Diabetic myopathy may occur more frequently in patients with type 2 diabetes than previously reported. In this population, T2-weighted and contrast-enhanced images have similar findings, and the increased coexistence of nephropathy makes administration of gadolinium-based contrast agents ill-advised. With a typical clinical presentation and MRI findings, a confident diagnosis can be made, and potentially harmful biopsy is avoided. Diabetic myopathy encompasses a spectrum of diseases, including muscle inflammation, ischemia, hemorrhage, infarction, necrosis, fibrosis, and fatty atrophy. It is usually seen with long-standing, poorly controlled diabetes.