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The Rational Clinical Examination
David L. Simel, Drummond Rennie
Diabetic Peripheral Neuropathy
Jamil N. Kanji, Rebecca E. S. Anglin, Dereck L. Hunt, MD, Akbar Panju
Clinical Evaluation for Diabetic LFPN


Topics Discussed: complications of diabetes mellitus, diabetes mellitus, diabetic neuropathy, diabetic peripheral angiopathy, peripheral neuropathy

Excerpt: "Patients with diabetes can develop neuropathies for reasons unrelated to diabetes. It is imperative that the clinician carry out a detailed medical history to help identify other conditions that may also cause or contribute to peripheral neuropathy. Some of these include alcoholism, vitamin B12 deficiency, endocrinopathies, vasculitides, heavy metal exposure, drug use, and malignancy (direct or paraneoplastic).9 Further discussion regarding diagnosis, workup, and management of other etiologies of peripheral neuropathy is beyond the scope of this article and can be found in the referenced review.9The presence of skin changes of the leg and foot, abnormal hair loss, and skin ulceration of the feet (including the heels and web spaces) should be noted.12 The presence of a foot ulcer makes the likelihood of diabetic neuropathy extremely high...."
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