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Clinicians should consider and investigate: Vitamin B12 deficiency (particularly in metformin userscheck serum B12) Hypothyroidism (check thyroid function) Chronic kidney disease (check renal function and eGFR) Alcohol excess Medication-related neuropathy Urgent referral criteria per NICE NG19: Same-day referral to the multidisciplinary foot care service for new ulceration, signs of infection, or suspected active Charcot arthropathy Emergency hospital admission for suspected sepsis, acute limb-threatening ischaemia, or deep-seated soft tissue or bone infection Treatment and Management Options in the UK Management of diabetic neuropathy encompasses both disease-modifying strategies targeting the underlying metabolic dysfunction and symptomatic treatments addressing neuropathic pain and functional impairment

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These interactions are often related to overlapping side effect profiles or indirect effects on the bodys physiological processes

Erika said shes seen Maggies physical health dramatically change with normal blood work, non-fatty liver and not being pre-diabetic