A 67-year old-woman presents to the clinic for evaluation of numbness in her feet. The symptoms started gradually and are more noticeable now. There is no weakness in her feet or difficulty walking. Her past medical history is significant for Type 2 diabetes for the past 10 years and she currently takes metformin and glyburide. Physical examination confirms sensory loss in the feet to touch and vibration. Which of the following is most characteristic of diabetic neuropathy?

Diabetic neuropathy usually presents as peripheral polyneuropathy, usually bilateral, and can include symptoms of numbness, paresthesia, severe hyperesthesia, and pain. Impairment of proprioceptive fibers can lead to gait abnormalities and Charcot joints. Mononeuropathy is less common and is often spontaneously reversible. Common syndromes include wrist or foot drop and third, fourth, or sixth cranial nerve palsies. Autonomic neuropathy may cause gastroesophageal dysfunction, bladder dysfunction, and orthostatic hypotension. Randomized controlled trials in Type 1 and 2 diabetes demonstrate that good glycemic control results in lower microvascular complications such as retinopathy or neuropathy.