History
Screen for symptoms of diabetic neuropathy (see Table 2).
Review diabetes history, disease management, daily glycemic records, and previous hemoglobin A1C levels.
Identify any family history of diabetes or neuropathy.
Review medication history (including use of over-the-counter products and herbal or homeopathic products) and environmental exposures.
Review for other causes of neuropathy, including vitamin B12 deficiency, alcoholism, toxic exposures, medications, cancers, and autoimmune disease.
Physical examination
Vital signs and pain index
Supine and standing blood pressure for postural hypotension
Cardiovascular examination to look for arrhythmias, absent or diminished pulses, edema, or delayed capillary refilling
Cutaneous examination to look for extremity hair loss, skin or nail changes (including callus), and pretrophic (red) areas, especially between toes
Neurologic examination using the 5.07 Semmes-Weinstein (10-g) nylon filament test (10-g monofilament test)
Inspection of feet for asymmetry, loss of arch height, or hammer toes
Evaluation of all positive screening findings
Annual diabetes evaluation
Evaluation for neuropathy as discussed above
Sensorimotor examination and evaluation of cranial nerves, muscle strength, and range of motion
	Document distribution, intensity, and type of sensory or motor deficits.
	Evaluate small nerve fibers with temperature, light touch, or pinprick testing.
	Test large nerve fibers by vibratory sensation, position sense, muscle strength, sharp-dull discrimination, and two-point discrimination.
Autonomic examination, including orthostatic blood pressure measurements
	Consider heart rate variability tests and electrocardiography if sensory neuropathy is present or symptoms warrant further evaluation.
	Consider heart rate variability tests in the patient who has had type 1 diabetes for 10 years or type 2 diabetes for five years; consider cardiac stress testing before the patient starts an exercise program.