- Having diabetes for a long time raises your risk of diabetic neuropathy, or permanent nerve damage.
- You may notice numbness, tingling, and pain in your feet first, and then elsewhere in your body.
- Treatment can help ease symptoms, but managing your blood sugar may help prevent this condition.
Diabetic neuropathy is one of the most common complications of type 1 and type 2 diabetes that over half of all people living with diabetes eventually develop.
The condition is a type of nerve damage that tends to happen slowly over time, so the longer you live with diabetes or uncontrolled blood sugar, the greater your risk.
If you have diabetic neuropathy, you may not notice any symptoms at first. But eventually you might experience numbness, pain, and tingling sensations in your feet, and then elsewhere in your body.
Apart from taking a considerable toll on your health, diabetic neuropathy can also contribute to health and mental health complications, including amputation, depression, and sleep disorders.
Read on to learn more about diabetic neuropathy, including the main signs and symptoms, your options for treatment, and strategies to prevent it.
You’ll likely notice nerve damage in your feet first, says Dr. Sabeena Malik, a board-certified neurologist and assistant professor at the University of Toledo College of Medicine and Life Sciences. Symptoms you may experience include:
- Pins and needles, or your feet feeling “asleep”
- A sensation of ants crawling on your feet
- A sensation of socks bunched up between your toes, even when you aren’t wearing anything on your feet
- A sensation of swollen feet and calves, even when there’s no visible swelling
Your specific symptoms and their severity can vary. You may experience mild symptoms at first, though they can get worse over time. Eventually, you may begin to notice these symptoms in your hands, as well.
Other symptoms you might experience include:
Types of diabetic neuropathy
There are four main types of diabetic neuropathy.
This form of neuropathy is the most common. It can affect your feet, legs, arms, and hands.
If you have peripheral neuropathy, you may not notice injuries because you may not experience pain or heat due to the damaged nerves.
But injuries that go untreated can become infected — and if an infection becomes severe enough, it may spread or cause tissue death. In some cases, this may require amputation of the affected limb.
Also called focal neuropathy, this condition occurs when a specific nerve or group of nerves become damaged. It can cause severe pain and weakness in the affected area.
Carpal tunnel syndrome is one common example of mononeuropathy.
Mononeuropathy symptoms may resolve over time without treatment, but if they don’t improve, it’s best to connect with your doctor for more guidance on next steps.
Autonomic neuropathy is the second most common type of neuropathy in people with diabetes.
The autonomous nervous system controls the organs that function without your control, like your stomach, intestines, heart, kidneys, and bladder. Damage to the autonomic nerves can make it harder for these organs to function properly, so you may have a harder time noticing and responding to your body’s needs.
For example, neuropathy affecting the bladder could cause incontinence. Neuropathy that develops in your stomach and intestines, on the other hand, could lead to slower digestion, which can ultimately affect your blood sugar.
If the damage affects nerves in your skin and heart, you may not realize when your blood sugar levels drop, due to the absence of tell-tale signs like sweating and a rapid heartbeat.
This form of diabetic neuropathy is also called diabetic amyotrophy. It more commonly affects people who are:
With proximal neuropathy, you’ll usually experience sudden, severe pain with muscle weakness in your hips, thighs, or buttocks. This pain and weakness may extend to your chest, abdomen, and arms.
Typically, it affects only one side of the body at first, but it may involve both sides over time.
After your symptoms begin, they may get worse at first and then slowly begin to improve over six months to a year. Your symptoms may not go away completely, however.
Causes and risk factors
The exact cause of diabetic neuropathy is unknown, but researchers believe it relates to blood sugar levels that remain consistently high over a long period of time.
To put it simply, high blood sugar destroys the blood vessels that provide nutrients to your nerves. Without the nutrients they need, the nerves become damaged and die.
Malik says the main risk factors for diabetic neuropathy are high HbA1C levels and having diabetes for a long time — the longer you live with diabetes, the greater your chances of experiencing nerve damage.
Other contributing factors include:
If you notice numbness and tingling in your feet, along with any other signs of diabetic neuropathy, you’ll want to make an appointment with your doctor right away.
To find the right diagnosis, your doctor may start by asking a few questions about your symptoms, blood sugar management, and any other health concerns you might have.
Typically, they’ll also check your:
- Blood sugar
- Ability to feel sensations
- Heart rate and blood pressure
- Arms, hands, and feet for injuries
- Skin for changes in color or textures
They may also recommend nerve function tests, like a nerve conduction velocity test or an electromyography.
While any nerve damage you experience can’t be reversed, treatments for diabetic neuropathy can still ease your symptoms. The main treatment goals include:
Your doctor may prescribe medication and recommend physical therapy to help you achieve these goals.
Medications that may help improve symptoms of diabetic neuropathy include:
- Anti-seizure medications: Drugs used to prevent seizures, such as gabapentin and pregabalin, can also help relieve pain related to nerve damage.
- Antidepressant medications: Some antidepressants may also relieve the pain related to nerve damage, even if you don’t have depression. Examples include amitriptyline, nortriptyline, duloxetine, and venlafaxine.
- Vitamin D: Research suggests injections of high doses of vitamin D may ease pain related to nerve damage. That said, this treatment may not be widely used in the United States.
- Pain-relieving creams, sprays, or patches: These topical treatments often contain lidocaine or capsaicin, and you can apply them to your skin to relieve pain or burning.
Certain physical therapy procedures may also relieve symptoms of diabetic neuropathy like pain and weakness. Examples include:
- Strength training: Also called resistance exercise, this form of training aims to strengthen muscles by making them work against a weight or force.
- Low level laser therapy (LLLT): This non-invasive treatment uses light to help repair tissue and reduce pain and inflammation.
- Transcutaneous electrical nerve stimulation (TENS): This procedure involves the use of electric currents on the skin to treat pain.
These medications and other treatments can help ease your symptoms, so it’s essential to follow your doctor’s recommendations and take prescription medications as directed.
Taking extra care of your feet can also make a difference.
These steps can help:
- Wash your feet with lukewarm water daily. After drying your feet, moisturize them and check for any signs of injury.
- If you notice an injury, let your doctor know right away. They can offer guidance on preventing infection.
- Avoid walking with bare feet. Instead, opt for cotton socks and shoes that fit comfortably. Your doctor or podiatrist may also prescribe specific shoes that help prevent injuries.
- Trim your toenails carefully to avoid accidental nicks.
- Get your feet professionally examined each year by a podiatrist or your primary care doctor
How to prevent it
If you live with diabetes, these steps may help lower your chances of developing neuropathy:
- Take your medication as prescribed: Your medication can help your blood sugar, blood pressure, and cholesterol levels stay within their target range, which may help prevent nerve damage. If you experience unpleasant side effects, you can ask your doctor about changing your medication, but it’s important to keep taking it until they tell you otherwise.
- Check your blood glucose levels regularly: Your blood glucose levels show how well your blood sugar is controlled, which can help you track the effects of your diet, physical activity, and medications. You can use this information to make the right choices for your health needs. Your doctor may also recommend taking an HbA1C test at least twice a year
- Follow your diabetes meal plan: Aim for a diet rich in vegetables, fruit, fish, lean proteins, whole grain, and legumes. Choosing low-salt, low glycemic index foods without added sugar over processed, sugary foods can also make a difference. Eating nourishing, balanced meals can help you manage your blood sugar, but it also helps your body function properly and heal.
- Exercise regularly: If you’re able to exercise, aim for about 150 minutes of exercise, like brisk walking, each week. Exercise offers numerous health and wellness benefits, including keeping your heart and blood vessels healthy and improving circulation to your nerves.
- Try to stop smoking: Smoking both reduces the oxygen in your blood and makes it harder to regulate blood sugar. Smoking also releases toxic chemicals such as hydrogen cyanide, benzene, arsenic, and formaldehyde into your body. Those effects damage cells and blood vessels while worsening inflammation, which can ultimately lead to more nerve damage.
- Limit alcohol: Experts recommend limiting alcoholic drinks to one per day for women and two per day for men or less. Examples of one drink include 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits like gin, rum, vodka, or whiskey — though, these guidelines may vary depending on the alcohol content of your drink.
Diabetic neuropathy is a common complication of diabetes, but you can reduce your chances of experiencing it by working with your doctor to manage your blood sugar.
Getting regular exercise, following your diet plan, limiting alcohol and stopping smoking can also help prevent this condition.
If you experience symptoms of neuropathy, you can take steps to manage them and keep the condition from getting worse.
Your care team can offer more guidance with exploring your options for treatment and monitoring your symptoms to avoid serious complications, like infection or amputation.