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  • 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


  • 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


  • 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 ...

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