Dongosolo la matenda ashuga: matenda, mankhwala ndi kupewa

Matenda a shuga ndi matenda opatsirana a shuga a m'mitsempha amawonongeka chifukwa cha zovuta za metabolic zomwe zimachitika chifukwa cha matenda a shuga. Matendawa amawonetsedwa ndi kusamva bwino komanso kusagwira bwino ntchito.

Matenda a diabetes a neuropathy ali ponseponse ndipo amapezeka, malinga ndi olemba osiyanasiyana, mu 30-50% ya odwala omwe ali ndi matenda amtundu uliwonse.

Zoyambitsa ndi Zoopsa

Udindo waukulu mu pathological limagwirira a diabetesic neuropathy ndi wa micangiopathies, ndiko kuti, kuwonongeka kwamitsempha yamagazi yaying'ono yomwe imadyetsa makhoma onse a mitsempha komanso mitsempha yodutsa. Kusakwanira kwa magazi ku mitsempha ya mitsempha kumayambitsa kusokonezeka kwa metabolic mmenemo ndipo kumathandizira kuti pakhale kuchuluka kwa zopsinjika zama oxidative. Zotsatira zake, minofu yamanjenje imatupa, kayendetsedwe kazinthu zamagetsi zimakulirakulira. Mapeto ake, mitsempha ya mitsempha ya mitsempha.

Zinthu zomwe zimawonjezera mwayi wokhala ndi matenda a shuga:

• ukalamba
• ochepa matenda oopsa
• hyperglycemia
• yaitali matenda a shuga,
• kusuta
• kunenepa.

Mitundu ya matenda

Kutengera zojambula pamwambazi, pali:

• autonomic neuropathy. Zimagwirizananso ndi kuphwanya kwamkati ziwalo zamkati,
• zotumphukira neuropathy. Nthawi zambiri mitsempha ya msana imakhudzidwa.

Muzochita zamankhwala, gulu la syndromic limagwiritsidwa ntchito kwambiri:

1. Makamaka symmetric polyneuropathy. Kutengera ndi chotupa chachikulu cha zomverera kapena ma motor ma motor, chimagawidwa mu sensor ndi motor neuropathy, motsatana. Ndi zowonongeka nthawi imodzi yamitundu iwiri yamitse mitsempha, amalankhula za neuropathy yophatikizika.
2. Autonomic (vegetative) neuropathy. Imagawika mu sudomotor, mtima, kupuma, urogenital ndi m'mimba.
3. Multifocal (focal) neuropathy. Zimaphatikizira kutupa kosachiritsika kwamatenda, kukhathamira, cranial neuropathy, plexopathy (radiculoneuropathy), amyotrophy.

Nthawi zina mu mawonekedwe osiyana, ma neuropathy apakati amasiyanitsidwa, omwe amadziwonetsa:

• ngozi zapamsewu,
• encephalomyelopathy
• zovuta zamavuto amisala.

Magawo a matenda

Magawo atatu a matenda ashuga a m'mimba amadziwika:

1. Zachidule.
2. Clinical (mawonekedwe osapweteka, owawa komanso osapweteka).
3. Gawo la zovuta zakuchedwa (matenda ashuga, kupunduka kwa phazi, ndi zina).

Matenda a diabetes a neuropathy ali ponseponse ndipo amapezeka, malinga ndi olemba osiyanasiyana, mu 30-50% ya odwala omwe ali ndi matenda amtundu uliwonse.

Njira yodziyimira yodwala matenda a shuga imadziwika ndi:

• kumverera kwa kumva kulira, kuwotcha, khungu la khungu (paresthesia),
• nyama yamatumbo yamatumbo,
• kupweteka kwa zala ndi zala zakumanja, manja ndi mapazi,
• kuchepa kwa kutentha kwa kutentha
• kuchuluka tactile sensitivity (hyperesthesia),
• kufooka kwa minofu
• kufooketsa zovuta zakuya kwa tendon Reflex,
• kusokoneza kayendedwe ka kayendedwe ndi gait.

Kupweteka kwanthawi yayitali kumayambitsa kusowa tulo, komanso kukhumudwa kwambiri.

Ndi kudziyimira pawokha matenda ashuga neuropathy, zotupa za autonomic mantha dongosolo zomwe mkati mwa ziwalo zimawonedwa, zomwe zimayambitsa kusokonezeka kwa ntchito zawo. Chithunzi cha matenda amtunduwu cha matenda chimatsimikiziridwa ndi momwe ziwalo zina zimagwirira ntchito mokulira:

1. Mtima ndi matenda a mtima. Amayamba zaka zoyambira maphunziro a shuga. Tachycardia, orthostatic hypotension (kuchepa kwa kuthamanga kwa magazi pomwe wodwala asunthira m'malo), ndikusintha kwina kwa electrocardiogram (kukulitsa nthawi ya QT) ndizodziwika. Chiwopsezo chokhala ndi mawonekedwe osapweteka a myocardial infarction ukuwonjezeka.
2. Gastrointestinal diabetesic neuropathy. Zowonetsedwa bwino ndi hypersalivation, gastroparesis (kuphwanya m'mimba motility), matenda a gastroesophageal Reflux. Odwala nthawi zambiri amapezeka ndi zilonda zam'mimba ndi duodenal, gallbladder dyskinesia, acidity gastritis, matenda a ndulu, ndi hepatosis yamafuta.
3. Urogenital diabetesic neuropathy. Pali kuphwanya kwamvekedwe kwa ma ureters ndi chikhodzodzo, komwe kumayambitsa kukodzetsa kwamkodzo kapena kwamikodzo, ndikupanganso zofunikira pakukula kwa njira yotupa komanso yotupa ya kwamkodzo thirakiti (cystitis, pyelonephritis). Kwa amuna, urogenital neuropathy imatha kuyambitsa kuphwanya kwamphamvu kwa testicles ndi kusowa kwa erectile, ndipo mwa azimayi - anorgasmia ndi kuuma kwa mucosa ya ukazi.
4. Sudomotor diabetesic neuropathy. Amadziwika ndi kutuluka thukuta la thupi lonse (chapakati pa hyperhidrosis) ndi thukuta lochepetseka la manja ndi mapazi (ndi distal an- kapena hypohydrosis). Kuwonetsera kumeneku kwa neuropathy kumawonekera bwino usiku komanso pakudya.
5. Kupuma matenda a shuga. Zimaphatikizidwa ndi kuchepa kwa kaphatikizidwe ka surapyant, kupumira kwamapapo, nthawi zamapapo.

Popewa kukula kwa matenda ashuga a m'mimba, ndikofunikira kuyendetsa shuga m'magazi, idyani pomwepo ndikukhala ndi moyo wokangalika.

Zizindikiro

Kuzindikira matenda am'mbuyomu, makamaka mawonekedwe amtundu wamatenda, nthawi zambiri kumakhala kovuta. Choyamba, anamnesis amawunika, kenako kumayesedwa, komwe kumaphatikizapo:

• Kutsimikiza kwa ndende ya shuga, insulin, glycosylated hemoglobin, C-peptide mu seramu yamagazi,
• kuthamanga kwa magazi
• kutsimikiza kwa pulsation wa zotumphukira mitsempha,
• kupenda bwino kwamapazi kuti mupeze chimanga, chimanga, zotupa zam'mimba, zopunduka.

Kuphatikiza pa endocrinologist, akatswiri ena opapatiza (neurologist, gastroenterologist, cardiologist, gynecologist, andrologist urologist, ophthalmologist, podologist, orthopedist) amatenga nawo mbali pakuzindikira matenda am'mimba.

Pamaso pa matenda azachipatala zowonongeka pamtima, mtima woyeserera wa algorithm umathandizidwa ndi ECG, echocardiography, mtima mayesero (orthostatic mayesero, mayeso a Valsalva). Kuyesedwa kwa magazi kumachitidwanso chifukwa cha zomwe zili za lipoproteins ndi cholesterol.

Kuunika kwa mitsempha yodwala matenda a shuga

• electroneurography
• electromyography
• kuwunika kwa mitundu yosiyanasiyana komanso kosiyanasiyana kwa zomverera (zamkati, zododometsa, kutentha mtima, kutentha, kupweteka).

Ndi atypical maphunziro a matenda ashuga a m'mimba, kungakhale kofunikira kuchita zotsalira za pakhungu ndi (kapena) mitsempha ya ng'ombe, kenako ndikuwunika kwa zomwe zidapezeka.

Ndi zizindikiro zamatumbo am'mimba, zotsatirazi zikuwonetsedwa:

• Mayeso a Helicobacter
• Ultrasound yam'mimba,
• kusiyanitsa mawonekedwe am'mimba ndi matumbo,
• Endoscopy.

Kuzindikira mtundu wa urogenital mawonekedwe a matenda a shuga

• urinalysis
• Mayeso a Nechiporenko,
• Zitsanzo za Zimnitsky,
• electromyography minofu ya chikhodzodzo,
• intravenous urography
• cystoscopy
• Ultrasound a impso ndi chikhodzodzo ndi kuvomerezedwa kutsimikiza kwa kuchuluka kwa mabowo mkodzo.

Mankhwalawa a matenda a shuga aubongo amakhala aatali komanso ovuta, okhudza njira zosiyanasiyana za matenda. Ndikofunikira kuti pakhale chiphuphu cha shuga. Chifukwa cha izi, polamulira shuga mu seramu yamagazi, Mlingo wofunikira wa mankhwala a hypoglycemic kapena insulin amasankhidwa. Kuphatikiza apo, kusintha kwa moyo kumafunika:

• mulingo woyenerera mwamphamvu (tebulo Na. 9 malinga ndi Pevzner),
• zolimbitsa thupi zolimbitsa thupi,
• kulimbitsa thupi.

Kusintha machitidwe a metabolic, mavitamini a B, antioxidants (vitamini E, alpha-lipoic acid), zomwe zimayambira (zinc ndi magnesium kukonzekera) zimayikidwa.

Ndi zowawa zazikulu, mankhwala osapweteka a antiidal omwe akuwonetsedwa, komanso anticonvulsants.

Njira zochitira masewera olimbitsa thupi zimagwiritsidwa ntchito: acupuncture, kuwala pang'ono, mankhwala a laser, magnetotherapy, kukondoweza kwa magetsi m'mitsempha, kutikita minofu.

Kusamalidwa koyenera kwamapazi ndikofunikira:

• kupukuta khungu la mapazi ndi kirimu wapadera,
• osambira pafupipafupi phazi
• pedicure wamankhwala
• kuvala nsapato zapamwamba zomwe sizimeza phazi komanso osalipaka (ngati kuli kotheka, valani nsapato zamatumbo).

Therapy a mitundu ya matenda am'mbuyomu neuropathy iyenera kuchitika polingalira zomwe zimapangidwa mu matenda azachipatala.

Mavuto omwe angakhalepo komanso zotsatirapo zake

Zovuta zazikulu za zotumphukira za mtundu wa matenda ashuga ndi:

• kugwa kwa phazi,
• kusintha kwamiyendo kwa zala,
• zilonda zamkhungu zolakwika zam'munsi,
• odwala matenda ashuga phazi.

Kupweteka kwanthawi yayitali m'mapazi ndi m'manja ndi matenda am'mimba amachititsa matenda osokoneza bongo, kenako, kukhumudwa kwambiri.

Komanso matenda a shuga a shuga angayambitse Kukula kwa:

• asymptomatic hypoglycemia,
• kuphwanya kwamalonda,
• chizindikiro hemeralopia,
• diplopia
• kutopa kwapang'onopang'ono (matenda a shuga cachexia).

Ndi matenda oyamba ndi chithandizo cha matenda ashuga a mtima, ndiyotheka kuyimitsa matendawa. Matenda apamwamba a mitundu yovuta ya matenda ashuga ndioperewera.

Kupewa

Popewa kukula kwa matenda a shuga a matenda ashuga, muyenera:

• Mphamvu ya shuga ndende mu magazi seramu,
• chakudya
• zolimbitsa thupi koma zolimbitsa thupi,
• kutsatira kwambiri malangizo a insulin kapena makonzedwe othandizira odwala omwe amachepetsa shuga,
• munthawi yake matenda oyanjana,
• mayeso okhazikika a endocrinologist, neurologist ndi akatswiri ena othandizira.

Kanema wochokera pa YouTube pamutu wankhani:

Maphunziro: Ndinamaliza maphunziro ku Tashkent State Medical Institute ndi digiri ya zamankhwala mu 1991. Mobwerezabwereza anachita maphunziro apamwamba kwambiri.

Zochitika kuntchito: wogonetsa-wausiku wothandizirana ndi mzimayi, wogwirizananso ndi dipatimenti ya hemodialysis.

Chidziwitsocho chimapangidwa ndikupatsidwa chidziwitso chokhacho. Onani dokotala wanu chizindikiro choyamba cha matenda. Kudzipatsa nokha mankhwala kuopsa!

Peripheral Polyneuropathy

Peripheral Polyneuropathy yodziwika ndi kuwonongeka kwa mitsempha yotumphukira yam'munsi komanso m'munsi. Pali kugunda kwamphamvu, dzanzi, kupweteka, makamaka usiku, kumverera kwa "kukwawa."

Kuchepera kufooka miyendo, kusakhazikika kwa nyambo, kusokonekera kwamikono m'manja ndi m'miyendo. Mawonetsedwe amtunduwu wa polyneuropathy nthawi zambiri amatsogolera matenda ashuga a phokoso.

Autonomic neuropathy

Mawonetsero azachipatala a autonomic neuropathy ndi osiyanasiyana, zomwe zimabweretsa zovuta zazikulu pakuzindikira.

Mtima mawonekedwe limayamba chifukwa cha kuwonongeka kwa mitsempha yodziyimira payokha, kupereka chitetezo chamkati pamtima. Zotsatira za kuwonongeka kwa mitsempha ya vagus, njira yachifundo pamtima wa mtima imayamba kupezeka, kugunda kwamtima kwadzidzidzi kumawonekera - tachycardia, yomwe imapitilira masewera olimbitsa thupi ndikupuma, hypthension ya orthostatic, magawo a kuchepa kwa chikumbumtima - zochitika za syncopal zitha kudziwika. Autonomic cardiovascular neuropathy ndiye chifukwa chachikulu chopweteketsa myocardial infarction mwa odwala matenda a shuga.

At mawonekedwe am'mimba neuropathies amakhala ndi zovuta zamagetsi ndi kutuluka kwa m'mimba, gastroparesis, gastroesophageal Reflux. Nthawi zambiri pamakhala dyskinesia wa ndulu, matenda a ndulu, mavuto a peristalsis.

Mawonekedwe a urogenital kuwonetseredwa mwa kuphwanya mamvekedwe a chikhodzodzo ndi ma ureters, kukodza kwamkodzo, kusungika kapena kwamikodzo, kuchepa potency. Matenda amkodzo amathanso kulowa. Chifukwa mawonekedwe kupuma magawo a kulephera kupuma, kugona kwa usiku.

Pathogeneis ndi gulu

Zotsatirazi ndizofunikira kwambiri mu pathogenesis ya DPN:

1. Microangiopathy (kusintha komwe kumagwira ntchito komanso / kapena m'mapangidwe omwe amapanga ma microcirculation a mitsempha ya ulusi).

2. Matenda a Metabolic:

• Kachitidwe ka polyol shunt (njira ina ya kagayidwe kakang'ono ka shuga, momwe amasinthidwa kukhala sorbitol (pogwiritsa ntchito enzyme aldose reductase) kenako fructose, kudzikundikira kwa metabolites kumeneku kumabweretsa kuwonjezeka kwa osmolarity a malo a interellular).
• Kuchepa kwa mulingo wa myo-inositol, komwe kumabweretsa kuchepa kwa kapangidwe ka phosphoinositol (gawo lama membrane a maselo amitsempha), lomwe pamapeto pake limathandizira kuchepa kwa mphamvu ya metabolism komanso kusokoneza mitsempha.
• Zosapanga enzymatic komanso enzymatic glycation zama protein (glycation of myelin ndi tubulin (zigawo zikuluzikulu zamitsempha) zimayambitsa kuchepa kwa mitsempha komanso kuwonongeka kwa mapangidwe a mitsempha, glycation yamapuloteni oyambira apansi a capillaries amatsogolera pakukula kwake ndi ma metabolic mu michere yamitsempha.
• Kuchulukitsa kwa oxidative nkhawa (kuchuluka kwa okosijeni wa glucose ndi lipids, kuchepa kwa chitetezo cha antioxidant kumathandizira kudziunjikira kwa ma radicals aulere omwe ali ndi cytotoxic athari).
• Kupanga kwa autoimmune complexes (malingana ndi malipoti ena, ma antibodies ku insulin amalepheretsa kukula kwa mitsempha, komwe kumayambitsa kuwonongeka kwa ulusi wamitsempha).

Kugwirizana pakati pazinthu zosiyanasiyana za pathogenesis ya DPN kukuwonetsedwa Chithunzi 1.

Gulu ndi mawonekedwe akulu azachipatala a DPN

Distal sensory kapena sensorimotor neuropathy

Ndi ululu wocheperako wa ulusi yaying'ono:

• kuwawa kapena kuwawa
• hyperalgesia
• paresthesia
• kuchepa kwa ululu kapena kutentha kwa kutentha,
• zilonda zam'mapazi,
• kusowa kwa kupweteka kwamaso.

Ndi kuwonongeka kwakanthawi kwamafuta akulu:

• kutayika kwa kugwedeza mphamvu
• kutayika kwa chidwi,
• osangalatsa.

Mankhwala Neuropathy

Pachimake ululu neuropathy

Matenda ochititsa chidwi a demyelinating neuropathy

• Zosokoneza ana.
• Kusokonekera Kwachisoni.
• Asymptomatic hypoglycemia.
• Autonomic gastrointestinal neuropathy:
• atony wam'mimba,
• atony wa ndulu,
• matenda ashuga a m'mimba ("noarrurnal diarr"),
• kudzimbidwa
• fecal kulephera.
• Autonomic neuropathy yamtima dongosolo:
• ischemia yopanda ululu,
• orthostatic hypotension,
• kutentha kwa mtima
• orthostatic tachycardia,
• tachycardia yopuma,
• kugunda kwamtima
• kusintha kwa mizere ya circadian,
• utachepa masewera olimbitsa thupi.
• Autonomic neuropathy ya chikhodzodzo.
• Autonomic neuropathy ya njira yoberekera (erectile dysfunction, retrograde ejaculation).

Focal ndi multifocal neuropathies

• Oculomotor nerve (III).
• Mtsempha wamafupa (VI).
• Thirani mitsempha (IV).

Asymmetric proximal m'munsi miyendo neuropathy

• Asymmetric proximal motor neuropathy.
• Ululu kumbuyo, m'chiuno, mawondo.
• Kufooka ndi kuwongolera kwa chosinthika, chowonjezera ndi minyewa ya quadriceps yamatumbo.
• Kutayika kwa Reflex kuchokera ku quadriceps tendon.
• Zosintha zazing'ono zamalingaliro.
• Kuchepetsa thupi.

• Ululu umawonetsedwa kumbuyo, pachifuwa, m'mimba.
• Kuchepetsa mphamvu kapena kukomoka.

• Kuponderezana (phokoso):
  • nthambi yam'manja: mitsempha yapakati
  • nthambi yam'munsi: mitsempha ya tibial, mitsempha yamkati.
• Osakakamizidwa.

Kuchiza ndi kupewa DPN

Cholinga chachikulu cha chithandizo ndi kupewa DPN ndikuwongolera kwa glycemic control. Kafukufuku wambiri womwe wachitika zaka zaposachedwa watsimikizira motsimikiza kuti kukwaniritsa kuchuluka kwa shuga m'magazi mkati mwa tsiku 1 kumalepheretsa kukula kwa chiwonetsero cha DPN. Chithandizo chamakono kwambiri komanso chothandiza kwambiri cha neuropathy sichingathandize popanda kulipira chindapusa cha matenda ashuga.

Ndikudziwika kuti mu shuga mumakhala kuchepa kwa mavitamini ambiri ndikutsata, komabe, pochizira DPN, gawo lofunikira kwambiri limasewera ndikuchotsa kuchepa kwa mavitamini a gulu B. Neurotropic mavitamini (gulu B) ndi coenzymes omwe akukhudzidwa ndi njira zosiyanasiyana zamankhwala amuzolengedwa, kusintha mphamvu zama cell, ndikuletsa kupanga kwa zinthu zotsiriza glycation wa mapuloteni. Kukonzekera kwa mavitaminiwa agwiritsidwa ntchito pochiza DPN kwa nthawi yayitali. Komabe, kuphatikiza kwa mavitamini B onse kumawonjezera jakisoni kapena mapiritsi ena pang'ono pothandizira odwala, zomwe ndizovuta kwambiri. Mankhwala a Neuromultivitis amapewa kuchuluka kwa mankhwala ambiri, popeza piritsi limodzi, lomwe limapangidwa ndi filimu, lili kale:

• thiamine hydrochloride (vitamini B1) - 100 mg,
• pyridoxine hydrochloride (vitamini B6) - 200 mg,
• cyanocobalamin (vitamini B12) - 0,2 mg.

Thiamine (Vitamini B1) m'thupi la munthu chifukwa cha njira ya phosphorylation amasinthidwa kukhala cocarboxylase, womwe ndi coenzyme yomwe imakhudzidwa ndi mitundu yambiri ya enzymatic. Thiamine amagwira ntchito yofunika kwambiri pakuphatikiza chakudya chamthupi, mapuloteni ndi mafuta, amagwira ntchito mokhudzana ndi kupatsirana kwamanjenje mu ma synapses.

Pyridoxine (Vitamini B6) ndi yofunikira pakugwira bwino ntchito kwa chapakati ndi zotumphukira zamanjenje. Mu mawonekedwe a phosphorylated, ndi coenzyme yomwe imakhudzidwa ndi metabolism ya amino acid (decarboxylation, transamination, etc.). Imagwira ngati coenzyme ya michere yofunika kwambiri yomwe imagwira minyewa yamitsempha. Amagwira nawo biosynthesis yama neurotransmitters ambiri, monga dopamine, norepinephrine, adrenaline, histamine ndi γ-aminobutyric acid.

Cyanocobalamin (Vitamini B12) ndiyofunikira pakapangidwe kabwino ka magazi ndi kusokonekera kwa erythrocyte, komanso imachita nawo zochitika zingapo zamatsenga zomwe zimatsimikizira kuti ntchito yofunikira ya thupi: kusintha kwamagulu a methyl (mapuloteni ena osakanikirana, kuphatikizira kwa ma acid acid, mapuloteni, kusintha kwa ma amino acid, ma carbohydrate. Imakhala ndi phindu pamapulogalamu amanjenje (kaphatikizidwe kazinthu zama acid ndi lipid zomwe zimapangidwa ndi cerebrosides ndi phospholipids). Mitundu ya Coenzyme ya cyanocobalamin - methylcobalamin ndi adenosylcobalamin ndiyofunikira pakubwereza kwa cell ndikukula.

Kafukufuku wokhudzana ndi mawonekedwe amomwe amapezeka ndi mankhwalawa kwa odwala omwe ali ndi matenda a shuga a 2 akuwonetsa kuti Neuromultivitis imathandizira kwambiri pakuwoneka bwino kwa miyendo, komanso imachepetsa mwamphamvu kulimba kwa ululu wammbuyo. Izi zikuwonetsa kuchepa kwa chiwopsezo cha kukhala ndi zilonda zam'mapazi a trophic komanso kuwonjezeka kwa moyo wa odwala omwe ali ndi distal DPN. Tiyeneranso kudziwa kufunika kwa kuchititsa maphunziro panjira ya mankhwala, chifukwa mankhwalawa safuna kuti pakhale makolo.

Alpha lipoic acid ndi coenzyme ya michere yofunika ya kuzungulira kwa Krebs, yomwe imakulolani kuti mubwezeretsenso mphamvu zamagetsi, komanso antioxidant (monga othandizira zachilengedwe), zomwe zimapangitsa kuti pasakhale kuwonongeka kwina kwa mitsempha komanso kuteteza minofu ya mitsempha ku ma radicals omasuka. Poyamba, kwa masabata 2-2. (maphunziro osachepera - 15, molondola - 20) α-lipoic acid amamulembera ngati kulowetsedwa kwa iv. Pambuyo pake, amasintha mapiritsi okhala ndi 600 mg ya α-lipoic acid, piritsi limodzi / tsiku kwa miyezi 1.5-2.

Zochizira mtundu wopweteka wa DPN, ma analgesics osavuta, mankhwala osapweteka a antiidal (acetylsalicylic acid, paracetamol) akhoza kuwonjezeredwa pamankhwala omwe ali pamwambawa. Pakati pawo, ndikofunikira kuzindikira mankhwala a Neurodiclovit, okhala ndi mavitamini a diclofenac ndi B (B1, B6, B12), omwe ali ndi kutchulidwa kwa analgesic, anti-inflammatory and antipyretic.

Kugwiritsa ntchito kwa magulu oterewa ngati tricyclic antidepressants (amitriptyline 25-50-100 mg usiku), gabapentin (koyamba mlingo - 300 mg, kuchuluka kwa 300 mg tsiku lililonse la 1-3, mlingo waukulu - 3600 mg), pregabalin (mlingo woyambayo) akuwonetsedwa - 150 mg, kuchuluka mpaka 300 mg m'masiku 3-7, mlingo wokwanira - 600 mg (wogawidwa pamiyeso iwiri), duloxetine (koyamba mlingo - 60 mg 1 r. / Tsiku, nthawi zina amakwera mpaka 60 mg 2 r. / tsiku, mlingo waukulu ndi 120 mg).

Mankhwalawa autonomic m'mimba neuropathy amagwiritsidwa ntchito:

• ndi atony pamimba: cisapride (5-40 mg 2-4 p. / tsiku 15 mphindi asanadye), metoclopramide (5-10 mg 3-4 p. / tsiku), domperidone (10 mg 3 p / tsiku),
• ndi enteropathy (kutsegula m'mimba): loperamide (mlingo woyamba ndi 2 mg, kenako 2-12 mg / tsiku kwa chopondapo pafupipafupi cha 1-2 p. / tsiku, koma osapitirira 6 mg pa 20 kg iliyonse ya wodwala mu tsiku limodzi).

Zochizira za autonomic neuropathy zamtima (kupuma tachycardia), mtima β-blockers, calcium block blockers (mwachitsanzo verapamil, Diltiazem Lannacher) amagwiritsidwa ntchito.

Zochizira erectile kukanika, mtundu 5 phosphodiesterase inhibitors amagwiritsidwa ntchito (ngati palibe contraindication), intracavernous makonzedwe a alprostadil, prosthetics, upangiri wamaganizidwe.

Kwa kupewa kwapadera kwa hypovitaminosis ndi zovuta, odwala matenda a shuga amawayikira kukonzekera kwa multivitamin. Pankhaniyi, kukhazikitsidwa kwa mavitamini a B pamankhwala othandizira (Neuromultivitis) kumathandizanso.