Diabetic Peripheral Neuropathy
All patients should be screened for distal symmetric polyneuropathy starting at diagnosis of T2DM and at least annually thereafter.
Signs and symptoms
• 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.
• 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.
- Burning pain: Antidepressants:
o Imipramine – 50–150mg/day
o Amitriptyline – 75–150mg/day
Lancinating pain: Anticonvulsants:
o Carbamezapine – 400–800mg/day
o Sodium valproate – 10–15 mg/kg/day)
Give foot care education and advice on appropriate footwear.