Diabetic neuropathy

Overview

Diabetic neuropathy is nerve damage caused by long-term high blood sugar (glucose) levels in people with diabetes. It most often affects nerves in the feet and legs, but can also affect other parts of the body.

Yes, it is very common. About half of all people with diabetes will develop some form of neuropathy over time.

It mainly affects people with diabetes, especially those who have had diabetes for many years or have had difficulty keeping blood sugar levels in a healthy range. Both type 1 and type 2 diabetes can lead to neuropathy.

Symptoms

Common symptoms

• Numbness or reduced ability to feel pain or temperature changes, often starting in the feet or hands.
• Tingling, burning, or a 'pins and needles' feeling.
• Sharp, stabbing, or electrical-shock-like pain that is often worse at night.
• Loss of balance or coordination due to reduced feeling in the feet.

Symptoms in children

• Children with diabetes may have similar symptoms, but they may complain of 'funny feelings' in their feet or hands.
• They might not be able to describe the sensation clearly, so parents may notice changes in walking or clumsiness.
• Difficulty feeling shoes or socks properly, or complaints that shoes feel 'weird'.

Symptoms in older adults

• Older adults are more likely to have balance problems and falls because of the loss of feeling in their feet.
• They may also have a higher risk of foot injuries or infections that go unnoticed due to numbness.
• Symptoms like burning or tingling might be mistaken for normal ageing changes.

Causes

Main causes

• Long-term high blood sugar (hyperglycemia) damages the tiny blood vessels that supply oxygen and nutrients to nerves.
• Some people with diabetes have an increased inflammation response that can also harm nerve tissue.

Risk factors

• How long you have had diabetes – the longer you have it, the higher the risk.
• Poor control of blood sugar (high HbA1c levels).
• High blood pressure (hypertension).
• High cholesterol (dyslipidemia).
• Smoking.
• Being overweight or obese.
• Having other diabetes-related complications, like kidney disease.

When to see a doctor

See a doctor urgently if:

• If you discover a foot wound, blister, or cut and you have numbness that prevents you from feeling whether it is infected.
• If you have sudden weakness, trouble walking, or loss of coordination.
• If you experience any signs of a foot infection: redness, swelling, warmth, pus, or a fever.

Book a routine appointment if:

• As soon as you notice any new numbness, tingling, or pain in your hands or feet.
• If you have diabetes, you should have a foot examination by your healthcare provider at least once a year.
• If you already have neuropathy, see your doctor regularly (every 3 to 6 months) to monitor your feet and nerve health.

Diagnosis

Your doctor will take a detailed history of your symptoms and perform a physical exam, focusing on your feet and legs. They will also review your diabetes control (like recent blood sugar levels).

Tests that may be done

• A simple monofilament test: the doctor uses a soft, thin nylon fibre to see if you can feel light touch on your feet.
• A tuning fork test to check vibration sensation.
• Nerve conduction studies (a machine that measures how fast your nerves send signals) – usually only needed if the diagnosis is unclear.
• Blood tests to rule out other causes of nerve damage, such as vitamin B12 deficiency.

What to expect at your appointment

Most tests are painless and quick. You will be asked to sit or lie down while the doctor touches your feet or legs with different tools. The results are usually available during your appointment. If a nerve conduction study is needed, it involves small electrodes placed on your skin and may cause a mild tingling sensation.

Treatment

Treatment for diabetic neuropathy focuses on managing blood sugar to prevent further nerve damage, relieving symptoms, and protecting your feet from injury. While the nerve damage cannot be reversed, many people can control their symptoms and prevent complications.

Self-care at home

• Check your feet every day for cuts, blisters, red spots, or swelling. Use a mirror if you can't see the bottom of your feet.
• Wash your feet daily in lukewarm water and dry them gently, especially between the toes.
• Moisturize your feet (but not between the toes) to prevent dry, cracked skin.
• Wear well-fitting shoes and socks at all times. Never walk barefoot.
• Trim your toenails straight across to avoid ingrown nails.
• Protect your feet from extreme heat or cold – test water temperature with your elbow, not your foot.

Medical treatments

Your doctor may recommend medications that help calm nerve pain, such as certain types of medicines originally developed for seizures or depression – but these are used for pain relief and are not the same as taking them for those conditions. Other treatments include pain-relieving creams, patches, or physical therapy to improve strength and balance. All treatments should be discussed with your healthcare provider. Do not take over-the-counter painkillers for neuropathy without advice, as they may not work and can have side effects.

When is surgery considered?

Surgery is rarely needed for diabetic neuropathy itself. However, in severe cases where foot deformities develop (like bunions, hammertoes, or Charcot foot), surgery may be recommended to relieve pressure, correct alignment, or prevent ulcers. Always discuss with a podiatrist or surgeon specializing in diabetes.

Living with this condition

Living with neuropathy means paying extra attention to your feet and legs every day. Make foot checks part of your routine – for example, while brushing your teeth. Wear shoes that fit well and never go barefoot, even at home. Use soft, padded socks. If you have pain, gentle activity like walking or stretching can help, but avoid standing or walking for long periods if it worsens pain.

Lifestyle tips

• Quit smoking – smoking reduces blood flow to your nerves and makes neuropathy worse.
• Limit alcohol – alcohol can also damage nerves and increase pain.
• Keep your blood sugar within your target range – this is the most important thing you can do.
• Manage other health conditions like high blood pressure and cholesterol.

Diet and exercise

A balanced diet rich in fibre, vegetables, whole grains, and lean proteins helps keep blood sugar stable. Regular exercise, such as walking, swimming, or cycling, improves blood flow and can reduce neuropathic pain. Aim for at least 30 minutes of moderate activity most days, after checking with your doctor. Avoid high-impact activities that could injure your feet if you have numbness.

Mental health and emotional wellbeing

Living with chronic pain or numbness can be frustrating and may lead to anxiety, depression, or social isolation. It is normal to feel upset or worried. Talk to your healthcare provider about your feelings – they can refer you to a counselor or support group. If you feel overwhelmed or have thoughts of harming yourself, contact a crisis helpline immediately.

Prevention

Diabetic neuropathy can sometimes be prevented or delayed with good blood sugar control from the time of diagnosis. Keeping your HbA1c on target, managing blood pressure and cholesterol, not smoking, and being physically active all reduce your risk. Even if you already have diabetes, these steps can slow the progression of nerve damage.

Vaccines

While there is no vaccine for diabetic neuropathy, staying up to date with recommended vaccines (like flu and pneumonia) helps prevent infections that can complicate neuropathy, especially foot infections.

Screening programmes

All people with diabetes should have a foot examination at least once a year to check for early signs of neuropathy. If you have risk factors or already have symptoms, your doctor may recommend more frequent checks.

Complications

If left untreated

• Foot ulcers (deep sores) that can become infected and may lead to gangrene.
• Amputation of a toe, foot, or part of the leg if infection spreads or tissue dies.
• Falls and fractures due to loss of balance or weakness.
• Delayed wound healing anywhere on the body.

Long-term outlook

The outlook for people with diabetic neuropathy is generally good if you take an active role in managing your diabetes and caring for your feet. While the nerve damage cannot be fully reversed, you can prevent it from getting worse, treat pain effectively, and avoid serious complications like amputation. With regular check-ups and healthy habits, most people can continue to live independently and enjoy a good quality of life.

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