Optimize glucose control
First-line medications per ADA position paper 2017
Pregabalin 50 - 100 mg PO TID, starting at 50 mg TID, increasing to 100 mg TID after 1 week, max dose 600 mg/day
More rapid onset of action and less titration necessary as compared to gabapentin
However, extremely cost prohibitive for self-pay
Duloxetine at 60 - 120 mg/day, starting 30 mg PO BID, increasing to goal after 1 week, max 120 mg/day
SNRI, anti-depressant, not as cost-prohibitive as pregabalin
Does not appear to be associated with significant cardiovascular risk
Gabapentin is a questionably effective medication, but is low cost and has a relatively tolerable side effect profile
March 2017 systematic review revealed gabapentin is not beneficial
Effective treatments include duloxetine, venlafaxine, pregabalin, oxcarbazepine, TCAs, atypical opioids (tapentadol)
Ineffective treatments include dextromethorphan, gabapentin, typical opioids (oxycodone),  topical 'capsaicin
Gabapentin 300 mg QHS, increased to 300 mg BID, increased to 300 mg TID over 2-3 weeks
Graduation titration to 1800 - 3600 mg/day is necessary for it to be clinically effective
Pregabalin 50 - 100 mg PO TID, starting at 50 mg TID, increasing to 100 mg TID after 1 week, max dose 600 mg/day
More rapid onset of action and less titration necessary as compared to gabapentin
However, extremely cost prohibitive for self-pay
Duloxetine at 60 - 120 mg/day, starting 30 mg PO BID, increasing to goal after 1 week, max 120 mg/day
SNRI, anti-depressant, not as cost-prohibitive as pregabalin
Does not appear to be associated with significant cardiovascular risk
More rapid onset of action and less titration necessary as compared to gabapentin
However, extremely cost prohibitive for self-pay
SNRI, anti-depressant, not as cost-prohibitive as pregabalin
Does not appear to be associated with significant cardiovascular risk
March 2017 systematic review revealed gabapentin is not beneficial
Effective treatments include duloxetine, venlafaxine, pregabalin, oxcarbazepine, TCAs, atypical opioids (tapentadol)
Ineffective treatments include dextromethorphan, gabapentin, typical opioids (oxycodone),  topical 'capsaicin
Gabapentin 300 mg QHS, increased to 300 mg BID, increased to 300 mg TID over 2-3 weeks
Graduation titration to 1800 - 3600 mg/day is necessary for it to be clinically effective
Effective treatments include duloxetine, venlafaxine, pregabalin, oxcarbazepine, TCAs, atypical opioids (tapentadol)
Ineffective treatments include dextromethorphan, gabapentin, typical opioids (oxycodone),  topical 'capsaicin
Diabetic peripheral neuropathy
Physiologic stress response 
Axillary neuropathy
Diabetes mellitus 
Chronic inflammatory demyelinating polyneuropathy
Nonketotic hyperglycemia
Spinal accessory neuropathy
Hyperosmolar hyperglycemic state 