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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Diabetic, Have Issues With Neuropathy. Advisable Treatment?

My father is a diabetes patient who lives in South Asia. He is looked after by my brother who is a physician (pathologist) there. My father is currently having some issues with Neuropathy. Since I live in Canada, my brother asked me to consult with a physician from North America as he thinks there may be advanced medicines to help my father. My brother sent me the case history of my father and he also sent two questions. Please read them and any answer would be appreciated. Best regards. Patient details:- Age: 66 yrs Sex: male Weight: 59 kg, height: 1.74 meter.Chief complaints:- 1.     Severe weakness and parasthesia for 6 months. 2.     Severe Gastric irritation for 6 month. 3.     Burning sensation of whole body all day long during gastric exacerbation.History of present illness:- 1.     DM for 20years. RBS is within normal limit with medication of soluble insulin. 2.     Neuropathy and Gastroperesis due to long time DM. History of past illness:- 1.     Steven-Johnson syndrome 30 yrs back.Drug (medication) history:- 1.     Sulpher sensitive patient 2.     Now patient is taking the following drugs: a.     Insulin. Mixtard 30 (22+0+6unit) b.     Tab. Neuro B( Vit B1+B6+B12) c.     Tab. Mecobalamin. d.     Cap. Rabeprazole. e.     Tab. Flupenticzole+ Melitracin Question:- 1.     If there any supplement preparation that can reduce the symptom of Neuropathy and gastroperesis? 2.     If there any enzyme preparation that can help in digestion of a patient of gastroperesis and reduce the symptom of gastric irritation?
Wed, 15 May 2013
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General & Family Physician,  's  Response
Hello,
Despite advances in the understanding of the metabolic causes of neuropathy, treatments aimed at interrupting these pathological processes have been limited. Thus, with the exception of tight glucose control, treatments are for reducing pain and other symptoms.
These include ...
tricyclic antidepressants (TCAs), serotonin reuptake inhibitors (SSRIs) and antiepileptic drugs (AEDs). A systematic review concluded that "tricyclic antidepressants and traditional anticonvulsants are better for short term pain relief than newer generation anticonvulsants."
A combination of these medication (gabapentin + nortriptyline) may also be superior to a single agent.
The only three drugs approved by the FDA for diabetic peripheral neuropathy are the antidepressant duloxetine, the anticonvulsant pregabalin, and the long-acting opioid tapentadol ER.
As far as treatment of gastroparesis is concerned ,apart from trying methods like....
Eating smaller meals more frequently
Low fat foods
Avoiding fibrous fruits and vegetables
Taking more of liquid diet
Drinking more water and going for walk after meals
The medications used are medicines for..
Control of nausea and vomiting like PROCHLORPERAZINE
Medicines to stimulate muscles of stomach like METOCLOPRAMIDE.
Keep giving Tab neuro B and MECOBALAMIN

You must discuss with your treating doctor and try different combinations of medicines for the patient.
Thanks
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Diabetic, Have Issues With Neuropathy. Advisable Treatment?

Hello, Despite advances in the understanding of the metabolic causes of neuropathy, treatments aimed at interrupting these pathological processes have been limited. Thus, with the exception of tight glucose control, treatments are for reducing pain and other symptoms. These include ... tricyclic antidepressants (TCAs), serotonin reuptake inhibitors (SSRIs) and antiepileptic drugs (AEDs). A systematic review concluded that tricyclic antidepressants and traditional anticonvulsants are better for short term pain relief than newer generation anticonvulsants. A combination of these medication (gabapentin + nortriptyline) may also be superior to a single agent. The only three drugs approved by the FDA for diabetic peripheral neuropathy are the antidepressant duloxetine, the anticonvulsant pregabalin, and the long-acting opioid tapentadol ER. As far as treatment of gastroparesis is concerned ,apart from trying methods like.... Eating smaller meals more frequently Low fat foods Avoiding fibrous fruits and vegetables Taking more of liquid diet Drinking more water and going for walk after meals The medications used are medicines for.. Control of nausea and vomiting like PROCHLORPERAZINE Medicines to stimulate muscles of stomach like METOCLOPRAMIDE. Keep giving Tab neuro B and MECOBALAMIN You must discuss with your treating doctor and try different combinations of medicines for the patient. Thanks