Originally Posted by glenntaj

--that meant you should be tested for small-fiber neuropathies--although you may have some larger fiber dysfunction as well.

The most typical presentation of diabetic neuropathy IS a gradual feeling of nerve pain in the extremities (though there are other presentations). The stereotypic "numbness" that one sees in movies/advertisements is actually less common. This is because the mecahnism of neuropathy in diabetes is ischemic/vasculitic--there's actually less DIRECT damage to the nerve themselves from high blood sugars than there is to the microcirculatory system that supports them. This is why symptoms occur in the smallest nerves first (the ones that subsume the sensations of pain and temperature) that are the farthest away from the centers of circulation; with circulatory damage it's harder to get nutrients/oxygen to the extremities and metabolic waste away from them, and the smallest nerves are the most vulnerable.

Here's a good article on the mechanisms of diabetic small-fiber neuropathy (Dr. Vinik is one of the world's leading researchers in the area):

http://www.medscape.com/viewarticle/418568

Now, it IS true that many doctors, when they see you are diabetic, will blame ALL future nerve disorders on that, and this is shortsighted. There are a lot of idiopathic small-fiber sufferers out there, in which autoimmune molecular mimicry mechanisms are suspected. Take a look at this (especially the section on painful axonal idiopathic neuropathy):

http://www.dcmsonline.org/jax-medici...uropathies.htm

There are plenty of people who have a predominant small-fiber syndrome that never progresses beyond the sensory symptoms of burning-type pain. It's been speculated that the pain actually represents a lesser degree of damage than numbness--pain means damaged nerve are still signalling, albeit incorrectly, and numbness means the actual fiber has for the most part been compressed/damaged to the point of cell death. (There are people who have both sensations in the same body area at once.)

One other thing--regenerating nerves can also be quite painful, as the growth cones fight through other tissues and attempt to re-link to their terminal sites--the brain often interprets the odd signals produced during the process as pain.