Early diabetic neuropathy: Triggers and mechanisms

Figure 4 Hypotheses on distal-to-proximal progression of DPN. In normal PNS (top), neurons synthesize proteins in the cell body and transport them down the axon at the rate determined by axonal structural and functional needs. Impairment of synthesis or axonal transport of proteins will result in dying-back neuropathy, in which neurons with longest processes are affected first (middle). Alternatively, the neuropathy may result from effect of random local insults to the axon, with probability of accumulation of a critical number of such insults being higher for neurons having longer axons (bottom). Short arrows indicate non-specified axonal or neuronal injuries. Long solid or dashed arrows indicate normal or compromised axonal transport (respectively).