Table 2—

Stages of DPN*

Stage of neuropathyCharacteristics
No neuropathyNo symptoms or signs
Clinical neuropathy
 Chronic painfulBurning, shooting, stabbing pains with or without “pins and needles”; increased at night; absent sensation to several modalities; reduced/absent reflexes
 Acute painfulSevere symptoms as above (hyperesthesiae common), may follow initiation of insulin in poorly controlled diabetes, signs minor or absent
Painless with complete/partial sensory lossNumbness/deadness of feet or no symptoms, painless injury, reduced/absent sensation, reduced thermal sensitivity, absent reflexes
Late complicationsFoot lesions, neuropathic deformity, nontraumatic amputation
  • *

    * Types of DN: frequent, sensorimotor symmetrical neuropathy (mostly chronic, sensory loss, or pain), autonomic neuropathy (history of impotence and possibly other autonomic abnormalities); rare, mononeuropathy (motor involvement, acute onset, may be painful), diabetic amyotrophy (weakness/wasting usually of proximal lower-limb muscles).

  • Staging does not imply automatic progression to the next stage. The aim is to prevent, or at least delay, progression to the next stage.