CLINICAL PRACTICE. Diabetic Sensory and Motor Neuropathy.
Key Clinical PointsDiabetic Sensory and Motor Neuropathy Symptoms of distal symmetric motor and sensory polyneuropathy may be "positive" (manifested as sensations of tingling, burning, or stabbing pain) or "negative" (manifested as sensory loss, weakness, or numbness) These symptoms occur in one third of patients with type 1 or 2 diabetes. Decreased sensation confers a predisposition to painless foot ulcers and to amputations. Proprioceptive impairment leads to imbalance and unsteadiness in gait and to an increased likelihood of falls and serious traumatic injury. Laboratory testing should be used to rule out other causes of neuropathy, including vitamin B12 deficiency, which may occur with metformin use. Lifestyle interventions (diet and exercise) may restore nerve fibers, and exercises that improve strength and balance may reduce the risk of falls. Medications most commonly used in pain management include anticonvulsants (particularly gabapentin and pregabalin) tricyclic antidepressants, and serotonin.
The New England journal of medicine