Skip to Main Content

++

  • Diabetic polyneuropathy
  • Metabolic polyneuropathy

++

  • 250.60 Diabetes mellitus with neurological manifestations type 2 or unspecified type not states as controlled
  • 357.2 Polyneuropathy in diabetes

++

  • E13.40 Diabetes, diabetic (mellitus) with neuropathy

++
++

Description

++

  • Damage to peripheral sensory (most common) and/or motor neurons
  • Most likely due to demyelination, inflammation, ischemia or infarction from as yet poorly understood metabolic abnormality

++

Essentials of Diagnosis

++

  • Distinct clinical syndromes include
    • Distal, symmetrical, primarily sensory polyneuropathy affecting feet and legs in a chronic, slowly progressive manner (most common)
      • Usually unnoticed by patient until fairly progressed
      • Most common complaint is persistent numbness or tingling, worse at night
    • Acute ophthalmoplegia affecting cranial nerve III (oculomotor) and less often cranial nerve VI (abducens) on one side
    • Acute mononeuropathy of limbs or trunk, including painful thoracolumbar radiculopathy
    • Acute or sub-acute painful, asymmetrical, predominantly motor multiple neuropathy affecting upper lumbar roots and proximal leg muscles (diabetic amyotrophy)
    • Symmetrical, proximal motor weakness and wasting, usually without pain, with variable sensory loss, pursing sub-acute or chronic course
    • Autonomic neuropathy involving bowel, bladder, sweating, circulatory reflexes

++

General Considerations

++

  • Sensory loss puts patient at risk for skin tears, skin breakdown
  • Sensory and motor loss can result in loss of normal forces on joints, particularly foot and ankle, causing joint deformity over time
  • Sensory and motor loss puts patient at higher risk for injury, acute and repetitive
  • Peripheral nerve damage most common in lower extremities, but may occur in the upper extremities

++

Demographics

++

  • 15% of patients with diabetes have symptoms of polyneuropathy
  • 50% of cross-sectional sample of people with diabetes have evidence of peripheral nerve damage on nerve conduction velocity testing
  • Less than 10% have clinical neuropathy on diagnosis of diabetes
  • Infrequent in people under 30 years of age

++

Signs and Symptoms

++

  • Numbness
  • Tingling
  • Weakness, muscle atrophy
  • Loss or impairment of deep tendon reflexes, vibration, proprioception
  • Pain, burning, stabbing
  • Impaired balance
  • Altered gait
  • Impaired vision
  • Orthostatic hypotension

++

Functional Implications

++

  • Fall risk with mobility on uneven or unpredictable surfaces
  • Injury risk with items of unknown sharpness or temperature
  • Impaired driving due to lower-extremity neuropathy or ophthalmoplegia
  • Difficulty with fine motor tasks (writing, grooming, cooking, feeding, bathing)
  • Difficulty with gross motor tasks (transfers, gait, stair climbing, dressing)

++

Possible Contributing Causes

++

  • Cardiovascular risk factors associated with “metabolic syndrome” thought to be risk factors for diabetic polyneuropathy: triglyceride levels, body mass, hypertension
  • Poorly controlled diabetes results in higher likelihood of developing polyneuropathy

++

Differential Diagnosis

++

  • Spinal cord injury
  • Guillain–Barré syndrome
  • Tabes dorsalis
  • Lumbar radiculopathy
  • Peripheral vascular disease
  • Lyme disease
  • Leprosy
  • HIV-related neuropathy
  • Lupus erythematosus
  • Sarcoidosis
  • Polyarteritis nodosa
  • Rheumatoid arthritis

++

Laboratory ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.