A history and physical examination can be used to identify peripheral Diabetic Neuropathy. People with a history of diabetes who experience pain or numbness in their legs or feet should be diagnosed. The most frequent clinical signs include lower limb dysfunction, discomfort, muscle weakness, and loss of balance. Changes in the look of the feet, the prevalence of ulceration, and weakened ankle reflexes are all possible physical exam findings. The most helpful physical exam finding for big fibre Diabetic Neuropathy is an abnormally reduced vibration sensitivity to a 128-Hz tuning fork (LR range, 16–35) or pressure sensation with a 5.07 Semmes–Weinstein monofilament (LR range, 11–16). Large fibre peripheral neuropathy due to diabetes is less likely to occur when vibration testing (LR range, 0.33-0.51) or monofilament (LR range, 0.09-0.54) results are normal.
Nerve conduction tests may demonstrate diminished peripheral nerve function, but they infrequently correlate with the severity of peripheral Diabetic Neuropathy and should not be used as standard diagnostic procedures for the condition. More and more studies suggest using electrochemical skin conductance to measure small fibre neuropathy during QST and Sudomotor function tests to detect early indications of diabetic neuropathy and autonomic neuropathy.
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