What typical lab tests do you send off for evaluation of neuropathy?

Not too much has changed in over a decade regarding the recommendations on how we should approach initial laboratory testing in patients presenting with a neuropathy syndrome. Specifically for cases of distal symmetric polyneuropathy, the AAN practice parameter (reaffirmed in 2022) by England, et al., AAN 2009 recommends initial testing with blood glucose, B12 level, and metabolites (homocysteine and methylmalonic acid), and immunofixation. It should be noted that previously the recommendation for immunofixation (or SPEP) was to test in patients over 50 years old. Still, this age cutoff has been removed due to the increasing incidence of monoclonal gammopathy diseases in the younger population.

Beyond that, you will see a lot of variation ba...

Insurance will deny an HgbA1C test without a diagnosis of diabetes, which then remains on the patient’s list of conditions. How can this be avoided?