Diabetic neuropathy

E10.4/E11.4 + (G63.2* /G99.0* /G59.0* )

• Description
• General measures
• Medicine treatment
• Referral

DESCRIPTION

Neuropathies are a common complication of diabetes. They play an important role in the morbidity and mortality suffered by people with diabetes.

There are three major categories:

• peripheral neuropathy
• autonomic neuropathy
• acute onset neuropathies

GENERAL MEASURES

• Educate patient regarding appropriate footwear and good foot care.
• Patients with neuropathy should have their feet examined at every visit.

MEDICINE TREATMENT

Ensure appropriate glycaemic control.
Exclude or treat other contributory factors e.g.:

• alcohol excess
• uraemia
• vitamin B12 deficiency, if suspected
• HIV infection

Pain

• Amitriptyline, oral, 10–25 mg at night increasing to 100 mg, if necessary.

AND/OR

• Paracetamol, oral, 1 g 4-6 hourly when required.
  • Maximum dose: 15 mg/kg/dose.
  • Maximum dose: 4 g in 24 hours.

Gastroparesis:

• Metoclopramide, oral, 10 mg 8 hourly before meals.

REFERRAL

For further treatment, if the above measures do not control symptoms adequately.