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Diabetic Peripheral Neuropathy

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Introduction

All patients should be screened for distal symmetric polyneuropathy starting at diagnosis of T2DM and at least annually thereafter.

Risk Factors

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Signs and symptoms

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Diagnostic criteria

• Unsteady gait
• Burning, aching pain or tenderness in legs or feet (occurring at rest or at night, not related to exercise)
• Prickling sensations in legs and feet (occurring at rest or at night, distal>proximal, stocking glove distribution)
• Numbness in legs or feet (distal>proximal, stocking glove distribution)
• History of previous foot ulceration and/or amputation.

Investigations

• Sensation (10g monofilament or cotton wool)
• Vibration (128 Hz tuning fork)
• Postural hypotension and pulse (tibial and dorsalis)
• Inspect foot for structural abnormalities and ulceration.

Management

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  • Non-pharmacological

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  • Pharmacological

    Burning pain: Antidepressants:

    o Imipramine – 50–150mg/day
    OR
    o Amitriptyline – 75–150mg/day

    Lancinating pain: Anticonvulsants:

    o Carbamezapine – 400–800mg/day
    OR
    o Sodium valproate – 10–15 mg/kg/day)

    Give foot care education and advice on appropriate footwear.

Prevention

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Updated on,

25 Novemba 2020 07:04:14

References

1. STG

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