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Dr. Andrew Rynne

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What causes swollen nerves on feet, severe pain in legs and fatigue?

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Dr. Abhay A Mali

Diabetologist

Practicing since :2006

Answered : 805 Questions

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Posted on Mon, 19 Oct 2015 in Diabetes
Question: doctor my aunt aged 56 who's a diabetic for the past 4 months has been suffering from swelling of nerves below the thighs up to the feet. .as the day progresses from her routine work as a house wife she had been feeling severe pains in the legs.she completely feels the fatigue as the night arrives. .she had her blood sugar test n cholesterol levels in the blood on 06 SEP 2015. .her sugar levels were normal n SERUM TRIGLYCERIDES count was 268mg/dl..normal range was up to 150mg/dl. .remaining everything we normal. .she is getting exhausted quickly n the pain in the legs due to that swelling. .kindly suggest proper medication Plz. .
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Answered by Dr. Abhay A Mali 4 hours later
Brief Answer:
Painful neuropathy & Peripheral Arterial Disease need to be considered.

Detailed Answer:
Hi,

Thanks for your question.

After going through your question, I can understand your concern.

There might be possibility of
- Painful neuropathy - diabetes is one cause for it and/or
- Peripheral arterial disease (vasculopathy).

If patient with similar scenario would have present to me, I would have advised following tests-
- Complete Blood Count.
- Vitamin B12 level.
- Vitamin D level.
- Renal function test.
- Liver Function Test.
- Ultra TSH.
- Arterial doppler of lower limbs if clinically required (Based on her lower limb pulses, Ankle - Brachial Index, skin changes)

And I would have advised -
- Tab containing Pregabalin.
If there is no or inadequate response I may have increased the dose of Pregabalin with or without addition of other medicine like Amitryptilin or duloxetin.
- Tab containing Methyl cobalamine along with above.
- In resistant case I would have advised Tab tramadol.

All these changes in medicine needs detailed clinical examination and close follow up.
Once the reports of above test result get available further changes in medicines should be considered.

Along with this there is a need for good blood glucose level, blood pressure control.

Treatment for High Triglyceride level may not required always.
In the treatment of dyslipidemia other parameters of Lipid profile like LDL, HDL are more important.

It will be better for your aunt to consult her treating physician for detailed clinical examination, depending upon it appropriate decision regarding further evaluation and treatment can be made.

Hope this helps your aunt.

Regards,
Dr. Abhay Mali.
Diabetologist.






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