Numb : Part 1

A 60 year old man presents with numbness of both feet for 2 months.

He was diagnosed with type 2 diabetes mellitus 6 years ago, which is well controlled on Metformin alone. His medical history is otherwise unremarkable.

He consumes a mixed diet and only drinks socially.

His HbA1c is 6.0%, while a recent full blood count and serum creatinine were normal.

Select Relevant Investigations
Electrodiagnostic studies

Performed

There is a length dependent sensory and motor polyneuropathy.
ESR + S. Electrophoresis

Performed

ESR: 10 mm/1h
The serum plasma electrophoresis shows a normal pattern.
Serum Vitamin B12 and Folate

Performed

Serum Vitamin B12: 95 pg/ml (200 - 900)
Serum Folate: 10 ng/ml (5 - 16)
Serum TSH

Performed

Serum TSH: 1.0 mIU/L (0.4 - 4)

Select Relevant Management
Vit-B12 supplementation
Folate supplementation
Gabapentin
Protective footwear