Thread by @hyderabaddoctor

Common cause of nerve damage is often overlooked due to lack of awareness

1. 41-year old Mr Sheel presented with tingling, burning sensation & numbness of both feet of one year duration. Symptoms were present throughout the day, however, they worsened during nights.
#MedTwitter

2. Mr Sheel consulted a general physician, who ordered a few blood tests, which were all "normal". He suspected a diagnosis of peripheral neuropathy (damage of nerves in feet) and referred him for a neurologist's opinion for confirmation of diagnosis.
#neurotwitter

3. Neurologist evaluated Mr Sheel and found evidence of sensory neuropathy involving lower limbs (confirmed by nerve conduction studies). He also ordered a few additional blood tests, which were all "normal". He advised nerve biopsy test to find out the cause of nerve damage.

4. Mr Sheel consulted me for 2nd opinion before undergoing invasive test (nerve biopsy). I reviewed the history & after clinical examination- agreed with a diagnosis of peripheral neuropathy affecting sensory nerves.
However, on review of blood tests, I could spot the diagnosis.

5. HbA1C (glycated hemoglobin) done on two occasions were abnormal- 6.1 & 6.4 respectively and Fasting blood sugar was 120 mg%-consistent with a diagnosis of pre-diabetes.
My final diagnosis was Pre-diabetes with peripheral neuropathy. No further tests were needed at this stage.

6. Pre-diabetes is a common cause of peripheral neuropathy, causing tingling, burning and numbness of feet. In many studies, more than 10% patients (maximum up to 77%) with pre-diabetes were found to have peripheral neuropathy. Reference:
doi.org/10.1136/bmjdrc…

7. Take home message:
*Pre-diabetes should not be taken lightly, as it is a risk factor for nerve damage, as well as for #stroke and #heartattack.
*Lifestyle modification (diet and exercise) should be advised to people with pre-diabetes to prevent complications related to it.