Since early diabetic neuropathy may not cause symptoms, a careful examination to check for signs of neuropathy is very important. During the physical examination, the doctor may check:

• Your response to light touch, pressure, temperature, and vibration, particularly in your feet and legs. Simple tests can be used to screen for loss of sensation. The doctor may touch the end of your toe with a cotton wisp or a thin plastic fiber (called a monofilament test) to assess whether you sense light touch or pressure. To evaluate your sensation of temperature, a cold metal tuning fork may be held to your leg; a vibrating tuning fork may be touched to your foot to assess your sensation of vibration. These tests should be done on both feet.
• Your muscle strength.
• Your reflexes, especially those in your ankles and knees.
• Your blood pressure and pulse and how they change when you are in certain positions (lying down, sitting, standing).

During every visit, your doctor needs to examine your feet for cracked or peeling skin, excessive or reduced sweating, blisters, calluses, ulcers, signs of infection, bone and joint abnormalities, and other problems. You should have a complete foot exam at least once a year.