II. Epidemiology
- Most common Diabetic Neuropathy
- Accounts for 26% of Diabetic Peripheral Neuropathy
III. Symptoms
- Distal Paresthesias, hyperesthesias or numbness
- Symptoms worse at night
- "Stocking & Glove" Neuropathy
- Related to longest axons affected first
- Onset in the toes first and ascends proximally
- Muscle Weakness and atrophy may be noted
- Painful Peripheral Neuropathy occurs in a subset of Diabetic Peripheral Neuropathy (20%)
- Pain due to light stroking (dynamic mechanical Allodynia)
- Increased Temperature sensitivity (thermal hyperalgesia)
- Pain attacks
IV. Signs: Specific nerve functions affected
- Vibration and position sense
- Achilles and Patellar tendon Deep Tendon Reflexes
- Gait Ataxia
- Sharp-dull discrimination
- Two Point Discrimination
- Decreased "protective Sensation"
- 10 g Monofilament Test
- Muscle Strength may also be affected