Diabetic Neuropathy

Question 1

Diabetic neuropathy is managed in the same way as other forms of neuropathic pain.

What is used first line to diabetic neuropathy?

Answer 1

• First line - amitriptyline, duloxetine, gabapentin or pregabalin
• If first line doesn’t work swap to one of the others.

Question 2

What can you use as a rescue therapy in diabetic neuropathy?

Answer 2

Tramadol​

Question 3

What can be used for localised neuropathic pain (e.g. post-herpetic neuralgia)

Answer 3

Topical Capsaicin

Question 4

If pain is resistent, what can be done?

Answer 4

They can be referred to a pain management clinic.

Question 5

In terms of the bodies internal organs, what can be effeted by diabetic neuropathy?

Answer 5

Gastroparesis of the bowels.

Question 6

What are some symptoms of gastroparesis?

Answer 6

• Erratic blood glucose control
• Bloating
• Vomiting

Question 7

What is your management approach to gastroparesis?

Answer 7

Use of prokinetic agents

• Metoclopramide
• Domperidone
• Erythromycin

Question 8

A 51-year-old woman who is known to have poorly controlled type 1 diabetes mellitus is reviewed. Her main presenting complaint is bloating and vomiting after eating. She also notes that her blood glucose readings have become more erratic recently. Which medication is beneficial?

Answer 8

A prokinetic agent.

Metoclopramide

Domperidone

Erythromycin