What is diabetic neuropathy?

Diabetic neuropathy is nerve damage caused by chronically high levels of glucose (sugar) in the blood that is associated with diabetes. There are several different types of neuropathy, the most common being peripheral neuropathy and autonomic neuropathy.

Depending on the type, symptoms may include pain or numbness in the hands, feet, or legs; blood pressure, bladder function, digestive problems; and more. Although preventable, 60% to 70% of people with diabetes develop diabetic neuropathy.

Types of diabetic neuropathy

There are several types of neuropathy that can be associated with diabetes. Some people experience only one of them, while others may experience more than one.

  • Peripheral neuropathy is the most common type of neuropathy. It affects the extremities, such as the toes, feet, fingers, and hands, but may also involve the legs and arms.
  • Autonomic neuropathy affects the nerves that control the body’s systems and are responsible for daily bodily functions such as blood pressure, sweating, and digestion.
  • Proximal neuropathy is a rare nerve injury that affects the buttocks, thighs, or buttocks. It usually affects only one side of the body.
  • Focal neuropathy affects a single nerve, such as the wrist or back, and may also affect the nerves that control the muscles of the eye. It is less common than peripheral or autonomic neuropathy.

Other less common forms of neuropathy include:

  • Femoral neuropathy
  • Charcot joint or neuropathic arthropathy
  • compressive mononeuropathy
  • cranial neuropathy
  • Thoracic or lumbar radiculopathy
  • unilateral foot drop

diabetic neuropathy symptoms

The symptoms of diabetic neuropathy depend on the type of neuropathy a person has and which specific nerves are damaged.

Symptoms can range from mild to disabling. Although they usually get progressively worse, severe symptoms can come on suddenly.

Peripheral neuropathy usually affects both sides of the body. Symptoms may include:

  • burning pain in hands and feet
  • numbness and tingling
  • loss of pain or temperature
  • touch sensitivity
  • Difficulty walking due to coordination problems
  • muscle weakness
  • Sores on feet due to inability to notice the injury

Symptoms of autonomic neuropathy can vary widely, depending on the organs involved. People may encounter:

  • heart rate too fast
  • Dizziness when changing positions
  • bloating and nausea
  • diarrhea or constipation
  • incontinence
  • bladder problems
  • vaginal dryness
  • erectile dysfunction
  • Excessive or reduced sweating
  • Inability to perceive signs of low blood sugar
  • double vision
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Proximal neuropathy can cause pain in the buttocks, buttocks, or thighs, and corresponding weakness and loss of leg muscles. Weaknesses can make it difficult to stand up.

By definition, focal neuropathy affects one nerve. If the nerves in the arm or hand are damaged, it may cause pain, numbness, or weakness in the hand. If the facial nerve is affected, Bell’s palsy may result. Damage to the ocular nerve can lead to diplopia.


Persistently elevated blood sugar levels can lead to diabetic neuropathy.

Over time, uncontrolled glucose levels can interfere with nerve signaling and function. This can cause the walls of the capillaries to weaken, starving the nerves of oxygen and nutrients.

Uncontrolled glucose levels can interfere with nerve signaling and function.

In addition, high blood cholesterol, high blood pressure and low levels of vitamin B12 can also lead to neuropathy.

The diabetes drug metformin has the side effect of lowering B12 levels in the body. If you take metformin, talk with your healthcare provider about possible vitamin B12 supplementation to counteract this effect.

The risk of neuropathy increases with advanced age, overweight, and duration of diabetes, with the highest incidence among people with diabetes for more than 25 years.

Smoking and heavy drinking also significantly increase the risk, which narrows and weakens arteries and reduces blood flow to the extremities.

Neuropathy can also sometimes be caused by kidney disease, mechanical damage such as carpal tunnel syndrome, genetic factors, certain toxins, or widespread inflammation, which can trigger an autoimmune response that attacks the nerves.


Diabetic neuropathy is usually diagnosed based on a physical examination, an evaluation of your symptoms and medical history, and specific tests to rule out other conditions if needed.

All people with diabetes should have their feet checked at least once a year for signs of peripheral neuropathy. Your healthcare provider will check blood flow in your feet, the health of your skin, and your sensitivity to touch, temperature, and vibration.

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Tests for peripheral neuropathy may also include tests of your balance, reflexes, and walking gait. Nerve conduction studies or electromyography may be done to test how well the nerves are working.

For autonomic neuropathy, the specific test will depend on the symptoms you are experiencing. Your provider may check how your heart rate and blood pressure change with exercise. Tests can assess bladder and digestive function, or sweating.

Other possible causes of neuropathy symptoms may also need to be ruled out. This may include imaging tests such as X-rays or ultrasounds, blood tests to check thyroid function and B12 levels, eye exams, or more specific tests.


The best way to treat diabetic neuropathy is to manage pain and work to prevent the disease from progressing.

Because the underlying cause of diabetic neuropathy is diabetes, it is important to keep blood sugar within a target range.

Consult your healthcare provider to implement a therapeutic lifestyle program that includes medications and supplements, nutrition and exercise, and maintain proper foot care.

blood sugar control

Test your blood sugar levels regularly with a blood glucose meter to determine your condition’s baseline level and to inform your daily decision-making.

According to the American Diabetes Association (ADA), if your blood sugar control is stable, you should have a hemoglobin A1C lab test or other evaluation at least twice a year to see how well your blood sugar control has averaged over the past few months.

If you cannot adequately control your blood sugar levels, you should have an A1C test at least four times a year. The same is true if you have recently changed your treatment strategy.

What is the A1C test?


Not everyone with neuropathy experiences nerve pain. For those who do, over-the-counter pain relievers like Tylenol (acetaminophen) or non-steroidal anti-inflammatory drugs (NSAIDs) like Motrin or Aleve (ibuprofen) may help.

Healthcare providers are also now recommending very low doses of tricyclic antidepressants (TCAs) such as Elavil (amitriptyline) for chronic pain, or anti-epileptic drugs (AEDs) such as Neurontin (gabapentin) Or Lyrica (pregabalin), which work by reducing the frequency of nerve pain signals sent to the brain.

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In some cases, neuropathy pain may not respond to pain medication. This can lead to muscle weakness or more severe disability. If your discomfort is not relieved, contact your healthcare team and ask if your care plan should be adjusted.


In diabetic neuropathy, feet are at higher risk because they are not easily visible. A foreign object, such as a tack, can get stuck on the bottom of the foot, or the irritation can develop into an open wound or ulcer and go unnoticed due to loss of sensation.

People with diabetes need to take special care of their feet and have their problems checked regularly. Poor circulation is a common problem that can lead to slow healing, ulcers, infection, or tissue death (gangrene), which may require amputation.

More than half of all amputations each year are due to diabetes and diabetes-related complications. Most are lower extremity amputations, such as foot amputations. However, diligent foot care can prevent these manipulations from becoming necessary.


  • Check, wash, and thoroughly dry your feet daily.
  • Always wear well-fitting shoes and clean, dry socks; avoid walking barefoot.
  • Trim the toenails directly and file off the corners with an emery board, or have them trimmed by a podiatrist.
  • Do not use foot products, tools, or chemicals such as scrapers, scissors, files, or wart removal treatments, as these may cause harm.
  • do not smoke. Smoking restricts blood flow to the feet.
  • Let your healthcare provider know if your foot injury does not heal properly within a few days, or if you discover an injury of unknown origin and duration.

VigorTip words

If you have type 1 or type 2 diabetes, be sure to watch for signs of diabetic neuropathy. Losing sensation or noticing a tingling sensation in any part of the body is a sign that there may be a problem.

Active efforts to control blood sugar levels are the best way to manage and prevent the progression of neuropathy.