Diabetic neuropathy

High blood sugar can lead to nerve damage in feet and other areas of the body. Know the symptoms and how to take steps to prevent this diabetes complication.

Update Date: 10.06.2025

Overview
Symptoms
When to see a doctor
Causes
Risk factors
Complications
Prevention
Diagnosis
Treatment
Self care
Alternative medicine
Coping and support
Preparing for your appointment
Overview
Symptoms
When to see a doctor
Causes
Risk factors
Complications
Prevention
Diagnosis
Treatment
Self care
Alternative medicine
Coping and support
Preparing for your appointment

Overview

Diabetic neuropathy is a type of nerve damage that can happen with diabetes. Blood sugar, also called glucose, becomes high because of diabetes. Over time, high blood sugar can injure nerves throughout the body. Diabetic neuropathy most often damages nerves in the legs and feet.

Depending on the affected nerves, diabetic neuropathy symptoms may include pain and numbness in the legs, feet and hands. It also can cause problems with the digestive system, urinary tract, blood vessels and heart. Some people have mild symptoms. But for others, diabetic neuropathy can be painful and disabling.

Diabetic neuropathy is a serious health concern. It may affect up to half of people who have diabetes. But diabetic neuropathy often can be prevented. And people who have it can take steps to keep it from getting worse. The key is to tightly manage blood sugar and lead a healthy lifestyle.

Symptoms

There are four main types of diabetic neuropathy. You can have one type or more than one type of neuropathy.

The symptoms depend on the type of diabetic neuropathy you have and which nerves are affected. Usually, symptoms appear slowly over time. You may not notice anything is wrong until a lot of nerve damage has happened.

Peripheral sensorimotor neuropathy

This type of neuropathy also may be called distal symmetric peripheral neuropathy. It's the most common type of diabetic neuropathy. It affects the feet and legs first, followed by the hands and arms. Symptoms often are worse at night. They may include:

  • Loss of feeling, also called numbness, or less ability to feel pain or temperature changes.
  • A tingling or burning feeling.
  • Sharp pains or cramps.
  • Muscle weakness.
  • Being very sensitive to touch. For some people, even a bedsheet's weight can be painful.
  • Serious foot problems, such as ulcers, infections, and bone and joint damage.

Autonomic neuropathy

The autonomic nervous system controls blood pressure, heart rate, sweating, pupils, bladder, digestive system and sex organs. Diabetes can affect nerves in any of these areas. That can cause symptoms including:

  • A lack of the usual warning symptoms that let you know when blood sugar levels are low. This is called hypoglycemia unawareness.
  • Drops in blood pressure when rising from sitting or lying down. This is called orthostatic hypotension. It can cause dizziness or fainting.
  • A fast-beating heart while at rest.
  • Bladder or bowel problems.
  • Slow stomach emptying, also called gastroparesis. This can cause upset stomach, vomiting, a feeling of fullness and loss of appetite.
  • Trouble swallowing.
  • Changes in the way the eyes adjust from light to dark or far to near.
  • More or less sweating than usual.
  • Problems with sexual response. For instance, some people may have vaginal dryness or trouble feeling aroused. Others may have trouble getting or keeping an erection.

Proximal neuropathy

This type of neuropathy also is called diabetic polyradiculopathy. It often affects nerves in the thighs, hips, buttocks or legs. It can affect the stomach area and chest area. Symptoms often are on one side of the body. Rarely, they spread to the other side. Proximal neuropathy may include:

  • Serious pain in the buttock, hip or thigh.
  • Weak and shrinking thigh muscles.
  • Trouble rising from a sitting position.
  • Pain in the chest or the walls of the stomach area.

Mononeuropathy

This type of neuropathy also is called focal neuropathy. It damages a single, specific nerve. That nerve may be in the face, torso, arm or leg. It’s possible for mononeuropathy to affect single nerves in different parts of the body at the same time. Mononeuropathy may lead to:

  • Trouble focusing or seeing two images of the same object, also called double vision.
  • Not being able to move one side of the face. This is called paralysis.
  • Numbness or tingling in the hand or fingers.
  • Weakness in the hand that may result in dropping things.
  • Pain in the shin or foot.
  • Weakness that makes it hard to lift the front part of the foot. This condition is known as foot drop.
  • Pain in the front of the thigh.

When to see a doctor

Call your healthcare professional for a checkup if you have:

  • A cut or sore on your foot that is infected or won't heal.
  • Burning, tingling, weakness or pain in your hands or feet that makes it hard to do daily activities or sleep.
  • Changes in digestion, urination or sexual function.
  • Dizziness and fainting.

Tests can check for diabetic neuropathy before a person has symptoms of it. These are called screening tests. Screening tests can find diseases early when they're easier to treat. The American Diabetes Association recommends that screening for diabetic neuropathy start:

  • Right after you learn you have type 2 diabetes.
  • Or five years after you're found to have type 1 diabetes.

After that, screening is recommended once a year.

Causes

The exact cause of each type of neuropathy is unknown. Researchers think that over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals. This process may lead to diabetic neuropathy. High blood sugar also weakens the walls of the small blood vessels called capillaries that supply the nerves with oxygen and nutrients.

Risk factors

Anyone who has diabetes can get diabetic neuropathy. But these risk factors make nerve damage more likely:

  • Poor blood sugar control. Uncontrolled high blood sugar raises the risk of every medical complication that can happen with diabetes, including nerve damage.
  • Diabetes history. The risk of diabetic neuropathy rises the longer you have diabetes, especially if your blood sugar isn't well controlled.
  • Kidney disease. Diabetes can damage the kidneys. Kidney damage sends toxins into the blood, which can lead to nerve damage.
  • Being overweight. Having a body mass index (BMI) of 25 or more may raise the risk of diabetic neuropathy.
  • Smoking. Smoking narrows and hardens the arteries, lowering blood flow to the legs and feet. This makes it harder for wounds to heal. It also damages the peripheral nerves.
  • High blood pressure and high cholesterol. Both are linked with a higher risk of diabetic neuropathy.

Complications

Diabetic neuropathy can cause serious medical conditions, including:

  • Hypoglycemia unawareness. Most often, blood sugar levels below 70 milligrams per deciliter (mg/dL) — 3.9 millimoles per liter (mmol/L) — cause shakiness, sweating and a fast heartbeat in people living with diabetes. But people who have autonomic neuropathy may not feel these warning signs.
  • Loss of a toe, foot or leg. Nerve damage can cause a loss of feeling in the feet. That means even minor cuts can turn into sores or ulcers without being noticed. Sometimes, an infection can spread to the bone or lead to tissue death. Without fast treatment, a toe, foot or even part of the leg may need to be removed with surgery. This is called amputation.
  • Urinary problems. If the nerves that control the bladder are damaged, the bladder may not empty fully when urinating. Bacteria can build up in the bladder and kidneys, causing urinary tract infections. Nerve damage also can affect the ability to feel the need to urinate or to control the muscles that release urine. This can lead to leakage, also called incontinence.
  • Sharp drops in blood pressure. Damage to the nerves that control blood flow can affect the body's ability to adjust blood pressure. This can cause a sharp drop in pressure when standing after sitting or lying down. That may lead to lightheadedness and fainting.
  • Digestive problems. If nerve damage happens in the digestive tract, you may get constipation or diarrhea, or both. Diabetes-related nerve damage can lead to a condition in which the stomach empties too slowly or not at all. This is called gastroparesis. It can cause bloating and an upset stomach.
  • Sexual conditions. Diabetic neuropathy often damages the nerves that affect the sex organs. Symptoms may include vaginal dryness, having trouble becoming aroused, and difficulty getting or keeping an erection. This is called erectile dysfunction.
  • More or less sweating than usual. Nerve damage can disrupt how the sweat glands work. That makes it hard for the body to control its temperature properly.

Prevention

You may be able to prevent or delay diabetic neuropathy and the medical problems that can happen with it. To do so, closely manage your blood sugar and take good care of your feet.

Blood sugar control

A blood test called the A1C test looks at your average blood sugar level for the past 2 to 3 months. The American Diabetes Association recommends that people with diabetes have an A1C test at least twice a year. You also might hear it called the glycosylated hemoglobin, hemoglobin A1C or HbA1c test.

A1C goals may need to be tailored to each person. But for most adults, the American Diabetes Association recommends an A1C of less than 7.0%. The goal may be higher for older adults or those with other medical conditions. If your blood sugar levels are higher than your goal, you may need to change how you manage your diabetes. Your healthcare professional might change your medicine or add medicine to your treatment plan. Or you might be told to change your diet or physical activity.

Foot care

Foot problems are common with diabetic neuropathy. Examples include sores that don't heal and ulcers. But you can prevent many of these problems. The key is to take good care of your feet at home. And have a thorough foot exam at least once a year. Also have your healthcare professional check your feet at each office visit.

Follow your healthcare professional's advice for good foot care. To protect the health of your feet:

  • Check your feet every day. Look for blisters, cuts, bruises, cracked and peeling skin, redness, and swelling. Use a mirror to look at parts of your feet that are hard to see. Or ask a friend or family member to help check.
  • Keep your feet clean and dry. Wash your feet every day with lukewarm water and mild soap. Don't soak your feet. Dry your feet and between your toes thoroughly.
  • Moisturize your feet. This helps prevent cracking. But don't get lotion between your toes. It might make fungus more likely to grow.
  • Trim your toenails carefully. Cut your toenails straight across. File the edges gently so they are smooth. If you can't do this yourself, see a specialist in foot problems, called a podiatrist, for help.
  • Wear clean, dry socks. Look for socks made of cotton or moisture-wicking fibers. The socks should not have tight bands or thick seams.
  • Wear cushioned shoes that fit well. Wear closed-toed shoes or slippers to protect your feet. Make sure your shoes fit properly, and give your toes space to move. A foot specialist can teach you how to buy properly fitted shoes. The specialist also can show you how to prevent problems such as corns and calluses. If you have Medicare, your plan may cover the cost of at least one pair of shoes each year.
  • Protect your feet from the heat. Wear shoes if you walk on hot pavement or go to the beach. If you go barefoot outdoors, put sunscreen on the tops of your feet so they don't get sunburned.
  • Boost blood flow to your feet. If you can, put your feet up while you sit. And throughout the day, wiggle your toes around for a few minutes. It also helps to move your ankles in and out as well as up and down.

Diagnosis

To figure out if you have diabetic neuropathy, your healthcare professional gives you a physical exam. You're also asked questions about your symptoms and medical history.

During the exam, your healthcare professional most often checks:

  • Your overall muscle strength and tone.
  • The reflexes of your muscles and tendons.
  • How sensitive you are to touch, pain, temperature and vibration.

Along with a physical exam, your healthcare professional may do or order certain tests. The tests can help confirm whether or not you have diabetic neuropathy. They may include:

  • Filament testing. A soft nylon fiber called a monofilament is brushed over areas of your skin. This is done to check how sensitive you are to touch.
  • Sensory testing. This test is used to tell how your nerves respond to vibration and changes in temperature.
  • Nerve conduction testing. This test measures how quickly the nerves in your arms and legs conduct electrical signals.
  • Electromyography. Called needle testing, this test is often done along with nerve conduction studies. It measures electrical activity in your muscles.
  • Autonomic testing. Special tests may be done to determine how your blood pressure and heartbeat change while you are in different positions. The tests also can help identify whether your sweating is within the standard range.

Treatment

Diabetic neuropathy has no known cure. The goals of treatment are to:

  • Slow the disease from getting worse.
  • Relieve pain.
  • Manage health issues linked with diabetic neuropathy.
  • Help the parts of the body affected by neuropathy work better.

Slowing the disease from getting worse

The key way to prevent or delay nerve damage is to keep your blood sugar within your target range. Good blood sugar control may even improve some of your current symptoms. Your healthcare professional decides on the best target range for you based on certain factors. These include your age, how long you've had diabetes and your overall health.

Target ranges for blood sugar levels need to be tailored for each person. But, in general, the American Diabetes Association (ADA) recommends the following target blood sugar levels for most people with diabetes:

  • Between 80 and 130 mg/dL (4.4 and 7.2 mmol/L) before meals.
  • Less than 180 mg/dL (10.0 mmol/L) two hours after meals.

In general, the ADA recommends an A1C of 7.0% or lower for most people with diabetes.

Some healthcare professionals encourage slightly lower blood sugar levels for younger people with diabetes. They also may recommend slightly higher levels for older people with other medical conditions and who may be more at risk of low blood sugar complications. In general, your healthcare professional might recommend the following target blood sugar levels before meals:

  • Between 80 and 120 mg/dL (4.4 and 6.7 mmol/L) for people age 59 and younger who have no other medical conditions.
  • Between 100 and 140 mg/dL (5.6 and 7.8 mmol/L) for people age 60 and older, or for those who have other medical conditions, including heart, lung or kidney disease.

Other ways to help slow or prevent neuropathy from getting worse include:

  • Keep your blood pressure under control.
  • Stay at a healthy weight.
  • Get regular physical activity.

Relieving pain

Many prescription medicines are available for diabetes-related nerve pain. But they don't work for everyone. If your healthcare professional recommends medicine, be sure to ask about the benefits and side effects.

Pain-relieving prescription treatments include:

  • Anti-seizure medicines. Some medicines used to treat seizure disorders also are used to ease nerve pain. The American Diabetes Association recommends starting with pregabalin (Lyrica). Gabapentin (Gralise, Neurontin) also is an option. Side effects can include feeling drowsy or dizzy, and getting swelling in the hands and feet.

  • Antidepressants. Some of these medicines ease nerve pain even if you aren't depressed. Tricyclic antidepressants may help with mild to moderate nerve pain. Medicines in this class include amitriptyline, nortriptyline (Pamelor) and desipramine (Norpramin). Side effects can include dry mouth, constipation, drowsiness and trouble focusing. These medicines also can cause dizziness when changing position, such as from lying down to standing. This is a symptom of a sudden drop in blood pressure called orthostatic hypotension.

    Another type of antidepressant may help with nerve pain and have fewer side effects. It's called a serotonin and norepinephrine reuptake inhibitor (SNRI). The American Diabetes Association recommends the SNRI duloxetine (Cymbalta) as a first treatment. Another that may be used is venlafaxine (Effexor XR). Side effects can include nausea, sleepiness, dizziness, less appetite and constipation.

Sometimes, an antidepressant may be combined with an anti-seizure medicine. These medicines also can be used with certain pain relievers sold without a prescription, such as acetaminophen (Tylenol, others).Or you might get relief from a skin patch, cream or gel with a substance that prevents pain such as lidocaine.

Managing complications and restoring function

To manage health conditions linked with diabetic neuropathy, you may need care from specialists. For instance, a specialist called a urologist can treat urinary tract problems. A heart specialist, called a cardiologist, can help prevent or treat heart-related conditions.

The treatment you need depends on the neuropathy-related medical conditions you have:

  • Urinary tract problems. Some medicines affect the bladder. Your healthcare professional may suggest that you stop or change these medicines. Some bladder problems can be helped with a strict urination schedule. Or they can be helped by urinating every few hours while putting gentle pressure on the area below the bellybutton. Other methods may be needed to remove urine from a nerve-damaged bladder. For example, the bladder can be drained by placing a thin, flexible tube called a catheter into it.
  • Digestive problems. Diabetic neuropathy may slow the gut and cause constipation or slow movement of food from the stomach. This slow movement of food is called gastroparesis. Gastroparesis can cause symptoms such as belching, upset stomach or vomiting. You might get relief from these symptoms if you eat smaller, more frequent meals that are low in fiber and fat. Diet changes and medicines may help ease gastroparesis, diarrhea, constipation and upset stomach.

  • Low blood pressure when you stand. This condition is called orthostatic hypotension Treatment starts with simple lifestyle changes. Drink plenty of water. Get physical activity. Don't drink alcohol. Slowly change positions such as from sitting to standing. Sleep with the head of the bed raised 4 to 6 inches to help prevent high blood pressure overnight.

    Your healthcare professional also may suggest compression support for your stomach area and thighs. Examples of products that apply gentle pressure include an abdominal binder and compression shorts or stockings. Many medicines, taken either alone or together, may be used to treat orthostatic hypotension.

  • Sexual challenges. Medicines taken by mouth or by shot may improve sexual function in some men. But they aren't safe and effective for everyone. A pump called a vacuum construction device may boost blood flow to the penis. Women may benefit from vaginal lubricants.

Self care

These measures can help you feel better overall and lower your risk of diabetic neuropathy:

  • Keep your blood pressure under control. If you have high blood pressure and diabetes, you have an even higher risk of other medical problems. Try to keep your blood pressure in the range your healthcare professional recommends. Have it checked at every medical visit.
  • Make healthy food choices. Eat a balanced diet. Include a variety of healthy foods, especially vegetables, fruits and whole grains. Limit portion sizes to help reach or stay at a healthy weight.

  • Be active every day. Exercise helps lower blood sugar, improves blood flow and keeps your heart healthy. Work up to 150 minutes of moderate or 75 minutes of vigorous aerobic exercise a week. Or do a mix of moderate and vigorous exercise. Also aim to do 2 to 3 sessions of strength training a week. Plus, it's a good idea to take a break from sitting every 30 minutes. Get a few quick bursts of activity during your breaks.

    Talk with your healthcare professional or a physical therapist before you start exercising. If you have less feeling in your legs, some types of exercise may be safer than others. For example, walking with proper shoes tends to be safe. If you have a foot injury or a sore, stick with exercise that doesn't involve putting weight on your injured foot.

  • If you smoke, quit. Using tobacco in any form makes you more likely to develop poor blood flow in your feet. And that can cause problems with healing. If you use tobacco, ask your healthcare professional about resources available to help you quit.

Alternative medicine

Alternative treatments might help with pain relief. They may help on their own or along with medicines. But check with your healthcare professional before using any alternative treatment or dietary supplement. Your healthcare professional needs to make sure that they don't affect your main treatment or cause side effects.

For diabetic neuropathy, you may want to try:

  • Capsaicin. When capsaicin cream is put on the skin, it can ease pain in some people. Side effects may include a burning feeling and skin irritation.
  • Alpha-lipoic acid. This powerful antioxidant is found in some foods. It may help relieve nerve pain symptoms in some people.
  • Acetyl-L-carnitine. This nutrient is made in the body. A lab-made version is sold as a supplement. It may ease nerve pain in some people.
  • Transcutaneous electrical nerve stimulation (TENS). This prescription treatment may help prevent pain signals from reaching the brain. TENS sends tiny electrical impulses to specific nerve pathways through small electrode stickers placed on the skin. TENS is safe and painless. But it doesn't work for everyone or for all types of pain.
  • Acupuncture. With this technique, a practitioner places very fine needles into the skin. Acupuncture may help relieve the pain of neuropathy. And in general, it doesn't have any side effects. Keep in mind that you may not get relief right away. You may need more than one acupuncture session.

Coping and support

Living with diabetic neuropathy may be a challenge at times. Support groups can offer encouragement and advice. Ask your healthcare professional if there are any groups in your area. Or ask for a referral to a therapist. If you feel depressed, it can help to talk to a counselor or therapist. The American Diabetes Association also offers online support through its website.

Preparing for your appointment

Doctors who specialize in treating metabolic disorders and diabetes are called endocrinologists. If you don't already see an endocrinologist, you'll likely be referred to one if you show symptoms of diabetes complications. If you have symptoms of neuropathy, you may be referred to a specialist in brain and nervous system problems. This doctor is called a neurologist.

To prepare for your appointment, take the following steps:

  • Ask how to get ready. When you make the appointment, ask if there's anything you need to do beforehand. For example, you might be told to limit what you eat and drink.
  • Make a list of any symptoms you're having. Include all symptoms, even if some may not seem related to the reason for the appointment.
  • Make a list of key personal information. Include any major stresses or recent life changes.
  • Make a list of all medicines, vitamins, herbs and supplements you take. Include the doses.
  • Bring a record of your recent blood sugar levels if you check them at home.
  • Ask a family member or friend to come with you. It can be hard to remember everything your healthcare professional tells you during a checkup. Someone who joins you may remember something that you missed or forgot.
  • Make a list of questions to ask your healthcare professional.

Some basic questions to ask may include:

  • Is diabetic neuropathy the most likely cause of my symptoms?
  • Do I need tests to confirm the cause of my symptoms? How do I prepare for these tests?
  • If I manage my blood sugar, will my symptoms improve or go away?
  • What treatments do you recommend?
  • What types of side effects can I expect from treatment?
  • I have other health conditions. How can I best manage them together?
  • Are there brochures or other printed material I can take with me? What websites do you recommend?
  • Do I need to see a certified diabetes care and education specialist, a registered dietitian, or other specialists?

What to expect from your doctor

Your healthcare professional is likely to ask you questions such as:

  • How well are you managing your diabetes?
  • When did you start having symptoms?
  • Do you always have symptoms or do they come and go?
  • What impact do your symptoms have on your daily life?
  • Does anything seem to improve your symptoms?
  • What, if anything, seems to make your symptoms worse?
  • What's challenging about managing your diabetes?
  • What might help you manage your diabetes better?

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