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Male patient of age 45 Chief Complaints Symptoms Mention in title symptoms increase after meal Sleeplessness due to same problem History History of taking medication for DM since one year But glucose level in control Vitals Bp:110/70 Pulse:100 Physical Examination Weak Appetite increase Bowel on off loose may be due to Oral antidiabetic med Investigations Hb1ac 10.2 on 12/06/2020 Bs fasting :180 pp:380 Hb1ac 7.2 on 10/12/2020 fasting:84 pp170 Rbs :140 Diagnosis Peripheral neuropathy??? Management Patient take Tab:Methylcobalamin 1500 mcg once day plus pregaba 75 once daily since 1 month for same problem but not relief What should do to improve his symptoms??



As HBA1c comes down, PP sugar is the culprit. Glycemic variability is the issue in diabetics a lot. As present report suggests sugar are wnl, but would suggest adding voglibose 0.2 with lunch. Try getting his post dinner sugar if possible For neuropathy, u already using level A recommendation Pregabalin Pregabalin + Duloxetine works good too So Lyrica 75mg HS, Duloxee 30mg Morning, Rejunex CD3 OD, Folvite 5mg weekly

Aso get his CBC and Vit B12 levels assessed

Symptoms doesn’t appear to be due to peripheral neuropathy as history is very short (1 yr) DM is well controlled but may change the drugs as may be allergic symptoms to metformin.Antiallergic drug with anti anxiety at night may help.Liver function and renal function to be done to rule out abnormalities.

Lft Kft normal Patient taking Galvas met 50/850 bd plus glimperide 2mg bd since one year But dose of metformin reduce to 500 as Glucose level in control

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Uncontrolled diabetic with peripheral neuropathy Hba1c is more than 10 So far treatment of peripheral neuropathy is concerned shift on gabapentin 300mg+nortryptiline 10mg 1od at bedtime Treatment goes more than 6months Keep monitoring bsl

Thanks for advice sir Sir Ji hb1ac 10.2 in june month But it reduces to 7.2 in dec month Meanwhile gaba nt is good choice i think

Gabapin nt 400/10 hsod for diabetic neuropathy Neurobion forte tab BD

Valuable opinion

Symptoms are due to pregaba75.

Side effect Of metformin is vit b12 deficiency

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