A 64-year-old woman was admitted to the neurology service complaining of lower extremity weakness and pain. She was found to have lost more than 180 kg in a 2 1/2-year period. In addition, she had mild diabetes. A diagnosis of diabetic neuropathic cachexia was made. Not only is this case remarkable for the massive weight loss, but, to our knowledge, this is the first report of this syndrome in a woman.