Overview
Diabetic neuropathy is a type of nerve damage that occurs in people with diabetes, especially when blood sugar levels are poorly controlled over time. It can affect various parts of the body, but most commonly impacts the feet and legs, causing pain, tingling, numbness, or weakness.

Why It’s Important
If left untreated, diabetic neuropathy can lead to serious complications, including foot ulcers, infections, amputations, and chronic pain. It can also affect vital organs, making it harder to detect symptoms like low blood sugar or regulate heart rate and digestion.

Quick Facts

• Affects about 50% of people with diabetes over time

• More common in those with long-term diabetes, especially if blood sugar is poorly managed

• Tends to be chronic and progressive

• There are four main types:

  • Peripheral neuropathy (most common – affects feet, legs, hands)

  • Autonomic neuropathy (affects internal organs)

  • Proximal neuropathy (hip/thigh pain and weakness)

  • Focal neuropathy (sudden nerve damage to specific areas)

What Happens in the Body
Chronically high blood sugar damages the tiny blood vessels that supply nerves, leading to reduced oxygen and nutrients. This causes nerves to malfunction or die, disrupting how they send signals to and from the brain and spinal cord. Damage tends to start in the longest nerves, which is why symptoms often begin in the feet.

Common Signs and Symptoms

• Tingling (“pins and needles”) or burning in the feet or hands

• Numbness or reduced sensation

• Shooting or stabbing pain

• Muscle weakness

• Loss of coordination or balance

• In autonomic neuropathy:

  • Digestive issues (bloating, diarrhea, constipation)

  • Bladder problems

  • Erectile dysfunction

  • Low blood pressure when standing

  • Difficulty sensing low blood sugar

Diagnosis

• Based on medical history, symptoms, and diabetes status

• Physical exam with focus on sensation, reflexes, and strength

• Monofilament test to assess touch sensation in feet

• Nerve conduction studies or electromyography (EMG) may be used

• Important to see a doctor if:

  • You notice numbness, tingling, or foot wounds

  • Pain or weakness interferes with walking or sleep

  • Autonomic symptoms like digestive issues appear

Treatment and Management

• Strict blood sugar control is the most important way to slow or prevent nerve damage

• Pain management with:

  • Medications like pregabalin, duloxetine, or gabapentin

  • Topical creams (e.g., capsaicin)

  • Antidepressants or anticonvulsants for nerve pain

• Physical therapy and foot care are essential

• Treatment may also include:

  • Digestive support (e.g., dietary changes, motility meds)

  • Bladder/bowel treatments

  • Supportive shoes or braces

• It’s a lifelong condition, but symptoms can be controlled and complications prevented

Risks and Complications

• Foot ulcers and infections, often from unnoticed injuries due to numbness

• Amputation in severe, untreated cases

• Chronic pain and sleep disturbances

• Falls and mobility issues

• Sudden drops in blood pressure, especially with autonomic involvement

Who Is at Risk

• People with long-standing diabetes

• Poor blood sugar control

• High blood pressure or high cholesterol

• Overweight individuals

• Smokers (reduced circulation)

• Older adults with diabetes for 10+ years

Related Conditions

• Peripheral artery disease (PAD)

• Foot deformities

• Chronic kidney disease (can worsen nerve damage)

• Retinopathy and nephropathy (other diabetes complications)

When to See a Doctor

• If you have numbness, tingling, or foot pain

• If you notice sores that don’t heal

• If you’re diabetic and haven’t had a foot exam in over a year

• If you experience autonomic symptoms like dizziness, bladder issues, or digestive changes

Last Updated: June 21, 2025