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Distal Symmetric Polyneuropathy


Step 1: View clinicals

A 60 year old man presents with stabbing pains in all toes and both shins for several months. He feels as if he is stepping on broken glass when walking, and experiences burning pains in both feet at night. Further questioning reveals the presence of erectile dysfunction. He was diagnosed with type 2 diabetes 8 years ago, and is currently on maximum daily doses of oral Metformin and Glipizide.

Step 2: Order all relevant investigations


The HbA1c level is 9%

Monofilament test

Five sites are tested on each foot. Of these, 6 sites test negative.

Electrodiagnostic Studies

A length dependent sensorimotor axonal polyneuropathy is noted.

Sural Nerve biopsy

The nerve biopsy will be arranged next week.

Step 3: Select appropriate management

Start Insulin

Score: ★★☆