Go to page content

Symptom questionnaire for peripheral nerve damage in diabetes

You can think about the potential symptoms below before your appointment, or there may be a specific symptom survey at your diabetes care provider for you to fill out.

The questions below help to map the symptoms of potential peripheral nerve damage:

  • Are your feet ever numb?

  • Do you ever feel burning pain in your feet?

  • Are your feet sensitive to touch?

  • Do you have cramps in your feet?

  • Do you ever have tingling sensation in your feet?

  • Does the weight of a bed sheet on the skin of your feet feel painful?

  • When taking a shower, can your feet distinguish between hot and cold water?

  • Have you ever had a foot ulcer?

  • Has your doctor diagnosed you with diabetic nerve damage?

  • Do you frequently experience a general sense of weakness?

  • Are the symptoms you have listed more severe at night?

  • Do you have pain in your feet when you walk?

  • Can you feel your feet when you step down?

  • Is the skin of your feet so dry that it cracks?

  • Have you had an amputation?

Updated 30.9.2023