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Sensory Symptoms Numbness, tingling, or pins and needles (paresthesia) typically distal/stocking-glove in polyneuropathy Burning pain, allodynia, hyperalgesia common in small-fiber predominant neuropathy and CIDP Loss of proprioception and vibration sense sensory ataxia, positive Romberg sign Loss of pain/temperature sensation (small fiber) risk of unnoticed wounds Motor Symptoms Distal muscle weakness (foot drop in peroneal neuropathy, wrist drop in radial neuropathy) Atrophy of intrinsic hand muscles (ulnar/median neuropathy) Hyporeflexia or areflexia (ankle jerks lost early in length-dependent polyneuropathy) Fasciculations in severe axonal loss Autonomic Symptoms Orthostatic hypotension, dizziness on standing Gastroparesis, constipation or diarrhea, nausea Neurogenic bladder (hesitancy, retention, incontinence) Anhidrosis or gustatory sweating Sexual dysfunction

However, persistent cloudiness, visible particles, clumps, stringy material or a gel like texture may indicate that the peptide has not formed a uniform solution

These observations underscore the essential role of Sirt1 in mediating NNMTs regulatory effect on glucose metabolism