Neuro

Bilateral Peripheral Polyneuropathy in Diabetes

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Bilateral Peripheral Polyneuropathy in Diabetes, Diabetic Distal Symmetric Polyneuropathy, Diabetic Distal Sensorimotor Polyneuropathy, Stocking Glove Peripheral Neuropathy

  • 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
    2. Onset in the toes first and ascends proximally
  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
  1. Polyneuropathy
  • Management
  1. See Diabetic Peripheral Neuropathy
  • Complications
  1. Charcot Foot
  2. Diabetic Foot Wound
  3. Diabetic Foot Osteomyelitis
  4. Peripheral Neuropathy Tremor
  • References
  1. Snyder (2016) Am Fam Physician 94(3): 227-34 [PubMed]