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Bilateral Peripheral Polyneuropathy in Diabetes
Aka: Bilateral Peripheral Polyneuropathy in Diabetes, Diabetic Distal Symmetric Polyneuropathy, Diabetic Distal Sensorimotor Polyneuropathy
- Epidemiology
- Most common Diabetic Neuropathy
- Accounts for 26% of diabetic Peripheral Neuropathy
- Symptoms
- Distal Paresthesias, hyperesthesias or numbness
- Symptoms worse at night
- "Stocking & Glove" Neuropathy
- Related to longest axons affected first
- 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
- 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
- Differential Diagnosis
- Polyneuropathy
- Management
- See Diabetic Peripheral Neuropathy
- References
- Snyder (2016) Am Fam Physician 94(3): 227-34 [PubMed]