- A length dependent neuropathy, affecting most distal nerves first (i.e. feet)
- Most common peripheral neuropathy
- Typically related to longstanding & poorly controlled DM; though can also occur w/pre-diabetes
- Stocking glove pattern, with impairment of peripheral nerve function that occurs in an ascending pattern
- Can lead to painless loss of sensation or may be associated with neuropathic/burning type pain; may also cause autonomic dysfunction
- Sensory system affected to greater degree than motor
- Upper extremity symptoms uncommon until/unless disease in the lower extremities very advanced
- Decreased sensation, that starts in toes and moves proximally
- Diminished or lost lower extremity reflexes
- Decreased proprioception and vibration sense
- Sometimes distal weakness
- Can have neuropathic ulcers, often w/contribution from co-existent peripheral arterial disease