Bilateral Peripheral Polyneuropathy in Diabetes


Bilateral Peripheral Polyneuropathy in Diabetes, Diabetic Distal Symmetric Polyneuropathy, Diabetic Distal Sensorimotor Polyneuropathy

  • Epidemiology
  1. Most common Diabetic Neuropathy
  2. Accounts for 26% of diabetic Peripheral Neuropathy
  • Symptoms
  1. Distal Paresthesias, hyperesthesias or numbness
  2. Symptoms worse at night
  3. "Stocking & Glove" Neuropathy
    1. Related to longest axons affected first
  4. Muscle Weakness and atrophy may be noted
  5. Painful Peripheral Neuropathy occurs in a subset of diabetic Peripheral Neuropathy (20%)
    1. Pain due to light stroking (dynamic mechanical Allodynia)
    2. Increased Temperature sensitivity (thermal hyperalgesia)
    3. Pain attacks
  • Signs
  • Specific nerve functions affected
  1. Vibration and position sense
    1. Achilles and Patellar tendon Deep Tendon Reflexes
    2. Gait Ataxia
  2. Sharp-dull discrimination
  3. Two Point Discrimination
  4. Decreased "protective Sensation"
    1. 10 g Monofilament Test
  5. Muscle Strength may also be affected
  • Differential Diagnosis
  • Management
  1. See Diabetic Peripheral Neuropathy