MRCP2-1600

MRCP2-1600

A 63-year-old man with a history of type 2 diabetes presents at the clinic for a check-up. He is currently being treated with BD mixed insulin and metformin to prevent weight gain associated with insulin use. The patient has a medical history of an inferior myocardial infarction and severe narrow-angle glaucoma. Recently, he has been experiencing severe burning pain in both of his lower legs.

During the examination, the patient’s blood pressure is 142/82 mmHg, pulse is 70 and regular. He has lost sensation below the knees in both legs. The following investigations were conducted:

– Haemoglobin: 127 g/L (135-177)
– White cell count: 6.9 ×109/L (4-11)
– Platelets: 189 ×109/L (150-400)
– Sodium: 138 mmol/L (135-146)
– Potassium: 4.9 mmol/L (3.5-5)
– Creatinine: 143 µmol/L (79-118)
– HbA1c: 63 mmol/mol (<48) or 7.9% (<6.5) According to NICE guidance, what is the most appropriate way to manage his neuropathic pain?