Spinal cord disease in diabetes: Involvement of the spinal cord in people with diabetes. Most of the neurologic attention in diabetes mellitus has focused on distal symmetric polyneuropathy (DSP) -- abnormalities of the peripheral nerves, in particular, the nerves to the feet and hands. However, the nerve damage in diabetes can be more generalized and involve the spinal cord. The spinal cord is significantly smaller in diabetic patients with DSP compared to normal, whereas the spinal cord in diabetic patients without DSP is normal. Whether spinal-cord involvement in diabetes is a primary or secondary event in DSP is uncertain, but it is now crystal clear that the spinal cord can be an important target in diabetes.