What's New in Diabetic Neuropathy?

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Beware New FDA-approved-for-DPN medications “are likely to be no better and are considerably more expensive than older ones.” Presented by IHS Division of Diabetes - JAMA 2009; 302 (13): 1451-1458 34
Stepwise Management (IHS, JAMA) • Assess pain quantitatively • Identify relevant co-morbidities • Explain diagnosis and treatment plan and establish realistic expectations (50% improvement) • Treat the diabetes • Titrate first line to tolerance, effect • No relief, stop first line, start second line • Partial relief, add second to first • Third line last resort and consider adding from other classes • Give adequate trial at adequate dose (8 wks) • Try bupropion, topiramate, citalopram, parotexine if all else fails Presented by IHS Division of Diabetes 35
Page 1 and 2: What’s New in Diabetic Neuropathy
Page 3 and 4: * Presented by IHS Division of Diab
Page 5 and 6: Case Presentation • PMH: HTN, hyp
Page 7 and 8: Thinking • Classic presentation f
Page 9 and 10: Diabetic Neuropathies Focal/Multifo
Page 11 and 12: Classic Symptoms • Pain worsens a
Page 13 and 14: Patient Education • A condition t
Page 15 and 16: Michigan Neuropathy Screening Instr
Page 17 and 18: MNSI - Physical TEN POINTS MAX 0 PO
Page 19 and 20: Charcot Presented by IHS Division o
Page 21 and 22: Skin Abnormalities Presented by IHS
Page 23 and 24: Tuning Fork for Your Entire Sensory
Page 25 and 26: MNSI - Monofilament • Foot suppor
Page 27 and 28: Treatment • Glycemic control and
Page 29 and 30: Education 2 • Wear clean, dry, so
Page 31 and 32: IHS Guidelines 2010 • First Line
Page 33: AAN Recommendations Recommended, in
Page 37 and 38: Effect on Co-morbidities DULOX- ETI
Page 39 and 40: Amitriptyline • Check standing BP
Page 41 and 42: Pregabalin (Lyrica©) • Relative
Page 43 and 44: Topiramate (Topamax©) • AAN: ins
Page 45 and 46: Venlafaxine (Effexor ©) • 75-225
Page 47 and 48: Opioids • Dextromethorphan 400 mg
Page 49 and 50: Capsaicin, Isosorbide, Lidoderm©
Page 51 and 52: Autonomic Neuropathy • Orthostati

What's New in Diabetic Neuropathy?

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