Diabetic Polyneuropathy: Symptoms, Complaints, Signs

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).
  • 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.