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Diabetic Neuropathy

How diabetes can damage your nerves


Updated August 30, 2011

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Diabetic Neuropathy

Foot care is especially important when you have peripheral neuropathy.

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Neuropathy is a condition in which certain nerves in the body are damaged and, as a result, may cause pain, numbness and weakness. Though there are several causes of neuropathy, one of the most common is diabetes, often referred to as diabetic neuropathy.

It is estimated that about two-thirds of people with diabetes have at least some degree of neuropathy. The longer you have had diabetes, the greater the risk. Those with diabetes for more than 25 years are at greatest risk of developing neuropathy.

What Are the Types of Diabetic Neuropathy?

Though there are several types of neuropathy, the two most often experienced with diabetes are:
  • Peripheral neuropathy
  • Autonomic neuropathy

Peripheral neuropathy is the most common type among those with diabetes. It affects the nerves in the arms, hands, legs, feet and toes, which are the outermost regions of the body. The first signs of peripheral neuropathy usually appear in the feet and legs. These areas of the body are furthest from the heart and often struggle to the get adequate blood flow to keep the nerves healthy.

Autonomic neuropathy is also common in those with diabetes, and affects the nerves of such internal organs as the bowel, bladder, reproductive system, heart, lungs and eyes. Autonomic neuropathy can also result in an inability to sense low blood sugar (called hypoglycemia unawareness). This is why is it always necessary to check blood sugar with a glucose meter instead of relying upon your own bodily sensations to assess the fluctuation in glucose levels.

What Causes Diabetic Neuropathy?

Research has shown that a high concentrations of blood glucose over a long span of time greatly increases the risk of diabetic neuropathy. Smoking and excessive alcohol use have also been shown to contribute to the development of the condition.

What Are the Symptoms of Diabetic Neuropathy?

The symptoms of neuropathy vary depending on whether you have peripheral or autonomic neuropathy.

Symptoms of peripheral neuropathy include:

  • Tingling or pain in the toes, feet, legs, hands, arms and fingers
  • General weakness in the legs
  • Numbness or difficulty feeling heat or cold in the feet and hands

Symptoms of autonomic neuropathy include:

  • Problems with urination
  • Erectile dysfunction in men and vaginal dryness in women
  • Diarrhea or constipation
  • Digestive problems such as indigestion, nausea and vomiting

How Are the Diabetic Neuropathies Diagnosed?

A medical exam is needed to confirm a diagnosis of neuropathy. Different tests are used, depending on the type of neuropathy.

For peripheral neuropathy the doctor will check muscle strength, reflexes and sensitivity to touch and temperature. This should also include a thorough foot exam that assesses the circulation and degree of sensation in your feet.

For the diagnosis of autonomic neuropathy your doctor may also check your heart to see how it responds to deep breathing and changes in blood pressure when you stand up. It may also be necessary to perform an ultrasound test of the internal organs to see if the nerves have been affected.

How Are Diabetic Neuropathies Treated?

Your first means of treatment should be to get your blood glucose levels within a healthy range to prevent further nerve damage. This holds true whether you have peripheral or autonomic neuropathy.

Your doctor might also prescribe oral or topical medications to treat any nerve pain you might have. People with neuropathy need to be especially mindful of caring for their feet. Once there is a loss of sensation in the feet you may not notice a blister, sore or injury until it becomes infected. A minor sore can become a chronic sore if not immediately treated.

In addition to having an annual foot exam from your doctor, follow these self-care tips:

  • Inspect your feet and toes daily for any sores, swelling or red spots that could become sores.
  • Always wear shoes or slippers, even in your own home.
  • Wear thick, soft, seamless socks. There are certain types of sock made especially for people with neuropathy.
  • Wear shoes that fit well and have a roomy toe-box so your toes can move freely inside the shoe. This will reduce the friction between the toes and the chance of blisters.


American Diabetes Association. " Autonomic Neuropathy.“

American Diabetes Association. " Peripheral Neuropathy.“

National Diabetes Information Clearinghouse." Diabetic Neuropathies: The Nerve Damage of Diabetes."

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