Distal symmetric polyneuropathy from diabetes
Diabetic peripheral neuropathy most commonly presents as distal symmetric polyneuropathy, affecting the feet first with burning, tingling, numbness or pain that may spread upward in a stocking distribution. Hands may be involved later. The pattern reflects length-dependent nerve fibre degeneration, with the longest nerves affected earliest.
Risk factors include duration and severity of hyperglycaemia, poor glycaemic control, hypertension, smoking, dyslipidaemia and height. Neuropathy significantly increases fall risk and foot ulcer risk, making early identification and management essential. Clinical diagnosis is supported by nerve conduction studies when the cause or severity is uncertain.
- Burning, tingling, numbness starting in feet, stocking distribution
- Length-dependent pattern, longest nerves affected first
- Risk factors: hyperglycaemia duration, hypertension, smoking
- Increases foot ulcer and fall risk — early management essential
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Glycaemic control, pain management and foot care
Glycaemic control is the primary modifiable factor. Tight glucose management slows neuropathy progression, though established nerve damage may not fully reverse. Blood pressure, cholesterol and weight management contribute to vascular health supporting nerve function. Smoking cessation is essential.
Pain management addresses neuropathic pain with medications such as pregabalin, gabapentin, duloxetine or amitriptyline, selected based on comorbidities and side-effect profile. Foot care education covers daily inspection, appropriate footwear, skin care and prompt treatment of injuries to prevent ulceration. Regular foot screening identifies at-risk patients before complications develop.
- Glycaemic control — primary modifiable factor
- Neuropathic pain: pregabalin, gabapentin, duloxetine, amitriptyline
- Daily foot inspection and appropriate footwear
- Regular foot screening — prevent ulceration