peripheral neuropathy

A 65-year-old man with a 20-year history of poorly controlled type 2 diabetes mellitus, hypertension, and dyslipidaemia presents with a 6-month history of burning pain in his feet, worse at night, often waking him from sleep. He also reports feeling lightheaded when standing up quickly and has noticed difficulty initiating urination and a weak stream. On examination, his blood pressure is 135/85 mmHg supine and 115/70 mmHg after standing for 3 minutes. Neurological examination reveals decreased sensation to pinprick and light touch in a stocking distribution up to the mid-calf bilaterally. Vibration sense is reduced at the ankles. Ankle reflexes are absent. The remainder of the examination is unremarkable. His most recent HbA1c is 8.9%. Which of the following is the most likely underlying cause of his constellation of symptoms?

A 62-year-old woman with a 15-year history of type 2 diabetes mellitus presents to her general practitioner with complaints of worsening vision over the past six months. She also reports intermittent tingling and numbness in her feet, which has been progressively worsening. Her diabetes has been poorly controlled, with recent HbA1c levels consistently above 9%. She has a history of hypertension and hyperlipidemia, both of which are managed with medication. On examination, her blood pressure is 140/85 mmHg, and her BMI is 32 kg/m². Fundoscopic examination reveals microaneurysms and cotton wool spots. Urinalysis shows microalbuminuria. Which of the following interventions is most likely to address the underlying pathophysiological mechanism of her visual symptoms?

A 55-year-old man with a 15-year history of type 2 diabetes presents with numbness and tingling in his feet. On examination, there is reduced sensation to light touch and vibration in a stocking distribution. What is the most appropriate initial management for his symptoms?