Signs of neuropathy

The term “signs” in the medical field is used to indicate finding that a medical provider looks for on the physical examination to reach a diagnosis. These are explained below in the case of a physical examination to diagnose diabetic neuropathy. For “symptoms”, which in the medical field is the term used to describe your complaints such as numbness, tingling and pain, please refer to the article on “symptoms of neuropathy”.

When a medical provider performs a physical examination to evaluate for diabetic neuropathy, the examination often begins with an assessment off sensation in the upper and lower limbs. Your ability to feel light touch as well as pinprick sensation is assessed. One of the earliest clinical signs of diabetic peripheral neuropathy or polyneuropathy is a decrease or loss of pinprick sensation, followed by decrease or loss of light touch sensation. This is followed by loss of vibration feeling. The feeling of vibration is tested using a tuning fork. Loss of sensation in the “glove and stocking” distribution is often the term used to describe the manner in which most people develop peripheral neuropathy or polyneuropathy. There can be loss of sensation in other parts of the body as well like the chest, trunk or pelvic areas. When neuropathy worsens beyond loss of sensation, there is progression to actual weakness. The remaining part of the “neurological” or nerve testing examination includes an assessment of strength in the upper and lower limbs to look for any weakness.

The physical examination usually also includes testing of deep tendon reflexes, like the ‘knee jerk’. When peripheral neuropathy or polyneuropathy is present, the reflexes can be decreased or absent due to the damage of nerves. But one should keep in mind that it is possible for reflexes to be diminished or absent in certain healthy people as well. Therefore, it is most helpful for your physician to be able to compare your reflexes over time, to see if there is any change from your usual reflexes.

The examination for neuropathy should also include an evaluation of the skin and circulation in the feet and legs, and hands and arms. Changes in the skin color, texture, hair growth, wounds, etc can indicate the severity of neuropathy, and may need treatment.

Certain special functions like vision, taste, smell, movement of the facial muscles, muscles that allow speech, chewing, swallowing, etc are performed with the help of special nerves directly from the brain, called “cranial nerves“. These nerves may also be tested during the complete examination for neuropathy.

Since diabetes can also affect blood circulation, blood vessel pulsations in the feet, legs, hands and arms are usually checked during a physical examination for neuropathy. Most physical examinations will usually also include a check of blood pressure and heart rate, as well as listening for abnormal heart sounds or lung sounds.

Many doctors and medical providers would also check your balance and coordination, since these functions can be affected when neuropathy is present.

If your complaints involve certain organ functions like urinary or bowel problems, sexual problems, etc, or if your doctor suspects that you may have one of the neuropathies that affect specific organs in the body like the bowels, bladder, etc. then there are specific tests on physical examination that the medical provider will want to perform to better evaluate those organ functions.

Since diabetic neuropathy can affect nerves anywhere in the body, a proper physical examination will help reveal any abnormalities or affected areas. Depending on the finding, the medical provider might find it necessary to have certain special tests performed like blood tests, nerve conduction study, electromyography, etc. These will be discussed further in the article ‘Special tests for neuropathy’.

Do I have diabetic neuropathy? How can this website help?

The answer to the question “Do I have diabetic neuropathy?” is not always straight-forward. There are many other conditions that can cause similar symptoms and signs. A medical specialist can usually help answer this question for you based on your symptoms, examination signs and test results. But you too play a critical role in passing along the relevant information to your doctor to help in making the right diagnosis, and in understanding your condition. Also, you are your own best advocate and it makes sense for you to be a well-informed patient about your condition. Say for example your house needed some repairs. Would you spend your hard-earned money on repair work on your house without first learning as much as you can about the problem and the options to solve the problem. Similarly, it makes sense for patients with neuropathy (or any medical condition) to do the research so that they can ask the appropriate questions and stay actively informed informed about their medical condition. This can definitely translate into an accurate diagnosis and better treatment of the problem. WE ARE HERE TO HELP. This website can help in several ways.

1. Understand ‘What is diabetic neuropathy’ by reading the article on this topic. Then you will be able to better participate in the discussion about neuropathy with your doctor, and will also understand many of the medical terms used in your medical reports, books, websites, discussions, etc.

2. Learn about the different types of diabetic neuropathy and the symptoms, then compare with your own situation. You can find this information in the article ‘What are the different types of diabetic neuropathy’ and ‘Symptoms of diabetic neuropathy’.

3. If you would like to understand what your doctor looks for when he/she examines you, then you can read about the different signs that can appear when someone has neuropathy and what each sign means. You can even look to see if you have these signs before you see the doctor.

4. Do you need additional testing? What types of tests are performed when diabetic neuropathy is suspected and when should they be performed? Do all patients suspected to have diabetic neuropathy have all those tests performed? Answers to these questions can be found in the several  articles about the various tests in the ‘Tests and Diagnosis’ section.

5. Finally, I am sure you will be interested in knowing the different treatment options. But do all types of neuropathy need treatment? Can the symptoms of neuropathy just get better on their own? For the more troublesome and painful types of neuropathy, is medication the only options or are there non-medication options as well? Before discussing treatment with your doctor, we strongly recommend that you make yourself aware of the ENTIRE RANGE of treatments available, so that you can ask your doctor why they are recommending certain treatments and not others,and what will be the entire plan of treatment for you.


Knowledgeable patients who have made the effort to learn more about their condition, tend make better and more informed decisions about their care. Although there is no replacement for a face-to-face consultation, examination and sometimes additional testing under the supervision of a medical specialist, it is also important to be informed and aware of the various symptoms, signs, diagnostic tests and then the treatment options.

Symptoms of diabetic neuropathy

To get the most out of this article, we strongly encourage you to first read the article/post on ‘What is diabetic neuropathy?’ to understand the various nerve types in the body, normal function of the different nerves in the body, how they can be affected by diabetes, and the various medical terms used to explain neuropathy.

Is there more than one type of diabetic neuropathy?
Diabetes can damage almost any type of nerve in the body. Depending on the type of nerves affected by diabetes, symptoms of neuropathy can vary from person to person. The different types of nerves in the body are explained in the article ‘What is diabetic neuropathy?’ Some people have several different symptoms of neuropathy due to damage to different types of nerve. Others may have only one type of neuropathy. The most common form of diabetic neuropathy is peripheral neuropathy or polyneuropathy.

Types of diabetic neuropathy and SYMPTOMS of each type of neuropathy
Some people will have only one type of neuropathy if only one type of nerves is affected. Others may have several different groups of symptoms of neuropathy due to damage to more than one type of nerves. The most common form of diabetic neuropathy is peripheral neuropathy or polyneuropathy.

Diabetic peripheral neuropathy or polyneuropathy: When diabetes affects the nerves in the feet, hands, legs or arms, which carry sensations of touch, temperature, pain, balance, etc (sensory nerves) or the nerves which control muscle movements in the legs or arms (motor nerves), this type of neuropathy is called diabetic polyneuropathy (‘poly’ is the term used to indicate ‘multiple’, thereby meaning that polyneuropathy is a condition affecting multiple nerves) or diabetic peripheral neuropathy (the term ‘peripheral’ is used to indicate that nerves at the ‘periphery’ of the body are affected, for example the feet or hands, sometimes spreading to the legs or arms).

As explained in the article ‘What is diabetic neuropathy?’, nerves in the feet, hands, legs and arms may be ‘sensory nerves’ or ‘motor nerves’. Depending on which of these two types of nerves or both, are affected, one may have either sensory neuropathy or motor neuropathy.

* Sensory peripheral neuropathy or sensory polyneuropathy causes loss or altered sensation of touch, temperature or position sense. This results in numbness, tingling, clumsiness or balance problems. There can also be altered sensation of pain causing either loss of the ability to feel painful sensations, or constant feeling of pain in the affected area. Some people will develop a sign in which the affected part (foot, hand, arm or leg) is very sensitive to touch. In medical terms, this is called ‘hyperaesthesia’. When there is actual pain to even light touch, this is an even worse sign called ‘allodynia’. People who have developed allodynia find it painful to wear socks, shoes or even have a bed sheet touch the affected foot or hand. Medical specialists use these terms to describe the signs of neuropathy- these and other signs used by doctors and other medical providers will be discussed in depth in the article ‘Diagnosis of diabetic neuropathy’. The most commonly affected part of the body is the feet. The neuropathy can spread to affect the legs as well. It can also affect the hands and feet.
* Motor peripheral neuropathy or motor polyneuropathy is the term given to the type of neuropathy that affects the ‘motor nerves’ and causes weakness of the feet, legs, hands or arms.
* Mixed (sensory and motor) peripheral neuropathy or polyneuropathy is the term used when a person has both sensory and motor neuropathy.

Usually the early symptoms of diabetic polyneuropathy or peripheral neuropathy are numbness and tingling (sensory neuropathy). At this stage, all attempts should be made to prevent further progress of the neuropathy. Preventive as well as treatment methods have been discussed in other articles on this website. If the neuropathy progresses, then hyperaesthesia and allodynia may develop. Further progression results in weakness (motor neuropathy). Diabetic peripheral neuropathy does not alway follow this sequence. Some people may experience a more rapid progression to the motor neuropathy. In others, there is sudden development of weakness in muscles controlled by a single nerve or a group of nerves. This is called ‘focal neuropathy’, discussed below along with some other types of neuropathy.

Other types of diabetic neuropathy are less common than peripheral neuropathy or polyneuropathy, but need to be mentioned.

One form of neuropathy called focal neuropathy involves sudden or rapid development of weakness in muscles controlled by a single nerve or a group of nerves.  This can affect any part of the body, and may or may not be associated with pain.

In the condition called autonomic neuropathy, nerves that help control body functions are affected. Indigestion, nausea, vomiting, diarrhea or constipation can occur when the nerves to the stomach and intestines/bowel are affected. Abnormally high or low blood pressure can cause dizziness or fainting when the nerves that help control the heart and blood circulation are affected. Similarly, some other bodily functions that can be affected by diabetic neuropathy and cause problems are urinary retention (nerves to bladder affected), erectile dysfunction in men and vaginal dryness in woman (nerves to genital organs affected).


Thank you for reading this article, and we hope that you now have a good understanding of the possible symptoms associated with the different types of diabetic neuropathy, especially peripheral neuropathy or polyneuropathy.  We would recommend that you next read about the clinical ‘signs’ and tests that doctors and other medical specialists use to diagnose diabetic neuropathy, in the article ‘Diagnosing diabetic neuropathy’. Or you may browse the other topics on this website related to diabetes and foot pain.