Diabetic Peripheral Neuropathy: Causes, Symptoms, and Outlook

Diabetic peripheral neuropathy is nerve damage caused by diabetes that occurs in the extremities – the feet, legs, hands and arms. This is the most common type of neuropathy in people with diabetes, affecting about one-third to one-half of people with diabetes.

development risk diabetic peripheral neuropathy increased with the duration of diabetes. Other factors that may increase a person’s risk include blood sugar control (as measured by hemoglobin A1C), age, smoking, diabetic retinopathy, high triglycerides, height, and body mass index (BMI).

Causes of Diabetic Peripheral Neuropathy

The exact cause of peripheral neuropathy is unknown. But we do know that elevated blood sugar, metabolic factors, genetic susceptibility, and duration of diabetes increase risk.

Elevated blood sugar and insufficient blood flow can lead to nerve damage in the extremities. High blood sugar impairs the ability of nerves to transmit signals and cause chemical changes. Elevated sugar also damages the blood vessels that carry oxygen and nutrients to the nerves.

Nerve signaling in neuropathy is disrupted when normally sent signals are lost, inappropriate signals from nerves, or wrong nerve signals that distort the information sent.

When nerve damage to the extremities results in damage to multiple peripheral sensory and motor nerves, it is called diabetic polyneuropathy. This can lead to loss of sensation, difficulty in wound healing, and an increased risk of infection.

Diabetic Peripheral Neuropathy Symptoms

Symptoms will vary depending on the nerve affected. Small nerves protect your body by sending signals to your brain about pain and temperature changes; when these nerves are affected, you may experience heat and cold sensitivity and pain.

Diabetic neuropathy can also attack large nerves that detect touch and pressure and help you maintain balance.

Numbness and loss of protective sensation (LOPS)

Numbness in the hands and feet is a type of sensory neuropathy that affects large nerve fibers. People also experience numbness in the legs and arms.

LOPS indicates the presence of distal sensorimotor polyneuropathy and is a risk factor for diabetic foot ulcers. When your foot is unconscious, you are less likely to feel a foot injury. Undetected foot injuries can become infected.

Burning and tingling in the feet

tingling or burning pain in the foot, also known as feeling sluggishwhich occurs when small nerve fibers are affected. This is the most common early symptom of neuropathy.

Shooting pain and painful cramps

This type of neuropathy affects motor nerves and is often associated with muscle weakness. Painful cramps in the legs, especially when walking, that stop at rest may require further examination by a vascular surgeon. This doctor specializes in surgical procedures to correct blood flow problems.

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this symptom Intermittent claudicationmay be a symptom of peripheral vascular disease, in which the arteries supplying the limb are partially blocked.

lost balance

Peripheral nerve damage can affect balance and increase the risk of falls in people with diabetes.

Appearance of foot deformities

Underlying neuropathy and foot trauma can lead to foot deformities, including hammertoes, bunions, and Charcot feet.

Charcot foot affects the bones, joints and soft tissues of the foot and ankle. Diabetic neuropathy is the most common underlying cause. Sensory, motor, or autonomic neuropathy, trauma, and metabolic abnormalities can all cause Charcot foot.

Unfelt or unexplained foot injury

When people with diabetes lose consciousness in their feet, they may not feel it when they are injured. Untreated injuries can lead to bigger problems, such as ulcers or infections. It is important to wear the right shoes and avoid walking around barefoot.

Hot and cold sensitivity

Nerve damage can interfere with the body’s ability to sense temperature. The inability to feel or feel the heat increases the risk of burns. If your neuropathy affects your ability to sense heat, avoid going directly into the hot tub; use your forearm to check for water or other areas of your body that feel.

Nerve damage can also reduce blood flow to the feet and hands, making them feel cold or get cold faster.

pain affects sleep

Neuropathy that goes undetected or untreated for years can become serious. In this case, the pain may occur during daily activities, such as walking and sleeping.

Diagnosing Diabetic Peripheral Neuropathy

The American Diabetes Association (ADA) states, “Up to 50 percent of diabetic peripheral neuropathy may be asymptomatic. If preventative foot care is not recognized and implemented, patients are at risk of injury to their feet.”

It is important for people with diabetes to have their feet checked during routine doctor visits. A foot exam can be performed by your healthcare professional or a certified diabetes care and education specialist to visually examine your feet and determine your level of sensation. If there is a problem, further inspection may be required.

foot examination

The ADA Standard of Care recommends that “patients with type 1 diabetes for 5 years or more and all individuals with type 2 diabetes should be evaluated annually for diabetic peripheral neuropathy (DPN) based on history and simple clinical testing.”

People with a history of ulcers or amputations, foot deformities, foot numbness, and peripheral arterial disease (PAD) may have more frequent detailed foot evaluations. Clinical trials are available to assess the function and protective sensation of small and large fibers:

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  • Small fiber function: needle prick and temperature
  • Large Fiber Capabilities: Vibration sensing and 10-g monofilament or use of 128-Hz tuning fork
  • Protection sense: 10g monofilament
  • Examination and palpation of pedal pulse

Nerve conduction studies and electromyography

Nerve conduction studies (NCS) and electromyography (EMG) tests can be used to confirm the presence of peripheral neuropathy and assess its pattern and severity, prognosis, and possible treatment options. The ADA recommends that these types of tests are rarely needed unless the clinical features are atypical and the diagnosis is unclear.


A treatment plan should be developed based on a person’s unique health history and symptoms. There is no specific treatment for the underlying nerve damage, but blood sugar control helps prevent diabetic neuropathy in type 1 diabetes and may slow the progression of type 2 diabetes.

Medications and other non-drug strategies can help reduce pain and improve quality of life.

blood sugar control

For people with high blood sugar, optimizing blood sugar control can help prevent and slow the progression of neuropathy.

Glucose management strategies may include finding optimal medication options, encouraging medication adherence, and diabetes self-management education, such as meal planning, exercise, and smoking cessation.

Foot Care Education

Learning how to care for your feet is important for preventing and treating neuropathy. People with diabetes should know how to perform their own foot exam. To examine your feet, examine your toes and the soles of your feet (use an unbreakable mirror). Check your feet for dry, cracked skin.

After the shower, dry your feet, especially between your toes, without applying lotion between your toes. This area is very wet and lotion can increase the risk of fungal infection. Avoid walking around barefoot. Wear clean, dry cotton socks.

If you have a history of neuropathy or foot injury, check your feet daily. Be sure to contact your doctor if you notice anything suspicious or unusual.


Your doctor may talk to you about starting certain medications to reduce neuropathic pain. Lyrica (pregabalin), Cymbalta (duloxetine), or Neurontin (gabapentin) are recommended as initial pharmacological treatments for diabetic neuropathic pain.

special footwear

Therapeutic shoes are recommended for high-risk individuals with severe neuropathy, foot deformities, ulcers, callus formation, poor peripheral circulation, or a history of amputation.

when to see a doctor

Pain from neuropathy can affect quality of life and lead to feelings of sadness. If you experience pain, you should seek medical attention. Certain medications can help reduce pain.

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Also, you should contact your doctor if your wound does not heal, if you notice any deformity, or if you develop muscle pain, weakness, or cramping. Many people with diabetes benefit from a podiatrist who specializes in foot care.


Diabetic peripheral neuropathy is a very common type of neuropathy in diabetic patients. Screening, early detection and treatment can help prevent and slow the progression of the disease.

The earliest symptoms include numbness and tingling, which may come on gradually. All people with diabetes need to have their feet checked by a medical professional. Also, it’s important to know what to look for and how to check your feet.

VigorTip words

Diabetic peripheral neuropathy can be difficult and painful, but know that you are not alone. Contact your healthcare team for education and treatment based on your individual symptoms.

Early detection and treatment can prevent further progression and reduce the risk of complications and pain. Make sure your medical team examines your feet during your visit.

Frequently Asked Questions

  • What is the difference between diabetic neuropathy and peripheral neuropathy?

    Diabetic neuropathy is a general term that includes all forms of neuropathy in people with diabetes. This may include peripheral and autonomic neuropathy such as cardiac neuropathy, gastroparesis, urinary and sexual neuropathy, etc. Peripheral neuropathy usually affects the nerves in the feet, legs, hands, and arms.

  • Is peripheral neuropathy reversible in diabetic patients?

    Early detection and treatment can prevent neuropathy (especially type 1 diabetes) and stop or slow the progression of type 2 diabetes. But lost nerve function often cannot be recovered. However, if a person with diabetes has an underlying condition that causes neuropathy, such as vitamin B12 deficiency, treating the underlying condition can reverse the neuropathy. The American Diabetes Association recommends testing all patients with DPN for other causes of neuropathy, such as exposure to toxins, kidney disease, hypothyroidism, vitamin deficiencies, infections, malignancies, hereditary neuropathy, and vasculitis.

  • Will diabetic neuropathy go away?

    If the underlying cause of neuropathy is elevated blood sugar, controlling blood sugar may improve some symptoms. Unfortunately, when many people are diagnosed, some degree of permanent damage can occur.

  • What could be mistaken for a neuropathy?

    Neuropathy can have many causes. Sometimes people with cardiovascular disease and diabetes can also have peripheral arterial disease, which can cause numbness, tingling, and cramping-like sensations in the legs and feet.