Diabetic neuropathy is diagnosed by finding a characteristic symmetrical pattern of sensory loss starting in the feet, in someone with diabetes, after excluding other causes. Electrodiagnostic testing confirms and grades it where the picture is unclear or atypical.
Diabetic neuropathy is diagnosed by finding a characteristic symmetrical pattern of sensory loss starting in the feet, in someone with diabetes, after excluding other causes. Electrodiagnostic testing confirms and grades it where the picture is unclear or atypical.
The classic form is a length-dependent, symmetrical polyneuropathy: it starts in the toes and both feet together, progresses slowly upward, and only involves the hands once it has reached roughly the level of the knees. Sensory symptoms come first, including numbness, burning, tingling and pins and needles, often worse at night. Reduced sensation is easily missed because it is an absence rather than a symptom, and is sometimes first noticed as not feeling a blister or a stone in a shoe.
Examination tests sensation to light touch, vibration and temperature, checks ankle reflexes, and assesses strength. Vibration sense at the great toe is often the earliest measurable change. Foot inspection is an essential part rather than an add-on: reduced sensation means injuries go unnoticed, and an unnoticed ulcer is the complication that matters most. Anyone with diabetes and sensory symptoms should be checking their feet regularly rather than waiting for an appointment to do it.
Having diabetes does not mean diabetes is the cause. Vitamin B12 deficiency, thyroid disease, alcohol, kidney disease, certain chemotherapy agents and some other medications all cause neuropathy and several are treatable. Metformin, widely used in diabetes, can itself lower B12. An asymmetrical pattern, rapid progression, marked weakness or predominant hand involvement all argue against straightforward diabetic neuropathy and warrant electrodiagnostic testing, performed at both CNS offices.
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.