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The initial symptoms observed are reduced sensibility, burning sensation (occurring particularly at night and aggravating with contact) and tingling sensation in lower extremities  (pins-and-needles).
The clinical examination should include full neurologic examination of sensory and motor functions and reflex evaluation.
Specific laboratory workup, as well as nerve conduction tests and electromyography can supplement the diagnostic control.
Further examinations should be conducted to rule out other causes of polyneuropathy in case the patient reports one of the following symptoms: acute onset, asymmetry of symptoms, great deal of pain, marked motor symptoms or rapid progression of motor symptoms. Proper and effective treatment of diabetes mellitus with close blood glucose control, plays a major role in preventing and delaying the onset of symptoms in painful polyneuropathy.
Comparative studies on pharmacotherapies for painful diabetic polyneuropathy have demonstrated that tricyclic antidepressants are the most effective drugs. In the dosage of 120 mg, the number needed to treat (NNT) for more than 50% pain improvement was 4,9 patients (NNT 4,9), whereas in the 60 mg dosage the number to treat for  more than 50% pain improvement was 5,2 patients (NNT 5,2).
If there is contraindication for Duloxetine (Cymbalta), the treatment should start with amitriptyline (Saroten). Should the conservative treatment fail or serious intolerable adverse events occur from pharmacotherapy, Spinal Cord Stimulation (SCS) is indicated. Type I Diabetes is caused by an autoimmune disorder-a problem with the body's immune system. Pre-Diabetes is the same as Type II Diabetes, and is identified with blood glucose levels above. Smoking and blood fat level can cause blood vessels to narrow, which makes it difficult for the blood to flow throughout the body. Diabetes can damage the kidneys, which not only can cause them to fail, but can also ability to filter out waste products. Diabetics are 19 times more likely than those without diabetes to develop problems with the kidney. Diabetes retinopathy – damage to the blood vessels in the retina (back of the eye).
Glaucoma – increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision. Gingivitis – first stage of gums disease, redness around the gums, swelling and pain. Plaque – yellow sticky film, which leads to tartar formation and eventual tooth and bone loss.

People with diabetes are far more likely (65%) to have a foot or leg amputated than other people. Ulcers - Ulcers occur most often on the ball of the foot or on the bottom of the big toe. Check your feet daily for any changes, such as blisters, cuts, ulcers, redness and large calluses. Avoid using anything hot (heating pads, hot water bottles or hot bath water) on your feet. Always check your shoes for any rough edges, sand and any object that may cause irritation. Avoid lotions and creams that contain alcohol, additive, dyes and fragrances (perfume). Drink 4 glasses (8 oz) of water (ARP required 4 glasses of water per day) to give your body more fluid. Avoid lotions and creams that contain alcohol, additive dyes and fragrances (perfume).
Change in sleep patterns You have trouble falling asleep, you wake often during the night, or you want to sleep more than usual, including during the day. Change in appetite You eat more or less than you used to, resulting in a quick weight gain or weight loss. Trouble concentrating You can't watch a TV program or read an article because other thoughts or feelings get in the way. Suicidal thoughts You feel you want to die or are thinking about ways to hurt yourself.
Diabetes mellitus increases the risk of disorders such as coronary artery disease, cerebrovascular occlusion, peripheral artery disease, renal insufficiency, peripheral neuropathy, lower-extremity infection, ulceration, and amputation, and other disorders.
There are approximately 250 million people worldwide suffering from diabetes mellitus and 20-30 million of them suffer from neuropathy.
Nerve impairment is accompanied by microvascular dysfunction that affects the nerve vascular network.
Painful diabetic polyneuropathy has to be differentiated from other types of polyneuropathy with the use of specific tests.
Once symptoms begin, they rarely subside on their own and there is need for specific pharmacotherapy to cope with the neuropathic pain. However, their administration in high and effective doses is limited due to adverse events often occurring.

Treatment with gabapentin (Neurontin) has shown only small differences compared to amitryptiline (antidepressant). As long as the patient reports more than 50% pain relief during the trial period, the final implantation of the neurostimulation system is performed. Please always consult your doctor before taking any advice learned here or on any other website.
Neuropathy means damage to the nerve cells that run throughout the body, connecting the spinal cord to muscles, skin, blood vessels, and other organs.
Such complications frequently require admission into the hospital for evaluation and treatment.
Diabetic polyneuropathy is closely correlated with the diabetic chronicity and blood glucose control. This is due to oxidation, which is caused by hyperglycaemia and other disorders of homeostasis and metabolism. Symptoms may be accompanied by trophic changes and poor wound healing due to microangiopathy. The differential diagnosis from polyneuropathy of toxic aetiology is of particular high importance because it is a reversible condition. According to the results of three studies, 45-55% of patients who received duloxetine reported more than 50% improvement in pain intensity compared to the comparator drug. In the Pregabalin (Lyrica) group, 39-46% of patients reported over 50% pain improvement with the dosage from 300 to 600 mg. There are 4 studies showing satisfactory results for SCS in painful diabetic polyneuropathy and the method is recommended in case the conservative treatment fails. Many people with diabetes have artery disease, which reduces blood flow to the feet. Remember, even though some ulcers do not hurt, every ulcer should be seen by your health care provider right away. Close blood glucose control determines the prevention of painful diabetic polyneuropathy to a significant extent.
Duloxetine (Cymbalta), pregabalin (Lyrica) and gabapentin (Neurontin) seem to have similar efficacy in painful diabetic polyneuropathy.

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