Diagnosis of Peripheral Neuropathy

Signs and Symptoms of Diabetic Peripheral Neuropathy

Acute Neuropathy

Acute neuropathy is usually caused by small fiber neuropathy and presents as pain and paresthesia early in the course of diabetes. It is sometimes called "insulin neuritis", since frequently it appears after the initiation of insulin therapy. Symptoms are more prominent in the feet than in the hands and are usually worse at night. It typically lasts less than 6 months but the episodes of pain can be extremely severe and disabling. Pain may be of any quality (e.g., burning, stabbing) and accompanied by paresthesia (e.g., tingling, pins and needles). The skin (particularly of the lower legs) may be hypersensitive to any touch and even the slightest disturbance (e.g., light breeze) may be excruciating. This neuropathy may resolve spontaneously or may become chronic but the symptoms of acute painful neuropathy can be successfully treated in many patients.

When symptoms are extreme, they may lead to weight loss and depression. This situation is called diabetic neuropathic cachexia and it occurs more often in diabetic males than in diabetic females. Diabetic neuropathic cachexia usually responds to symptomatic treatment.

Chronic Polyneuropathy

This type of neuropathy often occurs up to several years after the onset of diabetes and persists longer than 6 months. It is also very debilitating and treatment may lead to addiction or abuse of powerful drugs used in an attempt to alleviate the pain. It may be resistant to treatment and, understandably, has a strong negative impact on the quality of life of the sufferer.

Diabetic Mononeuropathy

This is usually caused by vasculopathy where tiny blood vessels that supply a particular nerve become clogged. It may be accompanied by a deep aching pain followed by numbness or weakness.

Regional Neuropathic Syndrome

Groups of nerves in a specific region are damaged. It is seen in adult onset diabetes and is associated with diabetic amyotrophy (a disease of the nerves leading to the muscles). Symptoms usually begin with an aching in the leg which is followed by weakness.

Diabetic Autonomic Neuropathy

The symptoms of autonomic neuropathy, described above, affect up to 50% of diabetic patients.

Usually, symptoms of diabetic neuropathy begin with numbness and paresthesia in the foot and ascend up the leg. Over months or years, sensory loss usually intensifies and may eventually affect the arms and hands. The development of numbness in the feet is very important to note since it is usually the precursor to foot problems that can ultimately lead to ulceration, gangrene, and/or amputation. Loss of sensitivity to light touch and temperature is often an early symptom and may be followed by ataxia (lack of coordination). This increases the risk of falls and fractures