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Ask the Doctor
Understanding Diabetic Neuropathy

When you have diabetes, you may develop nerve damage in different parts of your body. It’s fairly common—the National Diabetes Information Clearinghouse reports that 60 to 70 percent of people with diabetes will develop diabetic neuropathy. You may have symptoms of pain, tingling, or numbness in your hands, arms, feet, and legs. Sometimes nerve problems can happen inside your body, in your digestive tract, heart, or sex organs. If you have had diabetes for a long time—more than 25 years—you are more likely to develop neuropathy, and it’s also more common if you have trouble controlling your blood sugar levels.

Why am I at risk of neuropathy just because of my diabetes?

High glucose levels caused by diabetes weaken blood vessels throughout your body, which means that the nerves are not as well nourished by oxygen and nutrients. This can cause them to perform poorly.

Is there anything I can do to prevent getting this condition?

The best way to minimize diabetic neuropathy damage is to maintain good glucose control. If you do begin to feel tingling or loss of sensation, it’s important to watch for any cuts or sores in the areas you have trouble feeling. Since you won’t feel the pain as much, and the glucose in your blood can lead to a higher rate of infection, you must take care of wounds early and make sure they heal properly. (Editors note: see our wound care article starting on p. 10.)

What are the symptoms of diabetic neuropathy?

For some types of neuropathy, you may not have symptoms for a while. Your nerves can be damaged without your knowing it. But a common symptom in peripheral neuropathy—damage to the limbs—is tingling, numbness or weakness in the hands, arms, feet or legs. Erectile dysfunction can also be an indication for men that nerve or vascular damage is present.

How will I know I have it?

If you have symptoms, your doctor will do a thorough physical exam, and even if you don’t, some of the things he or she will check at a regular appointment can indicate development of neuropathy. Blood pressure, heart rate, the strength of your muscles, etc., should be checked routinely and can help diagnose neuropathy.

People with diabetes should also have a thorough foot exam every year to check for neuropathy. First your doctor will examine your feet to check the skin and muscles. Your doctor also may tickle or prick your foot to see if you can feel different sensations. If you cannot feel these sensations, you may have the beginnings of neuropathy and it’s important for you to check your feet at home because sores you cannot feel can lead to infections and sometimes larger problems.

There are also tests that measure nerve damage, called nerve conduction studies. They measure how the electrical current is moving through your nerve and can indicate deterioration of the nerve. Your doctor may order this test to assess the status of neuropathy.

What are the best ways to manage diabetic neuropathy if I get it?

You must strive to control your glucose, lipid, and blood pressure numbers. Take a good look at your diabetes management program and make sure you are doing all that you can: meal planning, exercise, and medicine or insulin if you doctor recommends them. Bringing your blood sugar levels under control may slow the onset or progression of diabetic neuropathy. There is also treatment for pain. Some depression medicines seem to help with the pain of neuropathy, as well as drugs from the anticonvulsant and opioid classes. Sometimes a topical treatment can help, such as one that contains capsaicin.

Nancy CodoriNancy Codori, M.D., MPH, is a board-certified general internist. She has been practicing general internal medicine in Baltimore for 15 years. Much of her work has involved treating African American people in East Baltimore with type 2 diabetes, hypertension, obesity, elevated cholesterol and HIV. She is now a full-time faculty member in the division of General Internal Medicine at the Johns Hopkins School of Medicine, also in Baltimore, MD.