Symmetry of Sensory Loss in Developing Diabetic Sensory Polyneuropathy

Abstract

The medical literature presents diabetic sensory polyneuropathy (DSPN) as an axonal length-dependent symmetric pathology producing a stocking-like pattern of anesthesia in the lower extremities. This has been based on anecdotal reports. Objective research has shown that damage may not occur in a purely length-dependent manner. A stocking distribution of sensory loss is atypical, and plantar sensory loss predominates. A single-blinded, age-matched, control/experimental study was performed of the symmetry of nerve damage in developing DSPN. Control (n = 46) and experimental (n = 83) subjects were examined. The patterns of sensory loss and the severity of axonal damage were evaluated. The right/left symmetry of pathology was recorded for each individual. Although there was not a stocking pattern of anesthesia found in developing DSPN, the pattern and severity of anesthesia were found to be generally symmetric. The severity of sensory impairment was symmetric at the dorsal foot (93%), lateral foot (95%), and plantar foot (69%). The most predominant site of sensory impairment was also symmetric (81%). This argues against a purely metabolic etiology for axonal damage. An anatomic component is implied. Further research will need to include examination of the unique physical characteristics of predominantly affected nerves.

Thermal Perception Abnormalities Can Predict Diabetic Kidney Disease in Type 2 Diabetes Mellitus Patients

“…Our data are consistent with those of Weintrob et al [36] who reported that unmyelinated C small fibers are more vulnerable than myelinated Ad small fibers in diabetes [12,36]. Furthermore, previous studies have reported that diabetic small-fiber neuropathy is length dependent [37,38]. Longer nerves are more easily destroyed, so the distal nerves in the lower extremities are more vulnerable than those in the hands.…”

Reconsidering Nerve Decompression: An Overlooked Opportunity to Limit Diabetic Foot Ulcer Recurrence and Amputation

“…• For the hypothesized nerve enlargement in DSPN by strong objective level I evidence; 47,48 • Asymmetry and variability of global foot sensibility, Oxford EBM level II-1; 45,52 • High perineural tissue pressures within inflexible anatomic tunnel structures, and relief of pressure by ND, Level II-1; 35 • Subjective relief of DSPN pain, recovery of lost sensibility, and improved symptom scores, Level II-2 and II-3 evidence; 36,42 • Improved objective outcomes, including balance, perineural pressure, NCV, ulcer occurrence, prolonged protection from recurrence, and amputation risk, are supported by Level II-1 to Level II-2 evidence.…”

“…• For the hypothesized nerve enlargement in DSPN by strong objective level I evidence; 47,48 • Asymmetry and variability of global foot sensibility, Oxford EBM level II-1; 45,52 • High perineural tissue pressures within inflexible anatomic tunnel structures, and relief of pressure by ND, Level II-1;…”

Plantar Sensation and Balance in Patients with Type 2 Diabetes Mellitus with and without Peripheral Neuropathy

“…Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease damaging carbohydrate, fat and protein metabolism due to the absence of insulin secretion or decrease in insulin sensitivity of tissues, requiring continuous medical care 1,2 . Peripheral diabetic neuropathy (PDN) is one of the most common complications of diabetes characterized by a wide spectrum of problems, ranging from autonomous cardiovascular changes to diabetic foot ulcer, which decrease the pa-tient quality of life [3][4][5] . In addition, in individuals with peripheral neuropathy, significant disorders of tactile sense, vibration, lower extremity proprioception and kinesthesia sense can be observed 6 .…”