CASE LEARNING OBJECTIVES
Assess the signs and symptoms of diabetic neuropathy
List the goals of treatment for patients with diabetic neuropathy
Select appropriate nonpharmacologic and pharmacologic treatment regimens for patients presenting with diabetic neuropathy
Develop a monitoring plan that assesses the safety and efficacy of the patient's diabetic neuropathy management
"My feet are on fire and I cannot sleep."
History of Present Illness
Andrew Carter is a 60-year-old African-American male with type 2 diabetes who presents to your ambulatory care clinic with burning pain in both feet. He reports that "nothing has helped, even the medication I took for surgery last year." The pain has worsened over the past several months and is preventing him from falling asleep. Patient also says that in the past he could eat anything put in front of him, but lately he has been nauseated and felt full with a small amount of food. When asked, patient says that he takes all of his medicine at the same time on an empty stomach.
Type 2 diabetes diagnosed at age 39
Benign essential HTN diagnosed at age 44
Dyslipidemia diagnosed at age 39
Father had HTN and died from a stroke at age 67
Mother is alive at age 82 and has HTN and asthma
Sister is alive at age 57 with a history of asthma
Widowed 2 years ago, lives alone and is working at a grocery store. Son and daughter-in-law live out of state.
(−) alcohol, but he does smoke 2 ppd of cigarettes.
Allergies/Intolerances/Adverse Drug Events
Insulin glargine 10 units daily
Metformin 500 mg twice daily
Diphenhydramine 50 mg daily at bedtime as needed (has used over the past several days without relief)
Was on glipizide and metformin when he was first diagnosed, but insulin was started 3 months ago.
Feet: (+) paresthesia (burning, tingling) and allodynia that is worse at night, (−) for ulcer, cuts, sores, or deformities, (+) dry skin. (+) nausea and bloating, (+) for insomnia, (−) chest pain, SOB or dizziness.