Diabetic Neuropathy

Description

General Measures 

Medicine Treatment 

Referral

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ICD-10 Code: E10.4/E11.4 + (G63.2*/G99.0*/G59.0*)

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
  • Vitamin B12 deficiency, if suspected
  • Uraemia
  • 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

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Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, 2024 Edition