I have had diabetes for 12 years and I have been under good control. My highest A1c was 8.5, which was about four years ago. I was put on an insulin pump and my A1c is usually about 7. Anyway, I have had cold feet for the past two months. I wear socks all the time. When I am home, I wear socks and slippers. I was wondering if cold feet were a sign of neuropathy, even though I have been under good control. I understand that having diabetes for a long time, no matter what kind of control you have, you will experience some complications, but this seems soon if it is neuropathy.

Neuropathy involving sensation in the lower extremities is a common manifestation of both type 1 and type 2 diabetes. As you indicate, the presence of neuropathy is a function of duration of diabetes and overall level of control. When neuropathy is defined in clinical trials, the definition is usually substantiated by a comprehensive physical exam and some form of nerve function study. To say you have cold feet does not clinch the diagnosis of neuropathy. Make sure that when you go back to your physician, you have your shoes and socks removed and have them evaluate your feet extensively for sensation. Make sure they use a monofilament fiber to evaluate how you perceive light touch in areas over both feet. Other aspects of nerve function, such as vibration sensation, hot/cold discrimination, and two-point discrimination can be tested. It is only by having some objective parameters evaluated that a diagnosis can be made. I agree with you that cold feet may be a symptom. However, it occurs frequently enough in people without diabetes that it is nonspecific. Other clinical tests of neuropathy can be applied. Electromyograms (EMGs) are performed that evaluate the nerves that innervate various muscle groups and you can also have nerve conduction velocities assessed. These are more sophisticated tests. After the above are done, you and your doctor will be able to more accurately determine if neuropathy is present.

JTL