The following symptoms and complaints may indicate diabetic polyneuropathy:
Sensory insensitivity
- Formication
- Burning
- Lack of sensation of heat or cold
- Tingling sensation
- Furry feeling
- Swelling sensation
- Stinging
- Numbness
Motor symptoms
- Muscle spasms
- Muscle weakness
- Muscle twitching
- Pain
Sensory and motor disturbances (= sensorimotor diabetic polyneuropathy) usually occur uniformly in both legs and/or hands, so they are symmetrical (= distal symmetric polyneuropathy). Notice:
- In subclinical neuropathy, i.e., no presence of symptoms and clinical findings, quantitative neurophysiological tests are already positive.
- In a quarter of patients with peripheral sensorimotor diabetic polyneuropathy (synonym: diabetic sensorimotor polyneuropathy, DSPN), it is completely painless.
Other symptoms
- Gait unsteadiness
- Painless wounds
- Edema – water retention in the tissues
- Ulcer (ulcer)
- Foot deformities (indicating diabetic neuroosteoarthropathy).
- Hypo- or anhidrosis – decreased ability to sweat to the inability to sweat.
- Orthostatic hypotension* – lowered blood pressure due to vascular dysfunction.
- Rate rigidity* – heart rate can not be increased or slowed down.
- Resting tachycardia* * (a rapid, sustained heart rhythm of more than 100 beats per minute at rest)
- Ventricular arrhythmias* * (cardiac arrhythmia that is life-threatening because it can lead to ventricular fibrillation and sudden cardiac death) [demonstrable prolongation of QT duration].
- Nocturnal blood pressure elevations* * [reversal of normal circadian rhythmicity]
- Exercise intolerance and left ventricular dysfunction* * [impaired increase in heart rate and blood pressure during exercise; decreased left ventricular ejection fraction at rest and during exercise]
- Impaired hypoglycemia perception (impaired perception of hypoglycemia).
- Gastrointestinal symptoms*
- Dyspeptic symptoms (irritable stomach).
- Dysphagia (dysphagia)
- Odynophagia (pain when swallowing)
- Abdominal discomfort
- Nausea (nausea)/emesis (vomiting)
- Feeling of fullness
- Meteorism (flatulence)
- Gastroparesis (gastric paralysis) – delayed gastric emptying without the presence of mechanical obstruction; symptoms: early satiety, postprandial (“after meal”) fullness, upper abdominal pain, retching, nausea (20-30%), heartburn (15%), constipation (10-20%), recurrent diarrhea (diarrhea; 5-10%), and vomiting after food intake; possible sequelae: Malnutrition (malnutrition) due to recurrent vomiting and an increased rate of infection due to aspiration pneumonia (pneumonia caused by inhalation of foreign substances (in this case: stomach contents)).Incidence (frequency of new cases): type 1 diabetics at 5.2%; type 2 diabetics 4.2%.
- Diarrhea (diarrhea)
- Constipation (constipation)
- Fecal incontinence (inability to retain the intestinal contents as well as intestinal gases arbitrarily in the rectum).
- Mononeuropathies (damage to a single peripheral nerve; rare).
- Lumbar plexopathy (5%)
- Oculomotor nerve palsy (1%)
- Thoracolumbar radiculopathy (0.5%)
- Urogential symptoms*
- Micturition disorders (bladder dysfunction/voiding disorders):
- Frequency of micturition, residual urine, urinary tract infections, urinary stream attenuation, need for abdominal squeezing, urinary incontinence.
- Erectile dysfunction (ED; erectile dysfunction).
- Micturition disorders (bladder dysfunction/voiding disorders):
- Vertigo* (dizziness)
- Syncope* (momentary loss of consciousness).
* Indications of autonomic diabetic neuropathy * * Indications of cardiovascular autonomic diabetic neuropathy (CADN).
Other clues
- Early onset of neuropathic pain is suggestive of a diabetic etiology.
- Early gait disturbances, involvement of the arms, or marked asymmetry tend to argue against a diabetic genesis.