الفهرس 
IntroductionOnly 14 pages are availabe for public view
Abstract
Diabetes mellitus is a group of metabolic diseases in which a person
has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. This high blood sugar produces the classical symptoms of the disease.
There are three main types of diabetes mellitus, type 1 DM, Type 2 DM and gestational diabetes occurs in pregnant women
Diabetes mellitus is the most common chronic endocrine disorder, 366 million people have diabetes in 2011; by 2030 this will have risen to 552 million. Diabetes caused 4.6 million deaths in 2011.
(IDF) anticipates that the prevalence of diabetes in Egypt was reported 13.5%, and about 7.3 million of diabetic patient in Egypt in 2011, reaching to 12.4 million of diabetic patients by 2030.
DM burden on world economy (Caring for people with diabetes was estimated to cost the world economy $A355 billion in 2010, or 11.6 percent of total world expenditure on health care.)
It is a consistent finding across studies that diabetes is associated with impaired health-related quality of life (HRQOL), Both medical and psychosocial aspects of diabetes may negatively affect HRQOL; and vice versa. Complications of DM including microscopic or macroscopic ones greatly effect on the patient life.
Diabetic neuropathy increases among people who have had diabetes for at least 25 years. It is the most common micro vascular complication of diabetes; & the main predisposing factor for foot ulceration, infection amputation.
A systematic review of 52 studies in patients with one out of 6 different disorders associated with neuropathic pain established that neuropathic pain impairs physical and emotional functioning
Vitamin B12 is involved in the metabolism of every cell in the body.
B12 helps in maintaining the health of the nerve cell and the nervous system, the neurological symptoms often happen after a prolonged vitamin B12 deficiency.
Treatment of Diabetic neuropathy is by glycemic control mainly, care of the feet and controlling of pain by pharmacological treatment. Alpha-lipoic acid (ALA) in several short-term trials showed that it was helpful in relieving pain caused by diabetic neuropathy, and a randomized controlled trial that compared once-daily oral doses of 600 mg to 1800 mg compared to placebo has shown benefit.
Level A evidence exists to support the use of tricyclic antidepressants (e.g., amitriptyline), the anticonvulsants gabapentin and pregabalin, and the serotonin and norepinephrine reuptake inhibitor duloxetine. There is a randomized controlled trial (RCT) evidence for the use of opiates such as oxycodone and tramadol in painful DPN.
Many studies suggest a role of long use of metformin in vitamin B12 deficiency - A randomized study suggests that regular measurement of vitamin B-12 concentrations during long term metformin treatment should be strongly considered.
One study concludes that vitamin B12 deficiency is common among patients with type 2 diabetes and was related to nutrition. Some studies suggesting that Cbl deficiency is common in elderly diabetic patients and associated with neuropathy, it is responsive to Cbl therapy.
Some systematic review of clinical controlled trials shows that both vitamin B12 combination and pure MMC had beneficial effects on somatic symptoms, such as pain and paresthesia.
Other systematic review show usefulness of intrathecal injection of MMA in patients with diabetic neuropathy.
Henry Sun of the Institute of Molecular Biology at the Academia Sinica in Taiwan, suggesting that vitamin B12 has shown some effectiveness in minimizing several symptoms associated with diabetic neuropathy, including pain, numbness, prickling and tingling.