Brief Overview: Diabetic neuropathy is nerve damage caused by chronic hyperglycemia and metabolic/vascular injury in diabetes. The most common form is distal symmetric polyneuropathy (stocking–glove pattern), which may be painless or painful (burning, tingling, electric). Autonomic, focal, and proximal neuropathies also occur.
Prevalence: According to UpToDate, “The prevalence of diabetic polyneuropathy is a function of disease duration and severity, and estimates vary depending on presenting symptoms. A global systematic review and meta-analysis of >50,000 patients of all ages with diabetes reported a 30 percent prevalence of diabetic polyneuropathy .”
Etiology: According to the National Institute of Diabetes and Digestive and Kidney Diseases, “Over time, high blood glucose levels, also called blood sugar, and high levels of fats, such as triglycerides, in the blood from diabetes can damage your nerves. High blood glucose levels can also damage the small blood vessels that nourish your nerves with oxygen and nutrients. Without enough oxygen and nutrients, your nerves cannot function well.”
Risk Factors:
- Uncontrolled, or poorly controlled, diabetes
- Coronary artery disease
- Elevated triglycerides
- Overweight, obese
- Smoking
- Excessive alcohol consumption
- Advanced kidney disease
- Hypertension
Commonly Associated Conditions:
- Diabetes
- Metabolic syndrome
- Obesity
Common Medications:
- Medications to achieve and maintain control of diabetes, cholesterol, hypertension
- Pain management
- Gabapentin, pregabalin
- Capsaicin patches
- Antidepressants
Common Labs, Imaging, and Tests:
- Additional testing is not typically required
- Glucose, HgbA1c, kidney function testing for diabetes management
- Diabetic foot exam
Common Symptoms:
- Pain, burning, tingling, or numbness in the toes or feet
- Extreme sensitivity to light touch
- Sensory loss → imbalance, unsteady gait, foot injuries unnoticed
- Symptoms may develop in the hands
Common Treatments:
- TENS therapy
- Acupuncture
- Physical and occupational therapy
Physical Findings:
- Decreased vibration/monofilament sensation in toes/forefoot → ankles → hands (stocking–glove)
- Reduced/absent ankle reflexes, impaired proprioception
- Gait imbalance, positive Romberg (sensory ataxia)
- Foot skin changes, calluses, fissures, ulcers; decreased hair; warm/swollen foot in Charcot arthropathy
Potential Complications and Contraindications:
- Foot sores, ulcers, infections à amputation
- Balance and coordination difficulty à falls, fractures
- Chronic pain that can lead to depression and anxiety
- According to NIDDK, “Autonomic neuropathy can cause problems with how your organs work, including problems with your heart rate and blood pressure, digestion, urination, and ability to sense when you have low blood glucose.”
General Health and Lifestyle Guidance:
- Work with your healthcare provider to achieve and maintain control of your diabetes
- Perform daily foot checks; moisturize feet (not between toes); never walk barefoot; wear properly fitting shoes
- Balance & strength exercise (e.g., walking, tai chi, resistance training) 3–5 days/week – ask your healthcare provider what exercises are recommended and safe for you
- Orthostatic precautions may be necessary if dizzy (rise slowly, hydrate, compression stockings if advised by your healthcare provider). Discuss this with your healthcare provider.
- Work with your healthcare provider to manage weight. Ask about any recommended dietary modifications or recommendations.
- Limit alcohol consumption
- Tobacco cessation
Suggested Questions to Ask Patients:
- How long have you had diabetes? What was your last A1c?
- Describe your foot/hand symptoms (burning, tingling, numbness). Worst time of day?
- Any loss of balance, falls, or dizziness when standing?
- Have you noticed sores, blisters, or color changes on your feet?
- What medications have you tried for nerve pain? Any side effects?
- Do you check your feet daily? What shoes do you wear most?
- How do the symptoms affect sleep and daily activities?
- Any GI issues, bladder changes, or sexual dysfunction?
- Are you taking metformin? Ever had your B12 checked?
Suggested Talking Points:
- Nerve pain from diabetes is common and manageable; controlling blood sugar can help slow progression.
- First-line nerve pain meds (duloxetine, pregabalin/gabapentin, low-dose TCA) often help. Work with your healthcare provider to determine what the best treatment plan is for you.
- Daily foot care and the right footwear can help prevent ulcers and infections.
- Keep moving—regular activity can help improve pain, balance, and mood. Ask your healthcare provider what exercise is recommended and safe for you.
- Tell your healthcare provider right away about new foot wounds, worsening numbness, or frequent falls.
Sources:
- https://www.uptodate.com/contents/epidemiology-and-classification-of-diabetic-neuropathy?search=diabetic%20neuropathy&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
- https://www.uptodate.com/contents/management-of-diabetic-neuropathy?search=diabetic%20neuropathy&topicRef=5275&source=see_link
- https://www.uptodate.com/contents/diabetic-neuropathy-beyond-the-basics?search=diabetic%20neuropathy&topicRef=5280&source=related_link
- https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/what-is-diabetic-neuropathy
- https://www.hopkinsmedicine.org/health/conditions-and-diseases/diabetes/diabetic-neuropathy-nerve-problems
- https://my.clevelandclinic.org/health/diseases/21621-diabetic-neuropathy#management-and-treatment
This content was generated with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.