Hemifacial Spasm: This condition is characterized by intermittent, involuntary twitching or spasms of the facial muscles, often on one side of the face. The involvement of the muscles along the side of the nose and the twitching of the index finger and thumb could be related to the spread of the spasm or an associated condition. Uncontrolled diabetes can lead to nerve damage, which might contribute to the development of hemifacial spasm.

Focal Seizures: Seizures that originate in a specific area of the brain can cause localized symptoms such as twitching or spasms on one side of the face. The involvement of the index finger and thumb could indicate a seizure focus in the motor cortex.
Trigeminal Neuralgia: Although primarily known for causing facial pain, trigeminal neuralgia can also lead to muscle spasms or twitching in the face due to the irritation of the trigeminal nerve.
Diabetic Neuropathy: Uncontrolled diabetes can cause nerve damage leading to a variety of symptoms, including muscle twitching or spasms. The distribution of symptoms could be related to the specific nerves affected by neuropathy.

Multiple Sclerosis: This autoimmune disease can cause a wide range of neurological symptoms, including localized muscle spasms or twitching. Early diagnosis is crucial for effective management.
Stroke or Transient Ischemic Attack (TIA): Although less likely given the intermittent and relatively mild nature of the symptoms, it's essential to consider the possibility of a stroke or TIA, especially in a patient with uncontrolled diabetes, which is a significant risk factor for cerebrovascular disease.
Brain Tumor: A tumor in the brain, particularly one affecting the facial nerve or motor cortex, could cause localized twitching or spasms.

Dystonia: A neurological disorder characterized by involuntary muscle contractions, which could lead to repetitive movements or abnormal postures. Focal dystonias can affect specific parts of the body, such as the face.
Neurosyphilis: In its tertiary stage, syphilis can cause a variety of neurological symptoms, including muscle spasms or twitching, although this would be a rare consideration without other supporting evidence of syphilis infection.
Wilson's Disease: A genetic disorder leading to copper accumulation in the body, which can cause neurological symptoms, including tremors or muscle spasms. However, this diagnosis would typically be accompanied by other systemic or neurological signs.