If you've been diagnosed with prediabetes or type 1 or type 2 diabetes, getting checked for diabetic peripheral neuropathy—damage to nerves in your feet, lower legs, hands and elsewhere—is critical. Having this common condition diagnosed can help you get relief from nerve pain, protect your feet from small injuries before they become more serious, help you walk more easily if nerve damage is affecting your balance or coordination, and may motivate you to keep your glucose (blood sugar) within healthy limits and follow a healthy lifestyle strategies. This could prevent or delay the development of neuropathy if you have type 1 diabetes and may prevent or slow down the worsening of neuropathy if you have type 2 diabetes.
That’s why the American Diabetes Association, the American Association of Clinical Endocrinologists1 and the American College of Endocrinology recommend screening for PDN when you are first diagnosed with type 2 diabetes or five years after a diagnosis of type 1 diabetes. After that, get rescreened every year. See your doctor sooner if you develop symptoms, such as pain, tingling or numbness in your feet between screenings. If you have prediabetes, ask your doctor about a PDN screening if you have symptoms, the ADA now recommends. 2
Your screening may begin with a physical exam to assess your overall health – including your blood pressure, heart rate, reflexes, muscle strength, and ability to move.
Your healthcare provider will ask you questions about your health and your symptoms; he or she will also run a few tests. In addition, your doctor will rule out other causes of nerve damage such as thyroid problems, vitamin B12 deficiency, infections like Lyme disease or hepatitis B, some medications and more. 3
A key part of your screening is a foot exam. People with diabetes should have a comprehensive foot exam at least once a year – but studies show that this important check is skipped up to 80% of the time. 4 Your doctor will check the color and condition of your skin and look for ulcers. He or she will assess circulation in your feet and legs by looking for hair growth in those areas (more hair = better circulation) there, feeling your pulse and checking for temperature differences between your feet and lower legs. Changes in muscles and bones will also be examined.
Your doctor will also ask if you’ve had any slow-healing sores on your feet and if you’re having any neuropathy symptoms – such as tingling, burning or a numb feeling in your feet. Be sure to mention any symptoms you’re experiencing, even if they’re mild or seem like no big deal. A major red flag for neuropathy is what experts call “loss of protective sensation” or LOPS for short. This kind of nerve damage can make your feet feel as if they’re wrapped up in thick cotton or wool; Its dangerous because it raises your risk for injuries you may not notice, which can lead to infection and even amputation. 5
Several neurology tests are also recommended. Your doctor may use one or several. These include:
Pinprick test: Light touches with a pin-like device on parts of the feet and toes will show whether nerves are still sensitive to pain.
Ankle reflex: The test is performed at both ankles. With the patient sitting or lying, the examiner dorsiflexes the foot and gently strikes the Achilles tendon with the reflex hammer. 6
Vibration perception: The doctor may use a tuning fork on your feet to test your ability to feel the vibration from the tuning fork. If you cannot feel the vibration, that may indicate diabetic neuropathy.
Pressure sensation: Your doctor may use flexible nylon filaments to help determine how much pressure you can feel. He or she will use different sizes of filaments; each requires a different amount of pressure to make it bend. If you cannot feel the pressure of the filament, that may indicate diabetic neuropathy. 7 Some doctors will lightly touch your toes with a finger (as you close your eyes or look away) to check for pressure sensation instead.8
Nerve conduction velocity (NCV) and electromyography (EMG) tests are sometimes used to help diagnose diabetic neuropathy.
NCV tests measure how long it takes nerves to transmit signals. Damaged nerves don't transmit messages as quickly as they should.
EMG tests can help assess how well muscles are responding to the signals from nerves. If the nerves going to the muscles are damaged, they won't give clear signals and therefore, the muscles won't respond well.
1. Handelsman Yehuda et al: AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND
AMERICAN COLLEGE OF ENDOCRINOLOGY – CLINICAL PRACTICE GUIDELINES FOR DEVELOPING
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2. Pop-Busui R et al: Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care 2017;40:136–154. http://care.diabetesjournals.org/content/diacare/40/1/136.full.pdf
3. Pop-Busui R et al: Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care 2017;40:136–154. http://care.diabetesjournals.org/content/diacare/40/1/136.full.pdf
4. Armstrong David G et al. A 3-Minute Screening Exam for Diabetic Foot. Medscape Commentary, |January 04, 2016 http://www.medscape.com/viewarticle/856525
5. Pop-Busui R et al: Diabetic Neuropathy: A Position Statement by the American
Diabetes Association. Diabetes Care 2017;40:136–154 | DOI: 10.2337/dc16-2042. http://care.diabetesjournals.org/content/diacare/40/1/136.full.pdf
6. Yang, Zhirong et al. Simple tests to screen for diabetic peripheral neuropathy. Cochrane Database of Systematic Reviews. 26 February 2014. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010975/full
8. Miller, John D. How to do a 3-minute diabetic foot exam. The Journal of Family Practice. Nov. 2014; Vol 63, No
American Diabetes Association. Standards of Medical Care in Diabetes—2009. Diabetes Care. 2009;32:S13-61.