Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content ++ Diabetic polyneuropathyMetabolic polyneuropathy ++ 250.60 Diabetes mellitus with neurological manifestations type 2 or unspecified type not states as controlled357.2 Polyneuropathy in diabetes ++ E13.40 Diabetes, diabetic (mellitus) with neuropathy ++ 5G: Impaired motor function and sensory integrity associated with acute or chronic polyneuropathies +++ Description ++ Damage to peripheral sensory (most common) and/or motor neuronsMost likely due to demyelination, inflammation, ischemia or infarction from as yet poorly understood metabolic abnormality +++ Essentials of Diagnosis ++ Distinct clinical syndromes includeDistal, symmetrical, primarily sensory polyneuropathy affecting feet and legs in a chronic, slowly progressive manner (most common)Usually unnoticed by patient until fairly progressedMost common complaint is persistent numbness or tingling, worse at nightAcute ophthalmoplegia affecting cranial nerve III (oculomotor) and less often cranial nerve VI (abducens) on one sideAcute mononeuropathy of limbs or trunk, including painful thoracolumbar radiculopathyAcute 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 courseAutonomic neuropathy involving bowel, bladder, sweating, circulatory reflexes +++ General Considerations ++ Sensory loss puts patient at risk for skin tears, skin breakdownSensory and motor loss can result in loss of normal forces on joints, particularly foot and ankle, causing joint deformity over timeSensory and motor loss puts patient at higher risk for injury, acute and repetitivePeripheral nerve damage most common in lower extremities, but may occur in the upper extremities +++ Demographics ++ 15% of patients with diabetes have symptoms of polyneuropathy50% of cross-sectional sample of people with diabetes have evidence of peripheral nerve damage on nerve conduction velocity testingLess than 10% have clinical neuropathy on diagnosis of diabetesInfrequent in people under 30 years of age +++ Signs and Symptoms ++ NumbnessTinglingWeakness, muscle atrophyLoss or impairment of deep tendon reflexes, vibration, proprioceptionPain, burning, stabbingImpaired balanceAltered gait Impaired visionOrthostatic hypotension +++ Functional Implications ++ Fall risk with mobility on uneven or unpredictable surfacesInjury risk with items of unknown sharpness or temperatureImpaired driving due to lower-extremity neuropathy or ophthalmoplegiaDifficulty 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, hypertensionPoorly controlled diabetes results in higher likelihood of developing polyneuropathy +++ Differential Diagnosis ++ Spinal cord injuryGuillain–Barré syndromeTabes dorsalisLumbar radiculopathyPeripheral vascular diseaseLyme diseaseLeprosy HIV-related neuropathyLupus erythematosusSarcoidosis ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.