In diabetic neuropathy, which pattern is characteristic of sensory loss?

In diabetic neuropathy, which pattern is characteristic of sensory loss?

• A. Central motor neuropathy
• B. Autonomic neuropathy with orthostatic changes
• C. CN III palsy
• D. Stocking-glove sensory loss with paresthesias

Answer: (D)

The key pattern in diabetic neuropathy is a distal symmetric sensory polyneuropathy, classically described as a stocking-glove distribution. Because the longest nerves are affected first, sensation loss begins in the toes and then the fingers and gradually climbs up the limbs. Patients often notice burning, tingling, or numbness as well as reduced ability to feel vibration and temperature. Pathophysiology involves chronic hyperglycemia causing metabolic and microvascular nerve injury, leading to axonal degeneration and demyelination of small sensory fibers. Other diabetic complications like autonomic neuropathy with orthostatic changes or cranial nerve palsies can occur, but the hallmark pattern of sensory loss remains distal symmetric involvement in a stocking-glove distribution.

The key pattern in diabetic neuropathy is a distal symmetric sensory polyneuropathy, classically described as a stocking-glove distribution. Because the longest nerves are affected first, sensation loss begins in the toes and then the fingers and gradually climbs up the limbs. Patients often notice burning, tingling, or numbness as well as reduced ability to feel vibration and temperature. Pathophysiology involves chronic hyperglycemia causing metabolic and microvascular nerve injury, leading to axonal degeneration and demyelination of small sensory fibers. Other diabetic complications like autonomic neuropathy with orthostatic changes or cranial nerve palsies can occur, but the hallmark pattern of sensory loss remains distal symmetric involvement in a stocking-glove distribution.