, improved sleep, and reduced pain impact on life.

Medication combination: Pregabalin Capsules + Duloxetine enteric-coated tablets

Efficacy: Pregabalin Nervous Cellular membrane Calcium ion channels, inhibits abnormal nerve discharge, and provides rapid relief from burning-like and electric shock-like pain; Duloxetine (a dual-channel antidepressant) blocks pain signaling while relieving pain-induced anxiety and depression.

Usage: Pregabalin is initially 75 mg twice daily (can be increased to 150 mg twice daily after tolerance); Duloxetine 20 mg each time, once daily (take after breakfast to avoid nighttime excitement affecting sleep); take continuously for 2-3 months (after pain relief, pregabalin is gradually reduced).

Note: Avoid hot/cold compresses on hands and feet in case of pain (to prevent aggravation of nerve sensitivity); stay away from electronic devices 1 hour before bedtime (to assist in improving sleep); regular psychological evaluation (to relieve pain-related anxiety).

– Scheme 3: Diabetic autonomic neuropathy (gastrointestinal symptoms predominant)

Typical manifestations: long-term diabetic patients with postprandial bloating (swelling after eating half a bowl of rice), nausea and vomiting (obvious in the morning), constipation and Diarrhoea Alternating (such as sudden diarrhea after defecation once every 3 days) Gastroscopy /Enteroscopy without organic lesions, gastrointestinal motility monitoring suggestive “delayed gastric emptying”.

Stage of application: Autonomic nerve injury involves the gastrointestinal tract, with digestive disorders as the main symptom, which requires improvement of gastrointestinal motility and relief of abdominal distension and diarrhea.

Combination of medicines: Mosapride tablets + pancreatic enzyme enteric-coated capsules

Efficacy: Mosapride promotes gastrointestinal smooth muscle peristalsis, speeding up Gastric emptying , relieve abdominal distension and nausea after meals; pancreatic enzyme enteric-coated capsules supplement Digestive enzymes ( Lipase , Protease ), improve gastrointestinal digestive function and reduce abdominal distension and diarrhea.

Usage: Mosapride 5 mg each time, 3 times daily, taken 15 minutes before meals (to promote pre-meal gastrointestinal motility); Pancreatic Enzyme Enteric Capsules 0.3 g each time, 3 times daily, with meals (to be mixed with food to enhance digestive effect); 4-8 weeks of continuous administration, reduced to 2 times daily after symptom relief (consolidation for 2 weeks).

Note: Eat small and frequent meals (5-6 meals a day, avoid eating too much in a single meal to aggravate abdominal distension); Eat less greasy and gas-producing foods (such as fatty meats and sweet potatoes to reduce gastrointestinal burden); Take a 10-minute walk after meals (to assist gastrointestinal motility).

– Scheme 4: Diabetic autonomic neuropathy (mainly cardiovascular symptoms)

Typical manifestations: sudden dizziness and blackness in front of the eyes when standing ( Postural hypotension , after standing Systolic Descending ＞20 mmHg), with Panic (at rest) Heart rate ＞100 times/min), Chest tightness (aggravated after activity), electrocardiogram without organic cardiac lesions, 24-hour ambulatory blood pressure indication “large postural blood pressure fluctuations”.

Stage of application: Autonomic nerve injury involves cardiovascular disease, with orthostatic hypotension and abnormal heart rate as the main symptoms, and it is necessary to stabilize the blood pressure and regulate the heart rate.

Medication combination: Midodrine tablets + Ginsengsong Yangxin Capsule

Efficacy: Midodrine contracts peripheral blood vessels, raises blood pressure when standing, relieves dizziness and darkening of the eyes; Shensong Yangxin Capsules (Chinese patent medicine) replenishes qi and nourishes yin, activates blood circulation and unblocks collaterals, regulates heart rate, improves palpitation and chest tightness, and assists in stabilizing blood pressure.

Usage: Midodrine 2.5 mg each time, 3 times a day (take in the morning, noon and afternoon, avoid taking it before going to bed to prevent high blood pressure at night); Shensong Yangxin Capsules 4 capsules each time, 3 times a day, after meals; take continuously for 1-2 months, monitor the blood pressure in the supine position every 2 weeks (adjust the dose of Midodrine).

Note: Get up slowly while standing (stand from the lying →sitting→ position, stay for 30 seconds each time); wear Stretch socks (Promote lower limbs Venous reflux , assists in raising blood pressure); avoids standing for long periods of time (reduces orthostatic hypotension episodes).

– Option 5: Diabetic foot (Early neuropathy + mild infection)

Typical manifestations: numbness of the foot (insensitive to acupuncture, hot and cold), dry, peeling and dehiscent skin of the foot, slight redness and swelling between the toes, exudation (no obvious suppuration), weakened pulse of the arteries of the foot (weaker pulse of the dorsal artery of the foot when touched than on the opposite side), no obvious Ulcer .

Applicable stage: Diabetic foot In the early stage, nerve damage combined with mild infection requires nerve protection, anti-infection, and ulcer prevention.

Medication combination: methylcobalamin tablets + amoxicillin clavulanate potassium tablets + compound polymyxin B ointment

Efficacy: Methylcobalamin repairs damaged nerves in the foot and improves numbness; Amoxicillin potassium clavulanate kills pathogenic bacteria in the foot (eg Staphylococcus aureus ), control mild infections; compound polymyxin B ointment (external use) locally fights infections and promotes skin fissure healing.

Usage: Methylcobalamin 0.5 mg each time, 3 times a day, after meals; Amoxicillin potassium clavulanate 0.375 g each time, 3 times a day, after meals (for 7-10 consecutive days, a course of pedicure to prevent the spread of infection); Compound polymyxin B ointment 2 times a day, after cleaning the feet, apply to redness, swelling and cracks; take continuously/topically for 2-3 weeks.

Note: Wash your feet daily with warm water ℃water temperature below 37, measured with a thermometer to prevent burns); dry your feet with a soft towel after washing (especially between the toes); wear loose, breathable cotton socks (avoid frictional foot damage).

– Scheme 6: Diabetic neuropathy (combined muscle weakness)

Typical manifestations: long-term diabetic patients with muscular weakness of the lower limbs (handrails to climb stairs, louis wrestling), calf muscle atrophy (reduced calf circumference on both sides ＞2 cm) when healthier, accompanied by numbness of hands and feet, electromyography suggestive “motor nerve injury”.

Applicable stage: Nerve damage involves motor nerves, with muscle weakness and atrophy as the main symptoms, and requires repair of motor nerves and strengthening of muscles.

Medication combination: Methylcobalamin tablets + Vitamins B1 tablets + idebenone tablets

Efficacy: methylcobalamin + vitamin B1 synergistically repair motor nerve fibers and promote nerve signaling; Idebenone Improve nerve cell metabolism, enhance Nerve cells Vitality, assists in restoring muscle strength and delays muscle atrophy.

Usage: Methylcobalamin 0.5 mg 3 times daily; Vitamin B1 10 mg 3 times daily; Idebenone 30 mg 3 times daily; both taken after meals; continuously for 4-6 months, review EMG + calf circumference every 3 months (monitoring muscle recovery).

Note: Perform leg strength training under the guidance of a rehabilitator (such as straight leg raising, squatting against the wall for 10 minutes each time, twice a day); avoid sitting for long periods of time (get up and move for 5 minutes every 1 hour, prevent) Muscles Further atrophy; supplementation with high-quality protein (eg Eggs , Lean meat, 1.2g/kg body weight per day, assists muscle repair).

– Protocol 7: Diabetic neuropathy (progression of prevention, mild symptoms)

Typical manifestations: history of diabetes for more than 3 years, occasional slight numbness of hands and feet (short onset, self-relieving), no pain, weakness, mild slowdown of nerve conduction speed, acceptable glycemic control ( Glycated haemoglobin ＜7.5%).

Applicable stage: Early stage of neuropathy, mild symptoms, need to prevent aggravation of injury and delay the progression of the lesion.

Medication combination: methylcobalamin tablets + alpha-lipoic acid tablets

Efficacy: Methylcobalamin prevents further damage to nerve fibers, maintains Nerve conduction Function; alpha-lipoic acid scavenging Radicals (Increased free radicals cause nerve damage during hyperglycemia), protect nerve cells, and reduce the risk of nerve damage.

Usage: Methylcobalamin 0.5 mg each time, 3 times daily, after meals; alpha-lipoic acid 600 mg each time, once daily, after breakfast (with food to reduce gastrointestinal irritation); continuous administration for 6-12 months, review of glycated hemoglobin every 3 months (monitoring of glycemic control).

Note: Adhere to moderate intensity exercise (such as brisk walking, swimming) for 30 minutes daily, promote Circulation , assistive nerve repair); avoid alcohol ( Alcohol Worsening nerve damage); regular foot examination (once every 6 months, early detection and early intervention).

2. “Signals that the drug is effective indicate improvement of the condition”

After 2-4 weeks of regular medication, the appearance of these changes indicates that the protocol is symptomatic:

1. Remission of symptoms: gradual recovery of feeling in the hands and feet of numb people (can perceive needle stick and water temperature); reduction of pain frequency (such as from daily onset to 2-3 times per week) and weakening of intensity (does not affect sleep) in those with pain; reduction of abdominal distension after meals (can eat 1 bowl of rice normally) and regular bowel movements in those with gastrointestinal symptoms; reduction of dizziness attacks when standing in those with orthostatic hypotension.

2. Functional recovery: Increased leg strength (ability to climb stairs independently) and increased calf circumference in people with muscular weakness; healing of foot skin clefts and subsidence of redness and swelling in people with diabetic feet; neurological conduction velocity review prompts “conduction velocity is faster than before” (such as from 35m/s to 40m/s).

If symptoms do not improve after 8 weeks of medication (such as widening numbness, worsening pain, formation of foot ulcers), or new symptoms (such as severe diarrhea, syncope), the medication needs to be stopped and medical treatment is required (the program is adjusted to check for other complications).

3. Uncomfortable medication? Dispose of it as such

– Slight discomfort (common reactions): Mild diarrhoea, occasional after administration of epastat Rash (It will relieve on its own in 1-2 weeks); Midodrine may cause dry mouth (drinking more warm water, 1.5-2L per day can relieve it); duloxetine may cause dizziness in the early stage (it can be relieved by getting up slowly and avoiding sudden head turns).

– Obvious discomfort (need to be vigilant): Rash and itching (anaphylaxis) occur after taking amoxicillin and clavulanate potassium, and the drug should be stopped immediately; if methylcobalamin is taken for a long time (＞6 months), poor appetite and fatigue need to be checked Liver and kidney function (excluding drug accumulation); if pregabalin causes edema of the lower limbs, It is necessary to check the kidney function (to prevent the medicine from affecting the kidney drainage).

4. Medication courses and precautions

– Time to onset of action: Pain relief (Scheme 2) can be seen in 1-2 weeks; it takes 3-4 weeks to improve numbness and neurometabolism (Schemes 1, 7); it takes 4-6 weeks to repair muscle and autonomic nerve function (Schemes 4, 6).

– Course recommendations:

– Mild/preventive problems (scheme 7): take continuously for 6-12 months, then reduce to once daily after symptoms stabilize (maintain for 6 months);

– Moderate to severe problems (schemes 2, 4, 5): Consolidate for 1-2 months after symptom relief, and then gradually reduce the dose (for example, pregabalin is reduced from 2 times to 1 time per day);

– Chronic repair problems (schemes 1 and 6): It needs to be taken for a long time (6-12 months), and the dose should be adjusted regularly.

5. Keep these taboos in mind and avoid making mistakes

– Core principle: It is contraindicated for those who are allergic to pharmaceutical ingredients (such as yes) Penicillin Amoxicillin clavulanate potassium is contraindicated in those with allergies; use epastat and pregabalin with caution in those with severe renal impairment (creatinine clearance ＜30 ml/min) (reduce the dose to prevent drug accumulation); severe Heart failure Midodrine is contraindicated (may increase heart burden).

– Special groups: Duloxetine and midodrine are contraindicated in pregnant women (may affect the fetus); lactating women need to suspend breastfeeding (consult a doctor); the elderly (＞65 years old) need to take midodrine at a low dose (1.25 mg/time) Start monitoring blood pressure; Medication for diabetic neuropathy in children (＜18 years) requires physician evaluation (safety data are limited).

– Avoid incorrect combinations: Pregabalin is not taken with sedatives (such as diazepam) (aggravated) Somnolence , dizziness); duloxetine is not associated with monoamine oxidase inhibitors (eg Selegiline ) taken together (may cause serious adverse reactions); epasastat is not used with hypoglycemic drugs (eg Insulin ) Blind combination (needs to monitor blood sugar to prevent hypoglycemia).

6. Do 2 things well to assist nerve repair

1. Life care: strict sugar control (monitor blood sugar daily, use hypoglycemic drugs/insulin as directed by the doctor, control glycated hemoglobin below 7%); foot care (wash feet and check daily to avoid burns and trauma); regular exercise (such as brisk walking, Tai Chi , 30 minutes each time, once a day, to promote blood circulation and assist nerve repair).

2. Dietary conditioning: supplement B vitamins (eat more lean meat, eggs, spinach to assist neurometabolism); control salt and fat ＜daily salt 5g, eat less fat, prevent Hypertension , Hyperlipidemia Aggravate nerve damage); avoid high-sugar and spicy foods (such as sweets and chili peppers, reduce nerve irritation).

The core of the treatment of diabetic neuropathy is “early detection and early intervention”—— regular screening of neurological function (once a year) is required after the diagnosis of diabetes, and timely medication is used in case of numbness and pain. It is necessary to combine sugar control and life adjustment during medication to better repair nerve damage, relieve symptoms, and avoid serious complications (such as foot ulcers and amputations).