Neuropathy: Diabetes

Etiology

  • A length dependent neuropathy, affecting most distal nerves first (i.e. feet)
  • Most common peripheral neuropathy

Risk Factors

  • Typically related to longstanding & poorly controlled DM; though can also occur w/pre-diabetes

Symptoms

  • 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

Physical Exam Findings

  • 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

Links