Diabetic Peripheral Neuropathy
By Dr. Steven J. Dolgoff

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Peripheral Neuropathy and Diabetes

Peripheral neuropathy is nerve damage caused by chronically high blood sugar and diabetes. It leads to numbness, loss of sensation, and sometimes pain in your feet, legs, or hands. It is the most common complication of diabetes.

About 60% to 70% of all people with diabetes will eventually develop peripheral neuropathy, although not all suffer pain. Yet this nerve damage is not inevitable. Studies have shown that people with diabetes can reduce their risk of developing nerve damage by keeping their blood sugar levels as close to normal as possible.

What causes peripheral neuropathy? Chronically high blood sugar levels damage nerves not only in your extremities but also in other parts of your body. These damaged nerves cannot effectively carry messages between the brain and other parts of the body.

This means you may not feel heat, cold, or pain in your feet, legs, or hands. If you get a cut or sore on your foot, you may not know it, which is why it's so important to inspect your feet daily. If a shoe doesn't fit properly, you could even develop a foot ulcer and not know it.

"The consequences can be extraordinarily devastating and life-threatening," Tom Elasy, MD, director of the Diabetes Clinic at Vanderbilt University in Nashville, Tenn. "An infection that will not heal because of poor blood flow causes risk for developing ulcers and can lead to amputation, even death."

This nerve damage shows itself differently in each person. Some people feel tingling, then later feel pain. Other people lose the feeling in fingers and toes; they have numbness. These changes happen slowly over a period of years, so you might not even notice it.

"It's not like you wake up one morning and feel it," Elasy says. "The changes are very subtle. And because it happens as people get older, they tend to ignore the little tingles or subtle loss of sensation that is occurring - the signs of nerve damage. They think it's just part of getting older."

But there are treatments that can help slow the progression of this condition and limit the damage. "We have a lot of options for management of this condition," Elasy says. "Don't be too stoic. Talk to your doctors about it. This is important stuff."

"But the bad news is, it can get worse," he says. "If you've got tingling now, in 10 years it can be painful - if you don't address it now."


Symptoms of Nerve Damage

Numbness is the most common, troubling symptom of nerve damage, Elasy says. "People who lose sensation are of special concern. They're the ones who get ulcers on their feet - who can end up needing amputations."

People describe the early symptoms of peripheral neuropathy in many ways:



Pins and needles







Deep stabs


Symptoms of Nerve Damage continued...

Others describe sharp pain, cramps, tingling, prickling, a burning sensation, Elasy says.

Still others have exaggerated sensitivity to touch. "The minute you touch them, they feel extreme pain," Elasy explains. "When they lay a sheet over their feet at night, they are exquisitely sensitive to that touch."

The symptoms are often worse at night, he adds.

Be on the look out for these changes in how you feel:

Touch sensitivity. You may experience heightened sensitivity to touch, or a tingling or numbness in your toes, feet, legs, or hands.

Muscle weakness. Chronically elevated blood sugars can also damage nerves that tell muscles how to move. This can lead to muscle weakness. You may have difficulty walking or getting up from a chair. You may have difficulty grabbing things or carrying things with your hands.

Balance problems. You may feel more unsteady than usual and uncoordinated when you walk.

This occurs when the body adapts to changes brought on by muscle damage.

Because people with type 2 diabetes may have multiple health problems, doctors don't always diagnose peripheral neuropathy when symptoms first appear, Elasy says. "Patients need to be aware that their pain may be confused with other problems," he notes.

Make sure your pain is taken seriously, he advises. "Do not take it lightly if you have pain in your hand or foot. Things can be done to reverse it. It can be useful to see a pain specialist."

To help prevent the complications of peripheral neuropathy:

Examine your feet and legs daily. 

Apply lotion if your feet are dry. 

Care for your nails regularly. (Go to a podiatrist, if necessary). 

Wear properly fitting footwear and wear them all the time to prevent foot injury.

Diabetic Autonomic Neuropathy

Diabetic autonomic neuropathy most often affects the digestive system, especially the stomach, blood vessels, urinary system, and sex organs. To prevent autonomic neuropathy, continuously keep your blood sugar levels well controlled.

Symptoms of neuropathy of the digestive system may include:







Feeling full after small meals


Treatments of autonomic neuropathy of the digestive system may include:

Eat smaller meals



Symptoms of autonomic neuropathy of the blood vessels may include:

Blacking out when you stand up quickly

Increased heart rate


Low blood pressure



Early fullness


Treatments of autonomic neuropathy of the blood vessels may include:

Avoid standing up too quickly


Wearing special stockings


Symptoms of autonomic neuropathy of the male sex organs may include:

Unable to have or maintain an erection (erectile dysfunction)*

"Dry" or reduced ejaculations

*Note: Impotence needs to be evaluated by your doctor. It may be caused by your medicines or factors other than diabetes.


Treatments of autonomic neuropathy of the male sex organs include:


Penile implant

Vacuum erection device

Penile injections



Symptoms of autonomic neuropathy of the female sex organs may include:

Decrease in vaginal lubrication

Decrease in number of orgasms or lack of orgasm


Treatments of autonomic neuropathy of the female sex organs include:


Vaginal estrogen creams, suppositories and rings



Symptoms of autonomic neuropathy of the urinary system may include:

Unable to completely empty bladder


Incontinence (leaking urine)

Increased urination at night


Treatments of autonomic neuropathy of the urinary system include:


Self-catheterization (inserting a catheter into the bladder to release urine)



Diabetic Proximal Neuropathy


Diabetic proximal neuropathy causes pain (usually on one side) in the thighs, hips, or buttocks. It can also lead to weakness in the legs. Treatment for weakness or pain is usually needed and may include medication and physical therapy. The recovery varies, depending on the type of nerve damage. Prevention consists of keeping blood sugar under tight control.


Diabetic Focal Neuropathy

Diabetic focal neuropathy can also appear suddenly and affect specific nerves, most often in the head, torso, or leg, causing muscle weakness or pain. Symptoms of diabetic focal neuropathy may include:

double vision

eye pain

paralysis on one side of the face (Bell's palsy)

severe pain in a certain area, such as the lower back or leg(s) 

chest or abdominal pain that is sometimes mistaken for another condition such as heart attack or appendicitis

Diabetic focal neuropathy is painful and unpredictable, however, it tends to improve by itself over weeks or months and does not tend to cause long-term damage.


Other Nerve Conditions Seen With Diabetes

People with diabetes can also develop other nerve-related conditions, such as nerve compressions (entrapment syndromes).

Carpal tunnel syndrome is a very common type of entrapment syndrome and causes numbness and tingling of the hand and sometimes muscle weakness or pain.


Prevention of Diabetic Neuropathy

Keeping tight control of your blood sugar levels will help prevent many of these diabetes-related nerve conditions. Talk to your doctor about optimizing your individual diabetes treatment plan