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Additional protective measures include: Regular foot examinations (at least annually, more frequently for high-risk patients) and proper foot care to prevent complications Daily self-inspection of feet for injuries, redness, or changes Maintaining healthy lifestyle habits: balanced diet, regular exercise, avoiding excessive alcohol Managing cardiovascular risk factors (blood pressure, lipids) that contribute to nerve damage Avoiding other medications that may worsen neuropathy when possible For patients with painful diabetic neuropathy, evidence-based treatments include duloxetine, pregabalin, gabapentin, and tricyclic antidepressants

21 However, as all supplemented forms are converted to cobalamin, which then gets converted to either the methyl or adenosyl form, 18 this does not appear to be plausible

Quinn M, McMillin M, Galindo C, Frampton G, Pae HY, DeMorrow S