Diabetic Neuropathy

Diabetic peripheral neuropathy usually presents as distal symmetric polyneuropathy: symptoms begin in both feet and gradually move upward in a stocking distribution. Burning, electric or shooting pain, tingling, pins-and-needles sensations, numbness, and reduced vibration sense are typical. Symptoms often feel worse at night, when there are fewer competing sensory stimuli. Pain and sensory loss can coexist. A patient may describe severe burning across the soles yet fail to notice a blister, pebble in a shoe, or minor cut. That combination creates the central risk: pain affects sleep and function, while loss of protective sensation permits injury to progress unnoticed. The experienced nurse notices the pattern, not only the pain score. Bilateral distal symptoms that develop gradually fit diabetic peripheral neuropathy. A new one-sided deficit, a dermatomal pattern, or rapidly changing symptoms does not fit the usual pattern and needs further assessment rather than being automatically attributed to diabetes. A warm, swollen foot is not simply “neuropathic pain.” In a person with sensory loss, it raises concern for Charcot neuro-osteoarthropathy, particularly when the degree of swelling seems out of proportion to...