Assessment
ÎThorough physical examination and history ÎIf not previously determined, establish diagnosis of DM or impaired glucose tolerance by 2-hour oral glucose tolerance test:
> Serum glucose > 200 mg/dL for diabetes > Serum glucose 140-199 mg/dL for impaired glucose tolerance
ÎEstablish presence of neuropathy with:
> Validated questionnaires (Table 1): > Screening devices: ■ 10-g monofilament ■ 128-Hz tuning fork
ÎDetermine classic DPN from clinical presentation symptoms above
OR
Acute sensory neuropathy (less common form) characterized by:
> Severe burning pain and aching > Rapid onset of symptoms, often after periods of poor metabolic control or sudden changes in glycemic control
> Symptoms worse at night > Often accompanied by weight loss > Resolution often after return to euglycemia and within 12 months of onset
ÎEvaluate comorbidities (diabetes related or other):
> Depression > Diabetic retinopathy > Foot ulceration > Progressive muscle weakness > Sleep disturbance/disruption
Therapeutic Considerations for DPNP ÎQuality-of-life issues ÎReduction/modification of pain ÎOptimization of functionality ÎPharmacotherapy (Tables 2A, 2B) ÎFoot care (Table 3)
