Symptoms and signs of distal symmetric polyneuropathy (DSPN)

	Large myelinated nerve fibers	Small myelinated nerve fibers
Function	Pressure, balance	Nociception, protective sensation
Symptoms*	Numbness, tingling, poor balance	Pain: burning, electric shocks, stabbing
Examination (clinically diagnostic)^¶	Ankle reflexes: reduced/absent Vibration perception: reduced/absent 10 g monofilament: reduced/absent Proprioception: reduced/absent	Thermal (cold/hot) discrimination: reduced/absent^¶ Pinprick sensation: reduced/absent^¶

* To document the presence of symptoms for diagnosis.
¶ Documented in symmetrical, distal to proximal pattern.

From: American Diabetes Association. Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care 2017; 40:136. American Diabetes Association, 2017. Copyright and all rights reserved. Material from this publication has been used with the permission of American Diabetes Association.

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Symptoms and signs of distal symmetric polyneuropathy (DSPN)