In people with diabetes, the body's nerves can be damaged by decreased blood flow and a high blood sugar (glucose) level. This condition is more likely when the blood sugar level is not well controlled over time.
About one half of people with diabetes develop nerve damage. Symptoms often do not begin until many years after diabetes has been diagnosed. Some people who have diabetes that develops slowly already have nerve damage when they are first diagnosed.
People with diabetes are also at higher risk for other nerve problems not caused by their diabetes. These other nerve problems won't have the same symptoms and will progress in a different manner than nerve damage caused by diabetes.
Symptoms
Symptoms often develop slowly over many years. The types of symptoms you have depend on the nerves that are affected.
Nerves in the feet and legs are most often affected. Symptoms often start in the toes and feet, and include tingling or burning, or deep pain. Over time, nerve damage can also occur in the fingers and hands. As the damage gets worse, you may lose feeling in your toes, feet, and legs. Your skin may become numb. Because of this, you may:
Not notice when you step on something sharp
Not know that you have a blister or small cut
Not notice when your feet or hands touch something that is too hot or cold
Have feet that are very dry and cracked
When the nerves that control digestion are affected, you may have trouble digesting food due to reduced movement of the stomach (gastroparesis). This can make your diabetes harder to control. Damage to nerves that control digestion almost always occurs in people with severe nerve damage in their feet and legs. Symptoms of digestion problems include:
Feeling full after eating only a small amount of food
Gastric emptying study to check how fast food leaves the stomach and enters the small intestine
Tilt table study to check if the nervous system is properly controlling blood pressure
Your provider should check to see if your blood vitamin B12 level is normal, as low levels can contribute to neuropathy symptoms.
Treatment
Follow your provider's advice on how to slow diabetic nerve damage.
Control your blood sugar (glucose) level by:
Eating healthy foods
Getting regular exercise
Checking your blood sugar as often as instructed and keeping a record of your numbers so that you know the types of foods and activities that affect your blood sugar level
Taking oral or injected medicines as instructed by your provider
If you're prescribed medicines for symptoms of nerve damage, be aware of the following:
The medicines are often less effective if your blood sugar is usually high.
After you start the medicine, tell your provider if the nerve pain doesn't improve.
When you have nerve damage in your feet, the feeling in your feet can be reduced. You can even have no feeling at all. As a result, your feet may not heal well if they are injured. Caring for your feet can prevent minor problems from becoming so serious that you end up in the hospital.
Caring for your feet includes:
Checking your feet every day
Getting a foot exam each time you see your provider
Wearing the right kind of socks and shoes (ask your provider about this)
Support Groups
Many resources can help you understand more about diabetes. You can also learn ways to manage your diabetic nerve disease.
More information and support for people with diabetes and their families can be found at :
Nerve damage that hides the symptoms of the chest pain (angina) that warns of heart disease and a heart attack
Loss of a toe, foot, or leg through amputation, often because of a bone infection that does not heal
When to Contact a Medical Professional
Contact your provider if you develop any symptoms of diabetic neuropathy.
References
American Diabetes Association Professional Practice Committee. 12. Retinopathy, neuropathy, and foot care: standards of care in diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S231-S243. PMID: 38078577 pubmed.ncbi.nlm.nih.gov/38078577/.
Brownlee M, Aiello LP, Sun JK, et al. Complications of diabetes mellitus. In: Melmed S, Auchus RJ, Goldfine AB, Koenig RJ, Rosen CJ, eds. Williams Textbook of Endocrinology. 14th ed. Philadelphia, PA: Elsevier; 2020:chap 37.
Review Date:
2/10/2023
Reviewed By:
Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Internal review and update on 02/20/2024 by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.