Diabetic neuropathy is nerve damage that can develop in people with diabetes. Over time, high blood sugar can damage nerves and small blood vessels. This can change how nerves send messages between the brain, spinal cord and the rest of the body.
You may think of diabetic neuropathy as uncomfortable symptoms like burning, tingling or numbness in the feet. That’s common but neuropathy can affect more than the feet and legs. It can also affect your hands, kidneys, digestive system, bladder, heart rate, blood pressure and other body functions.
Exploring your treatment options early can help prevent long-term complications.
What causes diabetic neuropathy?
Long-term high blood sugar damages nerves and the blood vessels that support them. “Those small vessels supply the nerves with oxygen and nutrients. High blood sugar can then cause nerves to lose their function,” said Piroska Schlesinger, DPM, a podiatrist with Banner - University Medicine.
Both type 1 and type 2 diabetes can cause neuropathy. These factors make risk higher:
- High blood pressure
- High cholesterol
- Smoking
- Long-term diabetes
- Kidney disease
- Obesity
- Alcohol use
- Vitamin deficiencies
What are the symptoms of diabetic neuropathy?
Diabetic neuropathy symptoms depend on which nerves are affected. You may not notice symptoms at first. Or it may feel like tingling, burning or numbness in the toes, feet, fingers or hands.
“People often report having ‘odd’ sensations like feet that feel full or swollen, even though they don’t appear that way,” Dr. Schlesinger said.
Diabetic neuropathy can also be dangerous because you may not notice injuries.
You may also notice:
- Sharp pain
- Loss of feeling
- Sensitivity to touch
- Weakness
- Balance problems
- Foot wounds
- Dizziness
- Digestive problems
- Bladder changes
Types of diabetic neuropathy
Peripheral neuropathy
Peripheral neuropathy is the most common type of diabetic neuropathy. It usually affects your feet and legs but can sometimes affect your hands and arms. It can cause pain, tingling, numbness or loss of feeling, usually on both sides of your body.
Autonomic neuropathy
Autonomic neuropathy affects the nerves that control your automatic body functions, like digestion, heart rate, blood pressure, bladder function, sweating and sexual function.
Symptoms may include:
- Dizziness when standing
- Fast heart rate
- Digestive changes
- Nausea
- Constipation
- Diarrhea
- Bladder problems
- Sexual dysfunction
- Trouble sensing low blood sugar
Talk to your health care provider about these symptoms because they may affect safety and daily life.
Proximal neuropathy
Proximal neuropathy is a less common type of diabetic neuropathy that can cause pain or weakness in your hip, thigh, buttock or leg, often on one side of your body. It can make It hard to stand up from a chair, climb stairs or walk.
Focal neuropathy
Focal neuropathy affects one nerve or a small group of nerves and may cause sudden pain, numbness, weakness or tingling in one area. It can affect your hand, head, torso or leg.
Why diabetic neuropathy can be dangerous
“If you have neuropathy, you may not be able to tell when you step on sharp objects or have blisters or ulcerations from a shoe rubbing on your skin. You may only discover there is something wrong when your foot becomes red or swollen or you see drainage or bleeding,” Dr. Schlesinger said.
You could grab a hot pan and burn your hand without feeling it. Or tingling and numbness in your feet could make you more likely to trip or fall.
You could develop complications and poor circulation can make It harder for you to heal.
How is diabetic neuropathy diagnosed?
Diagnosing diabetic neuropathy involves:
- A review of your symptoms and medical history
- A physical exam to check for sensation, reflexes, pulses, skin changes, wounds and strength
- Checking if you can feel pressure, vibration or temperature
- Blood tests to check blood sugar control, kidney function, vitamin levels or other causes of symptoms
- Nerve conduction studies or electromyography in some cases
How to treat diabetic neuropathy
“It is very hard to treat peripheral neuropathy but controlling glucose levels and diabetes consistently should always be the first step. That’s important since once nerve damage reaches a certain point it cannot be reversed,” Dr. Schlesinger said.
Diabetic neuropathy treatment options focus on:
- Managing blood sugar
- Relieving pain
- Protecting the feet
- Improving balance
- Treating symptoms based on which nerves are affected
- Treating kidney, digestive, bladder, blood pressure or other autonomic symptoms
- Preventing wounds and infections
Managing blood sugar and overall health
These steps may help slow diabetic neuropathy and reduce your risk of complications:
- Managing blood sugar, blood pressure and cholesterol
- Getting regular physical activity
- Choosing a balanced eating plan
- Not smoking
- Avoiding or limiting alcohol
Diabetic neuropathy pain relief options
Pain relief for diabetic neuropathy looks different for each person. Some people need prescription medication. Others benefit from topical treatments, physical therapy, lifestyle changes or a combination of approaches.
Over-the-counter (OTC) pain relievers
Some people try acetaminophen or other NSAIDs for general pain but these may not work well for everyone. Tell your provider if you use OTC pain medicine regularly.
NSAIDs are not safe for everyone, especially people with kidney disease, stomach ulcers, blood thinners or certain heart conditions.
Topical treatments
Lidocaine creams or patches may help with localized pain. Capsaicin products may help but they can cause burning or irritation. Check with your provider before using topical products on broken skin, wounds or numb areas.
Prescription medications for nerve pain
Some antidepressants and anti-seizure medications can help calm nerve pain signals. Options may include duloxetine, pregabalin, gabapentin or some antidepressants. These medicines can have side effects, such as dizziness, sleepiness or swelling.
Medication choice depends on age, kidney function, other medications, fall risk, mental health symptoms and other health conditions. Opioids are generally not a first-choice long-term treatment for diabetic neuropathy pain.
Other treatments that may help diabetic neuropathy symptoms
You may want to talk to your provider about these options:
- Physical therapy for balance, strength, flexibility and walking safety
- Occupational therapy for daily tasks
- TENS therapy for pain
- Acupuncture
- Massage
- Relaxation, mindfulness or stress-management techniques
- Nutrition support
- Supplements, if your provider says they’re OK
Foot care with diabetic neuropathy
If you have diabetic neuropathy, these foot care steps are important:
- Check your feet every day
- Use a mirror or ask someone for help if you cannot see the bottoms of your feet
- Wash and dry your feet carefully, especially between the toes
- Moisturize dry skin but avoid lotion between toes
- Wear shoes that fit well
- Avoid going barefoot, even at home
- Check inside shoes before putting them on
- Trim toenails carefully
- Protect your feet from hot surfaces, heating pads and hot water
- Get regular foot exams
When to call a doctor
Call your provider if you notice:
- New tingling, burning, numbness or weakness
- Symptoms that are getting worse
- Pain that affects your sleep or activities
- Foot wounds
- Dizziness when standing
- New balance problems or falls
- Digestive problems
- Bladder problems
- Sexual function changes
Seek urgent care or emergency care if:
- A foot wound looks infected and you have fever or feel ill
- You have spreading redness or red streaks
- You have black or dead-looking tissue
How diabetic neuropathy can affect mental health
Diabetic neuropathy can affect your mental health because chronic pain, sleep problems, balance issues and managing your diabetes can increase stress, anxiety or depression. Support from loved ones, support groups or a counselor may help.
What to ask your doctor about diabetic neuropathy
- What type of diabetic neuropathy do I have?
- Are my symptoms from diabetes or something else?
- What can I do to slow nerve damage?
- What blood sugar goals are right for me?
- Should I see a podiatrist, endocrinologist, neurologist or pain specialist?
- What pain relief options are safest for me?
- Could my medications be making dizziness or balance worse?
- How often should I have foot exams?
- Do I need special shoes or inserts?
- What foot changes should I report right away?
- Could physical therapy help my balance or walking?
- What should I do if I notice a wound?
Bottom line
Diabetic neuropathy can affect pain, balance, foot health and daily life. A Banner Health provider can help you manage your blood sugar, relieve symptoms and protect your feet from complications.
Frequently asked questions about diabetic neuropathy
What is diabetic neuropathy?
Diabetic neuropathy is nerve damage caused by diabetes. It can affect the feet, legs, hands, kidneys, digestive system, bladder, heart rate, blood pressure and other body functions.
What are the first signs of diabetic neuropathy?
Early signs may include tingling, burning, numbness, sharp pain, sensitivity to touch or loss of feeling, often starting in the feet or toes.
What is the most common type of diabetic neuropathy?
Peripheral neuropathy is the most common type. It usually affects the feet and legs and may also affect the hands and arms.
Can diabetic neuropathy affect more than the feet?
Yes. Autonomic neuropathy can affect digestion, kidneys, bladder function, sweating, sexual function, heart rate and blood pressure.
Can diabetic neuropathy be reversed?
Nerve damage may not be fully reversible but managing blood sugar and treating symptoms can help slow progression, reduce pain and prevent complications.
What helps diabetic nerve pain?
Treatment may include blood sugar management, topical treatments, prescription nerve pain medicines, physical therapy, foot care and lifestyle changes.
When should I worry about numbness in my feet?
Numbness should be discussed with a provider, especially if it is new, worsening or linked with foot sores, balance problems, falls or injuries you did not feel.
How can I protect my feet with diabetic neuropathy?
Check your feet daily, wear well-fitting shoes, avoid going barefoot, protect feet from heat and keep regular foot exams.
