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The diagnosis of diabetic neuropathy can be difficult to determine. Diabetic neuropathy is highly underdiagnosed both by endocrinologists as well as other physicians because its symptoms can be subclinical. For example, the ankle jerk test or vibration perception test may be abnormal but the patient is not aware of them because they do not interfere with daily living. It is thought that up to 60% of patients with type 1 and type 2 diabetes may have signs of diabetic neuropathy upon being tested. The diagnosis of diabetic neuropathy is usually based on a minimum of two signs, symptoms, or tests. Most patients are unable to distinguish neuropathic from non-neuropathic pain, which adds to the importance of testing to determine the origin of the symptoms. The same tests used for nondiabetic neuropathy may be used to diagnose or confirm diabetic neuropathy, including:

• Physical exam
• Neurological exam
• Electrodiagnostic tests
• Nerve or skin biopsy
• Blood test

The American Diabetes Association recommends an annual comprehensive foot examination for asymptomatic diabetic patients and more frequent examinations for diabetics who have developed signs and symptoms of diabetic neuropathy. The annual foot exam should include:

• Careful inspection of both feet
• Palpation of the feet for pulses
• Evaluation of gait
• Check for proper shoe size and fit
• Thyroid function test