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Dx Diabetes Neuropathy Treatment: Read more..


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Consensus
The consensus is that the prevention and treatment of peripheral neuropathy is tight glycemic control (see diabetes Type I), it seems to have a restricted role with type 2 diabetes in which other metabolic factors are involved. The diagnosis of neuropathy due to B12 [aother B] vitamin deficiency remains a real challenge for the clinician. Indeed, positive and negative predictive values of serum B12 and metabolites assay are weak, only a good therapeutic response allows a reliable diagnostic." Furthermore, "B12 injections were more effective than nortriptyline for the treatment of symptomatic painful diabetic neuropathy." [Editor] A diabetic former pharmacist found that weekly injections of 5000iu of methanocolbamin gave measurable improvement to the physician's prick test. After 3 months, he reduced the dosage to 2500iu per week and the improvement continues.


Diabetic Neuropathy

WebMD states that there is no treatment for diabetic neuropathy. Best avenue is prevention.
N.H.S. Choice states "If the peripheral nerves become damaged it can cause the following symptoms: numbness and tingling in the feet and hands a burning, stabbing or shooting pain loss of co-ordination in the affected body parts muscle weakness Generally, the sooner that peripheral neuropathy is diagnosed the lower the chance of developing serious complications. That means it is important to see a GP if you experience symptoms of peripheral neuropathy.

In England, diabetes (both type 1 and type 2) is the most common cause of peripheral neuropathy. Over time, the high blood sugar levels associated with diabetes can damage the nerves. This type of nerve damage is known as diabetic polyneuropathy. It is estimated that around one in five people with diabetes has diabetic polyneuropathy. Peripheral neuropathy can have a wide range of other causes. For example, it can be caused by a viral infection, such as HIV, or as a side effect of certain medications. People who are at increased risk of periperhal neuropathy are recommended to have regular check-ups so that their nerve function can be assessed.

Peripheral neuropathy is a relatively common condition that affects around one in 50 people in England. Peripheral neuropathy usually affects older people: 8% of people who are 55 or over are affected by it.

The outlook for peripheral neuropathy can vary widely depending on the underlying cause and what sort of peripheral nerves have been damaged. For example, if the sensory nerves of the hands or feet are affected, the outlook is generally good. However, it is important that the underlying cause, often diabetes, is treated.

This is because over time, diabetic polyneuropathy can cause a diabetic foot ulcer (an open sore that develops in the foot). If the ulcer becomes infected, there is a risk that the foot tissue will begin to die and it may be necessary to amputate the foot.

The outlook is not so good in cases where neuropathy affects the automatic functions of the heart and circulation system (cardiovascular automatic neuropathy). This is because the condition can increase the risk of sudden death as a result of the heart suddenly stopping (cardiac arrest)."

The best treatment is tight glycemic (glucose) control.
It has been reported that a striking amelioration of symptoms can occur with continuous subcutaneous insulin administration, which may reduce the amplitude of excursions of blood glucose.

Medications Used in Treatment:
1. Alpha-lipoic acid
2. Topical capsaicin
3. Lidocaine patch
4. Pain Medication: Tramadol
6. Tricyclic Antidepressants: Amitriptyline, Duloxetine
7. SNRIs: Venlafaxine may be added to gabapentin:
8. Anabolic Steroids:

Suggested Links
*American Diabetes Association

*[Editor]: Lyrica fares no better than gabapentin in treating this condition. Lidoderm patches are equivalent. Lyrica®/pregabalin was of no proven benefit when given orally: Sufficient doses of pregabalin provided through intranasal or intrathecal methods ameliorated tactile allodynia and thermal hypersensitivity due to spinal nerve ligation or diabetic peripheral neuropathy, but there was no benefit of providing pregabalin at the level of the peripheral nerve.

*[Editor] Diabetic men should be on testosterone/ anabolic therapy (except when excluded by cancer concerns) for prevention of disease progression. This aspect of medical knowledge is clear now.
1. Every man with diabetes is testosterone deficient and peripheral neuropathy at this time is probably not treatable.
2. Testosterone cypionate 100mg intramuscular injection every 5 days costs less than $50.00 for 20 doses [100 days].
3. Nandrolone 50mg intramuscular weekly is anti-inflammatory, supports bone and muscle growth (reducing osteoporosis and muscle wasting) and reduces the need for EPO
(should the person be on dialysis).

*[Editor- Case Report] The form of Vitamin B12 that seems most effective is compounded methyl-cobalamin at doses of 1000-1500 mcg intramuscularly each week. The "Treatment with oral L-MethylFolate-MethylColbalamin-Pyridoxal 5'Phosphate appears to promote restoration of lost cutaneous sensation in Diabetes Peripheral Neuropathy". Combined with testosterone injections or implants, our patient reported reversal of the diabetic neuropathy he had had for 18 months prior to 24 months of treatment with testosterone alone.

*[Editor] The Chinese reported more improvement adding daily lipic acid (300-600mg) intravenously.
All the B vitamins are important and will reduce elevated homocysteine as well.


*[Editor]See Breakthrough in Diabetes: Lecture Series
[Editor] A comprehensive Cochrane Database Review of Chinese Herbal Medication shows that CHM was dramatically beneficial in the clinical trials reviewed when compared [or combined] with mecobalamin (a co-enzyme form of B12),however but not placebo. There was not enough scientific data to make recommendations although the article listed the following Chinese Herbs: milkvetch root, Chinese angelica, sichuan lovage rhizome,peony root, danshen root, earthworm, suberect spatholobus stem, safflower, cassia twig, unprocessed rehmannia root, peach seed liquorice root, kudzvine root, leech and debark peony root.
Mecobalamin is available in the U.S. over-the-counter as oral and topical preparations.

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