Thanks for the update Rakshith.

We feel Most Likely Diagnosis must be Diabetic Peripheral Neuropathy (Distal Symmetric Polyneuropathy).

✔️ Commonest neuropathy in diabetics

✔️ Presents with burning, tingling, numbness, worse at night

✔️ “Stocking” distribution

EVALUATE :

🔹 Check:

1: HbA1c (Glycemic control)

2: Vitamin B12 (esp. if on Metformin)

3: Renal function

Foot examination (ulcers, sensation, reflexes)

🔹 Bedside tests:

1: Monofilament test

2: Vibration sense (128 Hz tuning fork)

✅ Management

1️⃣ Optimize Glycemic Control (Most Important)

👉 Target HbA1c < 7% (individualized)

2️⃣ Symptomatic Treatment (Neuropathic Pain)

🔹 First-Line Drugs

1: Pregabalin

2: Gabapentin

3: Duloxetine

4: Amitriptyline (use cautiously in elderly)

🔹 Topical

1: Capsaicin cream

2: Lidocaine patch

3️⃣ Nutritional Support

💊 Methylcobalamin / B-complex

(If B12 deficient or symptomatic)

4️⃣ Foot Care (Prevention of Complications)

👣 Daily foot inspection

👣 Proper footwear

👣 Avoid barefoot walking

👣 Treat cracks/infections early

5️⃣ Lifestyle Measures

✔️ Regular exercise

✔️ Smoking cessation

✔️ Weight control

🎯 Take-Home Message

👉 Long-standing DM + Burning feet at night = Diabetic Neuropathy

👉 Control sugars + Neuropathic pain meds + Foot care = Best outcomes

TEAM MEDICOZ COMMUNITY