The basic screen for a new length-dependent neuropathy includes vitamin B12, glucose or HbA1c, thyroid function, renal function and a full blood count. B12 deficiency is common and reversible if caught early.
Patients on metformin or long-term proton pump inhibitors, and vegetarians, are at particular risk.
- Long-term metformin and acid suppression lower B12.
- Vegetarian diets, common in India, raise the risk of deficiency.
- Borderline B12 may need methylmalonic acid or homocysteine to confirm.
- Treat deficiency early; delay can leave permanent deficit.
Why it matters
B12 deficiency neuropathy is treatable and easily missed, especially in vegetarians and people on long-term metformin.
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