Diabetic neuropathy is nerve damage caused by prolonged high blood glucose, and it is the commonest cause of peripheral neuropathy seen in adult neurology clinics. The usual pattern is symmetrical numbness, burning or pins and needles that starts in the toes and moves upwards over years.
Diabetic neuropathy is nerve damage caused by prolonged high blood glucose, and it is the commonest cause of peripheral neuropathy seen in adult neurology clinics. The usual pattern is symmetrical numbness, burning or pins and needles that starts in the toes and moves upwards over years.
Two processes act together. Glucose itself drives metabolic changes inside the nerve, and the tiny vessels supplying the nerve are damaged so the blood supply falls. Longer axons are more vulnerable, because a longer cell has more to maintain and a longer distance to transport materials along. That is why the feet are affected before the hands and why the pattern is described as length-dependent. It also explains the sequence: the toes go first, then the feet, then the lower legs, and the hands only later if at all.
A stocking distribution, present on both sides roughly equally, with sensory symptoms well ahead of any weakness. Loss of vibration sense in the toes and absent ankle reflexes are often the earliest objective findings. Pain and numbness can coexist, which patients find contradictory and which is entirely typical. Autonomic forms present differently again, with lightheadedness on standing, early fullness after meals, altered sweating or bladder symptoms. An asymmetrical or rapidly progressive picture argues against simple diabetic neuropathy and prompts a wider search.
EMG and nerve conduction studies confirm large-fibre involvement, grade its severity and establish a baseline that later studies can be compared against. Their more valuable job is exclusion. Lumbar radiculopathy, carpal tunnel syndrome and other entrapment neuropathies all produce numb feet or hands in people who also have diabetes, and they are treated quite differently. Both offices run their own AANEM-accredited electrodiagnostic laboratory, which is why the study and the interpretation happen in the same place.
Glucose control is the main lever, and the evidence for it is strongest in type 1 diabetes and more modest in type 2. Blood pressure and lipids contribute, as do stopping smoking and reducing alcohol, which is independently neurotoxic. Vitamin B12 is worth checking in anyone taking metformin long term. Daily foot inspection, properly fitted footwear and prompt review of any wound matter enormously once protective sensation is reduced, because an injury that cannot be felt is an injury that gets worse unnoticed.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.