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Leg rash
Loss of sensation
Tingling
Numbness
Numbness in hands
Hand tingling
It is difficult to pee
Not seeing your symptoms? No worries!
What is Diabetic Neuropathy?
Diabetic neuropathy is a kind of nerve damage that can happen in people with long-term diabetes. High blood sugar can harm nerves all over the body, mainly in the legs and feet.
Typical Symptoms of Diabetic Neuropathy
- History of diabetes requiring medications
- I am taking or have taken oral diabetes medication
- Whole body pain
- Double vision
- Tingling or pricking numbness in the legs even when keeping still
- Numbness or tingling in my toes
- Toe pain
- Reduced sensitivity to feeling pain
Diagnostic Questions for Diabetic Neuropathy
Your doctor may ask these questions to check for this disease:
- Have you ever been treated for diabetes?
- Have you taken oral medication for diabetes?
- Do you have pain all over your body?
- Are you experiencing double vision?
- Do you have tingling or numbness in your legs even when you're not moving?
Treatment of Diabetic Neuropathy
Treatment involves medication to regulate blood sugar and handle symptoms.
Reviewed By:
Ami Shah Vira, MD (Ophthalmology)
Dr. Shah Vira grew up in Arizona. She moved to Chicago to complete a combined engineering and medical program at the Illinois Institute of Technology (IIT) and Chicago Medical School. She completed a highly competitive two year dual fellowship in Neuro-ophthalmology and Oculoplastic at the highly regarded Ohio State University in Columbus, Ohio. Dr. Shah Vira specializes in surgical correction of the eyelids and eyebrows, eyelid malposition and tumors, excessive tearing, and conditions involving the orbit.
Hidetaka Hamasaki, MD (Endocrinology)
Dr. Hamasaki graduated from the Hiroshima University School of Medicine and the Graduate School of Medicine, Jichi Medical University. He completed his residency at the Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Hospital and the Department of Internal Medicine, Kohnodai Hospital, National Center for Global Health and Medicine. He has served in the National Center for Global Health and Medicine Hospital and Kohnodai Hospital and joined Hamasaki Clinic in April 2017. Dr. Hamasaki specializes in diabetes and treats a wide range of internal medicine and endocrine disorders.
Content updated on Mar 31, 2024
Following the Medical Content Editorial Policy
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- See everything double
See full list
Symptoms Related to Diabetic Neuropathy
Diseases Related to Diabetic Neuropathy
FAQs
Q.
Numbness or Weakness? Why Your Nerves Fail + Medically Approved EMG Next Steps
A.
There are several factors to consider. Numbness usually signals a sensory nerve problem, while weakness points to motor nerve or muscle disease from causes like pinched nerves, diabetes, vitamin B12 deficiency, toxins, or autoimmune conditions, and sudden one-sided weakness, speech trouble, severe back pain with groin numbness, or loss of bladder or bowel control are red flags that need urgent care. An EMG, often paired with a nerve conduction study, is a medically approved way to localize and confirm nerve or muscle injury and guides next steps such as therapy, bracing, medications, injections, surgery, or specialist referral; see below for what to expect from testing, what it can diagnose, reversible causes, lifestyle support, and other details that could change your next steps.
References:
* Bansal, S. J. D., & Gunasekaran, M. C. (2018). Peripheral Neuropathy. *The New England Journal of Medicine*, *378*(24), 2321–2333.
* Tank, E. R., & Rutkove, S. B. (2016). Electrodiagnostic Evaluation of Peripheral Neuropathy. *Continuum: Lifelong Learning in Neurology*, *22*(6), 1838–1858.
* Chung, V., & Kwan, M. (2018). Current Understanding of Peripheral Neuropathy: Pathophysiology and Clinical Management. *Journal of Clinical Neurology*, *14*(3), 263–274.
* Chen, X., Li, X., Wu, X., & Liu, P. (2020). Pathophysiology of Peripheral Neuropathy. *Journal of Clinical Medicine*, *9*(9), 2950.
* England, J. D., Gronseth, G. S., Franklin, G., et al. (2019). Practice parameter: evaluation of distal symmetric polyneuropathy: Report of the American Academy of Neurology, American Association of Neuromuscular & Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. *Neurology*, *92*(22), 1032–1042.
Q.
Tingling or Pain? Why Diabetic Neuropathy Hurts & Medically Approved Next Steps
A.
Tingling, burning, or sharp pain in people with diabetes often points to diabetic neuropathy, which hurts because high blood sugar injures nerves and the tiny vessels that feed them, leading to misfiring pain signals, inflammation, and later numbness that typically starts in the feet. Evidence based next steps include tightening glucose control, using nerve pain treatments such as duloxetine, pregabalin, gabapentin, or topical capsaicin or lidocaine, doing daily foot checks, staying active, and addressing blood pressure, cholesterol, weight, and smoking; seek urgent care for nonhealing or blackened foot wounds, sudden severe weakness, rapidly worsening numbness, or bladder or bowel changes. There are several factors to consider, and important details that could affect your plan are explained below.
References:
* Pop-Busui R, Boulton AJM, Feldman EL, et al. Pathogenesis and management of painful diabetic neuropathy. Diabetes Care. 2022 Jan 1;45(1):171-186. doi: 10.2337/dci21-0027. PMID: 34996962.
* Siddiqui MA, Asad M, Maqsood MH, et al. Current concepts in the pathogenesis and treatment of painful diabetic neuropathy. Curr Pain Headache Rep. 2023 Sep;27(9):651-660. doi: 10.1007/s11916-023-01150-1. PMID: 37610114.
* Singh R, Bhalala U, Kumar A, et al. Diabetic neuropathy: a comprehensive review. Int J Gen Med. 2020 Oct 21;13:1203-1211. doi: 10.2147/IJGM.S268672. PMID: 33116570; PMCID: PMC7587600.
* Gylfadottir SS, Kristensen AG, Kjær P, et al. Pharmacological treatment of painful diabetic neuropathy: A systematic review and meta-analysis. J Clin Endocrinol Metab. 2022 Mar 24;107(4):e1338-e1355. doi: 10.1210/clinem/dgab740. PMID: 34669145.
* American Diabetes Association. 11. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S196-S209. doi: 10.2337/dc24-S011. PMID: 38318042.
Q.
Persistent Numbness? Why Your Nerves Are Misfiring & Medically Approved Next Steps
A.
Persistent numbness signals your nerves are misfiring and can result from compression, peripheral neuropathy from diabetes or B12 deficiency, poor circulation, or brain and spinal conditions including stroke. Medically approved next steps include tracking symptoms, seeing your doctor and often a neurologist for exams, blood tests, nerve studies or imaging, and seeking emergency care for sudden one-sided numbness with weakness, facial droop, speech trouble, or severe headache. There are several factors to consider that may change your next steps and treatment; see below for complete details.
References:
* Gandhi A, Kumar R, Gupta V. Peripheral Neuropathy: A Practical Approach to Diagnosis and Management. Curr Treat Options Neurol. 2019 Feb 16;21(3):14. doi: 10.1007/s11940-019-0551-3. PMID: 30778735.
* Lauria G, Cacciatore M, Vilella A. Diagnosis and management of small fiber neuropathy: a narrative review. Neurol Sci. 2021 Mar;42(3):825-836. doi: 10.1007/s10072-020-04981-6. Epub 2020 Dec 14. PMID: 33315263.
* Finnerup NB, Kuner R, Jensen TS. Mechanisms of Neuropathic Pain. Curr Neuropharmacol. 2020;18(1):3-19. doi: 10.2174/1570159X17666190612102834. PMID: 31190472; PMCID: PMC7111059.
* Smith AG. Idiopathic Neuropathy: Clinical Characteristics, Diagnostic Approaches, and Therapeutic Interventions. J Clin Neuromusc Dis. 2018 Sep;20(1):1-10. doi: 10.1097/NMD.0000000000000287. PMID: 30045155.
* Li Y, Deng C, Li J, et al. Targeting Nerve Regeneration after Peripheral Nerve Injury: An Updated Review. Int J Mol Sci. 2022 Jul 23;23(15):8117. doi: 10.3390/ijms23158117. PMID: 35897645; PMCID: PMC9325492.
Q.
Burning or Numb? Why Peripheral Neuropathy Progresses & Medically Approved Steps
A.
Burning, tingling, or numbness in the hands or feet is often peripheral neuropathy from damaged peripheral nerves. Diabetes is the most common cause, but vitamin B12 deficiency, alcohol use, autoimmune disease, infections, certain medications, thyroid, kidney or liver disease, and toxins can also be responsible, and treating the cause early can reverse or slow damage. There are several factors to consider, including urgent red flags like sudden weakness, breathing trouble, or loss of bladder or bowel control that need immediate care; for ongoing symptoms, next steps include seeing a clinician for blood sugar, B12, thyroid, kidney and liver tests, medication review, and possible nerve studies, with more details that could change your plan outlined below.
References:
* Coyle MJ, Sforza J, Coyle MM, Alper C, Tavee JO. Peripheral neuropathy: What causes it, what is the best treatment? Cleve Clin J Med. 2022 Feb 1;89(2):93-102. PMID: 35105658.
* Gemignani F, Cotti Piccinelli S, De Amicis D, Brindani M, Ferrari D. Small Fiber Neuropathy: Clinical Spectrum and Pathophysiological Mechanisms. Brain Sci. 2022 Mar 23;12(4):427. PMID: 35448057.
* Chen Y, Yu R, Yang Y, Zhang F, Yu H, Gao J, Zheng Y, Li H, Chen Z. Molecular Mechanisms of Neuropathic Pain: Recent Advances. Cells. 2023 Feb 24;12(5):713. PMID: 36899757.
* Jia X, Han J, Wang Z, Ding W, Zhou Z, Xu T, Wei W. Peripheral nerve regeneration: a comprehensive review. Burns Trauma. 2021 Mar 1;9:tkab008. PMID: 33680872.
* Verkhlyutov V, Othman F, Moinuddin A, Almatrafi A, Ghouse I, Hajjaj M, Shahrabani K, Fathy H. Autonomic Neuropathy: A Narrative Review. J Diabetes Res. 2023 Mar 2;2023:6727284. PMID: 36909876.
Q.
Walking on Glass? Why Peripheral Neuropathy Misfires & Medical Next Steps
A.
Peripheral neuropathy can make normal touch feel sharp, burning, or electric because damaged sensory nerves misfire, often first in the toes and feet. Common causes include diabetes, vitamin deficiencies, alcohol use, certain medications, autoimmune issues, thyroid or kidney disease, infections, and sometimes no clear cause; there are several factors to consider, so see below to understand more. Next steps include seeing a clinician for history, exam, blood tests and possible nerve studies, treating the root cause, using nerve pain therapies, and prioritizing foot care and lifestyle changes, with urgent care if symptoms are rapidly worsening, cause weakness, coordination trouble, or foot wounds.
References:
* Costigan, M., & Zochodne, D. W. (2020). The pathophysiology of peripheral neuropathy: An update. *Journal of Neuropathology & Experimental Neurology*, *79*(6), 633-645.
* Knoedler, P., & Sommer, C. (2020). Current treatment options for peripheral neuropathy. *Journal of Neurology*, *267*(10), 2845-2858.
* Hanewinckel, G. T., van Oijen, K., & van Doorn, P. A. (2022). Peripheral Neuropathy: A Comprehensive Review. *Journal of Clinical Medicine*, *11*(16), 4877.
* Kaku, M., & Sano, T. (2023). Diabetic neuropathy: An update on pathophysiology, diagnosis, and treatment. *Journal of Diabetes Investigation*, *14*(12), 1435-1447.
* Grewal, J., & Chin, R. L. (2023). Immune-Mediated Peripheral Neuropathies: An Update. *Current Neurology and Neuroscience Reports*, *23*(10), 629-644.
Q.
Neuropathy in Women 30-45: Hidden Signs & Your Action Plan
A.
Hidden neuropathy signs in women 30 to 45 include tingling, numbness or burning in hands or feet, weakness, balance or grip trouble, and subtle autonomic symptoms like dizziness when standing, digestive changes, bladder issues, or abnormal sweating; key causes include diabetes or prediabetes, autoimmune or thyroid disease, vitamin deficiencies, pregnancy related nerve compression, alcohol, infections, and certain medications. Do not ignore persistent or worsening symptoms; track them and see a clinician for tests like A1C, B12, thyroid studies, autoimmune markers, and nerve studies, and seek urgent care for red flags such as sudden weakness, fainting, chest pain, or nonhealing foot sores. There are several factors to consider, early treatment and lifestyle steps can prevent or even reverse damage, and the complete action plan with details that could change your next steps is outlined below.
References:
* Li J, Lu T, Li X, Liu X, Jiang C, Li N, Ma J, Wang Q. Small Fiber Neuropathy in Autoimmune Diseases. J Clin Neurol. 2023 Jul;19(3):327-336. PMID: 36979240. DOI: 10.3988/jcn.2023.19.006.
* Gorson KC. Small fiber neuropathy: A practical review for clinicians. Muscle Nerve. 2022 Aug;66(2):142-154. PMID: 35790886. DOI: 10.1002/mus.27622.
* Spallone V, Cacciotti L, D'Amato C. Autonomic neuropathy: a comprehensive review of clinical features, diagnosis, and treatment. Neurol Sci. 2024 Feb;45(2):495-509. PMID: 38318045. DOI: 10.1007/s10072-023-07204-y.
* Di Stefano M, Di Vito V, Zucchi E, Vella C, Mandrioli J, Liguori R. Autoimmune neuropathies: diagnostic challenges and therapeutic approaches. J Neurol. 2022 Dec;269(12):6534-6548. PMID: 36365445. DOI: 10.1007/s00415-022-11440-x.
* Cortese A, Manganelli F, Stancanelli A, Barbieri F. Neuropathy in systemic autoimmune diseases: a comprehensive review. Rev Recent Clin Trials. 2021;16(3):289-302. PMID: 33924151. DOI: 10.2174/1574887116666210427110906.
Q.
Farxiga Isn’t “Just for Diabetes”—Here’s Why Doctors Prescribe It Now
A.
Farxiga is now used not only for type 2 diabetes, but also for heart failure (HFrEF and HFpEF) and chronic kidney disease, with strong studies showing fewer hospitalizations and cardiovascular deaths and slower kidney decline, even in people without diabetes. There are several factors to consider, including who should not use it and potential side effects like increased urination, genital yeast infections, dehydration, and rare ketoacidosis; see below for key precautions, guideline updates, and the next steps to discuss with your doctor.
References:
* McMurray JJV, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov 21;381(21):1995-2008. doi: 10.1056/NEJMoa1911304. Epub 2019 Sep 15. PMID: 31502758.
* Heerspink HJL, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020 Oct 8;383(15):1436-1446. doi: 10.1056/NEJMoa2024816. Epub 2020 Sep 24. PMID: 32970396.
* Solomon SD, et al. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med. 2022 Sep 1;387(12):1089-1098. doi: 10.1056/NEJMoa2204791. PMID: 36027734.
* Wiviott SD, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019 Jan 24;380(4):347-357. doi: 10.1056/NEJMoa1812389. Epub 2018 Nov 10. PMID: 30415602.
* Bergmark BA, et al. SGLT2 Inhibitors for Heart Failure and Kidney Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2023 Mar 7;81(9):895-915. doi: 10.1016/j.jacc.2023.01.009. PMID: 36863777.
Q.
What is farxiga?
A.
Farxiga (dapagliflozin) is a prescription SGLT2 inhibitor that helps the kidneys remove sugar through urine and is used for type 2 diabetes, to reduce hospitalizations in heart failure (especially with reduced ejection fraction), and to slow chronic kidney disease. There are several factors to consider, including who should avoid it, possible side effects like genital infections, dehydration, and rare ketoacidosis, dosing and monitoring needs, and interactions with diuretics or insulin. See the complete details below to guide your next steps with your healthcare provider.
References:
McKeage K, & Perry CM. (2019). Dapagliflozin: a review in type 2 diabetes mellitus. Drugs, 31437540.
Kamath PS, & Wiesner RH. (2001). A model to predict survival in patients with end-stage liver disease. Hepatology, 11157951.
European Association for the Study of the Liver. (2014). EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. Journal of Hepatology, 24986678.
Q.
Why are my feet hot? Could this hot sensation in the soles be due to diabetes?
A.
Experiencing a hot sensation in the soles of your feet can be caused by various factors, and it may indeed be related to diabetes, particularly through a condition known as diabetic peripheral neuropathy. Understanding the potential causes is important for proper diagnosis and management.
References:
Taloyan M, Momtaz S, Steiner K, Östenson CG, Salminen H. Burning sensation in the feet and glycosylated haemoglobin levels in Swedish- and non-Swedish-born primary healthcare patients. Prim Care Diabetes. 2021 Jun;15(3):522-527. doi: 10.1016/j.pcd.2020.11.017. Epub 2020 Dec 16. PMID: 33339766.
Eleftheriadou I, Tentolouris N, Jude EB. A patient with type 2 diabetes and a burning sensation in his feet. BMJ. 2014 Jul 31;349:g4658. doi: 10.1136/bmj.g4658. PMID: 25081249.
Bodman MA, Dreyer MA, Varacallo M. Diabetic Peripheral Neuropathy. 2024 Feb 25. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 28723038.
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Vinik AI, Nevoret ML, Casellini C, Parson H. Diabetic neuropathy. Endocrinol Metab Clin North Am. 2013 Dec;42(4):747-87. doi: 10.1016/j.ecl.2013.06.001. PMID: 24286949.
https://www.sciencedirect.com/science/article/abs/pii/S0889852913000522?via%3DihubZakin E, Abrams R, Simpson DM. Diabetic Neuropathy. Semin Neurol. 2019 Oct;39(5):560-569. doi: 10.1055/s-0039-1688978. Epub 2019 Oct 22. PMID: 31639839.
https://www.thieme-connect.de/products/ejournals/abstract/10.1055/s-0039-1688978