By Juan Lopez, PharmD, FIACP

Diabetic neuropathy is nerve damage caused by diabetes where, over time high blood sugar levels can injure nerves and the small blood vessels that nourish these nerves. Peripheral neuropathy is a common type of nerve damage that typically affects the feet and legs, followed by the hands and arms. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), one-third to one-half of people with diabetes have peripheral neuropathy.

Symptoms of peripheral neuropathy can include numbness, pain, tingling, burning sensations and loss of muscle tone in the hands and feet, loss of sensation to temperature changes, inability to feel physical injury, loss of balance, and joint damage.

Treatment starts with bringing blood sugar levels within targeted ranges. Medications and certain types of physical therapy can be used to manage the painful symptoms of diabetic neuropathy.

Vitamin B1 has been used for decades to treat neurological conditions, in particular diabetic neuropathy. A deficiency in thiamine is commonly noted in patients with diabetic neuropathy, as well as those that have developed neuropathies due to malabsorption. Benfotiamine is a fat-soluble form of thiamine (vitamin B1) that has demonstrated improved absorption, higher blood levels, and longer maintained blood and tissue concentrations as compared to the more common water-soluble thiamine. Once absorbed, benfotiamine is rapidly converted to the biologically active thiamine.  Interestingly, benfotiamine, which has been used in Germany, and is now available without a prescription, supports nerve health for those with diabetes-induced nerve damage.

Benfotiamine has a number of mechanisms for its beneficial effects, including the correction of thiamine deficiency.  Benfotiamine can increase the activity of an important enzyme in glucose metabolism (transketolase), decrease the build-up of toxic glucose metabolites that can damage nerves, protect endothelial cells from glucose-induced damage, and correct endothelial damage caused by high blood sugars.

Various studies have been done on the use of benfotiamine in diabetic neuropathy patients, including the use of benfotiamine in combination with additional B vitamins. The best patient response was seen in studies that used a larger daily dose of benfotiamine. Treatment was well tolerated by patients, and no benfotiamine-drug interactions were reported. A study of 20 patients given 400mg daily of benfotiamine showed improvement in neuropathy scores and decrease in pain complaints over a 3-week period. Another study compared benfotiamine treatment doses of 300mg versus 600mg over a 6-week duration, finding that improvement was more pronounced at the higher benfotiamine dose and increased with treatment length.

Daily doses of oral benfotiamine range from 300mg to 600mg in divided doses.

A combination nutritional formulation may provide patients with an economical advantage as they can combine multiple ingredients targeting nerve health into one product. These combination products may include lipoic acid, acetyl L-carnitine, vitamin B6, vitamin B12, and folate, in addition to benfotiamine. Speak with a pharmacist to find out which high-quality professional grade nutritional supplement company they recommend.

Our pharmacists are available to discuss nutritional therapy options for diabetic neuropathy patients. For more information, please call 407-260-7002.