My name is Dr. Hamid Sajjad. In this video, I want to talk about the available and approved treatments for nerve involvement in diabetics, which we call diabetic neuropathy. At the beginning of the discussion, I will talk about the common complaints of patients and then I will discuss the available treatments. If you are interested, watch the rest of the video. People around diabetic patients must have heard one of these sentences, they often complain about tingling and burning in their feet, pain and excessive sensitivity in their feet, burning in their feet and the feeling as if someone is stabbing them. ... The feet are very sensitive to the touch so that they feel very uncomfortable even with the contact of the bed sheet, a feeling as if the socks are on but it's not really so, the feet are irritated at night, the feet are cold or very hot, as if something is wrong with the feet. He doesn't feel it and it's like a dead limb, not feeling the pain on the foot so that even with blisters and wounds, they still don't realize that they don't feel the heel when walking, weakening of the muscles of the arms and legs, when standing. They sit or walk without balance, not feeling the coldness or hotness of what touches the feet, the shape of the bones and muscles of the feet change, the wounds on the feet become chronic and they heal slowly. These symptoms are usually in the legs, but may also occur in the hands. Most of these symptoms, especially the burning and shooting pains, get worse at night. Sometimes the painful symptoms improve, but the feeling of coldness and numbness in the legs remains chronically. As soon as any doctor notices one of these complaints, he immediately remembers the involvement of the peripheral nerves by diabetes, which we call diabetic neuropathy. Diabetic neuropathy discussion It is very detailed and I don't want to talk about all the aspects of this problem now. Hopefully, I will talk at the right time. In this video, I just want to talk about the existing treatments for diabetic neuropathy, which we have heard a lot about over the years. It is possible that different methods can solve this problem. It is good to refer to reliable authorities and see what their latest opinion is to reduce the pain and discomfort of this common problem of diabetic patients. In a diabetic patient who is diagnosed with diabetic neuropathy, the first thing to do is to make sure that the sugar level is regulated, because it has been shown that if better control of the sugar level is carried out in the early stages of diabetic neuropathy, it will prevent the progression and worsening of this problem. can Some people believe that capsiacin creams or pepper creams or lidocaine creams or clonidine creams can be used to reduce the pain of these patients, but their usefulness has not been proven in research. All these creams and ointments are available in our pharmaceutical market, but it does not seem It is useful and finally maybe 10% of patients are satisfied with these. But if you ask if a specific drug has been prepared for this problem... the answer is no, but now some of the properties of drugs from other families are used, such as anticonvulsants or antidepressants, but in special doses and not their usual therapeutic doses for Convulsive or depressive illnesses. The results of the use of carbamazepine, which is an anticonvulsant drug, and venlafaxine, duloxetine, and amitriptyline, which are all antidepressants, have been reported to be useful in treating the pain of these patients. The US Food and Drug Administration three drugs, duloxetine, which is an antidepressant, and gabapentin, which are from the group It is anticonvulsant, and a drug called slow release tapentadol, which has properties similar to narcotics, has been approved for this problem. Some doctors believe that it is better to use lidocaine strips or patches to reduce pain before starting those drugs. From the family of anticonvulsants, pregabalin is a candidate drug of this family for diabetics. But research has shown that its effect is low. Whether other anticonvulsant drugs such as zonisamide, carbamazepine, topiramate, valpuric acid work better than pregabalin, good results have not yet been obtained. From the family of antidepressants, duloxetine and venlafaxine are the best for diabetics. In the research done for these, an average effect of these has been seen. Imipramine, desiprapramine, nortriptyline, and amitriptyline, which are both from the same family of antidepressants, can be used as both the first and second line of treatment for diabetics. Among these, imipramine has been researched more and found that it can reduce the pain to some extent, but the patient suffers from drug side effects, which are dose-dependent. One of the important side effects of this drug is cardiac side effects, which causes heart rhythm disorders. Dry mouth and sleep disorder are other problems of this medicine. But if low d