Length-dependent sensorimotor neuropathy from chronic hyperglycaemia, the leading cause of diabetic foot ulceration.
Clinical features
- • Glove-and-stocking numbness
- • Burning nocturnal pain
- • Loss of ankle jerks and vibration sense
- • Painless ulceration
Investigations
- • 10 g monofilament and 128 Hz tuning fork annually
- • Exclude B12 deficiency, hypothyroidism, alcohol, uraemia
Management
- • Optimise glycaemia and cardiovascular risk
- • First-line pain: duloxetine, amitriptyline, pregabalin or gabapentin
- • Podiatry, footwear, daily foot inspection
Clinical pearls
- • Foot ulcer + neuropathy = urgent multidisciplinary foot service referral
- • Rapid glycaemic correction can precipitate treatment-induced neuropathy
Related in WardRound
Educational — verify locally.
