A 58-year-old woman with long-standing type 2 diabetes presents with burning pain and numbness in both feet, worse at night. Monofilament testing is decreased.
Which of the following is the best next step in management?
A. Start gabapentin and optimize glycemic control
B. Order MRI spine to rule out compression
C. Begin insulin therapy immediately
D. Prescribe aspirin for cardiovascular protection
Hint: What is the mechanism of diabetic neuropathy?
Diabetic neuropathy is caused by prolonged high blood sugar, which damages nerves through oxidative stress, reduced blood flow, accumulation of sorbitol, and formation of harmful glycation end-products.
Correct answer: A. Start gabapentin and optimize glycemic control.
The patient is showing classic signs of diabetic peripheral neuropathy—burning pain, numbness, and reduced monofilament sensation.
This results from chronic hyperglycemia-induced nerve damage due to oxidative stress and microvascular injury.
Gabapentin helps manage neuropathic pain, and improving blood sugar control slows progression.