Diabetic Neuropathy Symptoms in Feet and Treatment Options

Diabetic neuropathy symptoms usually begin in the feet and legs as numbness, tingling, burning or sharp pain, and they can spread to the hands and arms. The NIDDK’s diabetic neuropathy page says symptoms “can range from pain and numbness in your feet to problems with the functions of your internal organs, such as your heart and bladder.” Some people with nerve damage have no symptoms at all, according to UCSF’s diabetic neuropathy overview, so a foot exam matters even when you feel fine.

What does sensorimotor neuropathy mean?

UCSF lists sensorimotor neuropathy as another name for the peripheral type, saying peripheral neuropathy is “also called distal symmetric neuropathy or sensorimotor neuropathy.”

What are the symptoms of diabetic neuropathy?

Peripheral neuropathy is the most common form. The NIDDK page, last reviewed February 2018, says about one-third to one-half of people with diabetes have peripheral neuropathy. MedlinePlus says over half of people with diabetes get some form of it, and UCSF gives a range of 60 to 70 percent for any form. Estimates differ across these pages, so treat any single percentage with care. The symptoms by area are below.

What are the worst signs of neuropathy?

The signs to act on are the ones that point to a problem you may not feel. Get checked promptly if you notice:

• A blister, cut, sore or swelling on a numb foot that you did not feel happen. Injuries that go unnoticed can become infected, and an infection that is not treated promptly may spread to the bone (MedlinePlus, UCSF).
• Dizziness or faintness when you stand up quickly.
• Persistent nausea, vomiting or trouble swallowing.
• Lows in blood sugar that you no longer feel coming. Autonomic neuropathy can remove the warning symptoms of low blood sugar, and the NIDDK explains how low blood glucose is treated.
• Chest or belly pain. Nerve-related pain in these areas can feel like heart disease, a heart attack or appendicitis (MedlinePlus), so have it checked right away rather than assuming it is neuropathy.

What is the worst thing for neuropathy?

Two things matter most for protecting nerves and feet: blood sugar that stays high, and injuries you do not notice. MedlinePlus says keeping blood glucose as close to the normal range as possible protects nerves throughout the body, and numb feet hide sores. Smoking is also a named risk: MedlinePlus says smoking increases the risk of foot problems and amputation, and UCSF lists smoking and alcohol use among the lifestyle factors that contribute to nerve damage.

Can diabetes cause numb hands when I wake up?

Hand numbness can come from neuropathy or from a pinched nerve such as carpal tunnel, and a clinician can tell them apart through examination and testing. UCSF notes that feet and legs are likely to be affected before hands and arms, and that these symptoms are often worse at night. MedlinePlus says people with diabetes tend to develop nerve compressions, and carpal tunnel syndrome “causes numbness and tingling of the hand and sometimes muscle weakness or pain.” UK HealthCare describes carpal tunnel as nerve compression at the wrist. Waking with numb hands is worth reporting, because a clinician can test for carpal tunnel and neuropathy separately.

What gets mistaken for neuropathy?

• Carpal tunnel syndrome, the pinched nerve at the wrist that causes numbness and tingling in the hand.
• Heart and belly problems. Chest or abdominal pain from a focal nerve problem can be mistaken for heart disease, a heart attack or appendicitis (MedlinePlus).
• Other nerve disorders with other causes. Polyneuropathy can come from nutritional deficiencies, liver disorders or cancer as well as from diabetes, as one clinic’s Louisville page explains.
• Numbness from elsewhere in the body. A related-post summary on the Certified Foot & Ankle Specialists site describes numbness in the feet as possibly one of the first symptoms of something else going on in the lower extremities or body.

A clinician sorts these out with a physical exam and a foot check. MedlinePlus says doctors diagnose neuropathy from symptoms and a physical exam, and a nylon monofilament test checks feeling in the feet. Nerve conduction tests are sometimes used, but they are rarely needed to diagnose neuropathy.

What are the five stages of neuropathy?

It sorts diabetic neuropathy into four types, and each type affects different nerves:

• Peripheral: the feet and legs, sometimes the hands and arms. This is the most common type.
• Autonomic: the nerves that control organs, including heart rate, blood pressure, digestion, bladder and sweat glands.
• Focal: single nerves, most often in the hand, head, torso or leg. Carpal tunnel is the most common example.
• Proximal: a rare type in the hip, buttock or thigh, usually on one side of the body. Symptoms gradually improve over months or years.

If a chart you saw lists five stages, ask your clinician which of these four types applies to you.

Can nerve damage from diabetes be reversed?

Current care is aimed at slowing the damage and easing symptoms. MedlinePlus describes new treatments that may help slow, prevent, or even may help address nerve damage as future possibilities, as scientists learn more about the causes of neuropathy. Certified Foot & Ankle Specialists’ own page says its doctors may help address symptoms in many cases. That is the practice’s claim, and reversal is described above as a possible future result, not current care. Ask what it would mean for your own test results.

How is diabetic neuropathy treated?

MedlinePlus describes three parts: bring blood glucose into the normal range to help prevent further nerve damage, treat pain and other symptoms with medicines or other therapies, and take special care of your feet. It also says symptoms may get worse when blood glucose is first brought under control, and that over time, keeping blood glucose lower helps lessen symptoms. If you take medicines that can lower blood sugar, learn the lows and how to respond to them in the low blood sugar symptoms and treatment guide.

Which treatments are approved, which are still being studied, and which are everyday routines?

MedlinePlus reports that the U.S. Food and Drug Administration has approved duloxetine and pregabalin for painful diabetic peripheral neuropathy. Check the current label for the latest details. Other medicines are also used for nerve pain, and a combination may help people with severe pain. Prices change, so check cost with your pharmacy, your insurer or the product label.

Certified Foot & Ankle Specialists’ page describes NeuRemedy as formulated for the nerves in the feet and legs, and for pain associated with neuropathy. These are the page’s statements. Separately, the FDA’s warning on illegally sold diabetes treatments covers products that claim to treat diabetes naturally or to replace diabetes medicine, and says FDA has not evaluated those products as safe and effective.

Do massage and foot massages help neuropathy?

Massage is a question to bring to your clinician, not a treatment this guide can recommend. The main safety point is that neuropathy can dull feeling, so pressure or injury may go unnoticed (MedlinePlus). Some people with neuropathy also have extreme sensitivity to touch, even light touch (UCSF). Check your skin after any foot rub or massage, and tell your clinician before you start, especially if you have a sore or ulcer.

Is walking good for neuropathy?

Walking is a form of physical activity, and MedlinePlus lists physical activity among the ways to help control blood glucose, which is the first treatment step. Whether walking suits your neuropathy is a question for your clinician. NCCIH says eating well and being physically active can help people with diabetes keep blood glucose, blood pressure and cholesterol in target ranges and prevent or delay diabetes problems. The NIDDK also says activity beyond your usual routine can lower blood glucose for up to 24 hours afterward, so ask your clinician how a new walking routine fits your diabetes plan. If your feet are numb, check them before and after each walk, wear shoes that fit and let your toes move, and break in new shoes gradually.

How do people live with nerve pain from peripheral neuropathy?

MedlinePlus says people with severe nerve pain may benefit from a combination of medicines or treatments, and should talk with a health care provider about their options. Day to day, the foot care MedlinePlus describes does much of the protecting:

• Wash your feet daily in warm, not hot, water with mild soap, and dry between the toes.
• Look at the bottoms of your feet every day for cuts, blisters, redness, swelling or calluses. A mirror, or another person, can help.
• Wear shoes or slippers, and thick, soft, seamless socks.
• Use a bed cradle if bedding bothers sensitive feet.
• Have a comprehensive foot exam each year. People diagnosed with peripheral neuropathy need more frequent exams.

MedlinePlus says comprehensive foot care programs can reduce amputation rates by 45 to 85 percent. That figure comes from MedlinePlus, which cites 2004 amputation data, so treat it as an older estimate rather than a current one.

How do I keep healthy with diabetes?

NCCIH says people with diabetes can take steps to manage their condition and stay healthy through healthy food choices, physical activity, adequate sleep and stress management, and that diabetes medicines are often part of treatment. UK HealthCare lists the neuropathy prevention steps as keeping blood glucose in your target range, monitoring blood pressure and cholesterol, checking your feet daily, and having a yearly exam for neuropathy.

What should I bring to my next appointment?

Bring a written timeline of your symptoms: when each started, where you feel it, whether it is worse at night, and what makes it better or worse. The guide to building a symptom timeline for a primary care visit shows how to lay this out. Also note:

• Which area is affected, and whether it feels numb, tingling, burning or sharp.
• Any sore or blister you did not feel, and how your shoes fit.
• Dizziness on standing, digestion changes, bladder changes, or changes in sweating.
• Recent blood sugar readings, and any lows you noticed or did not notice.
• Every medicine, cream, patch or supplement you use for nerve symptoms.

You can open the visit with a line like this: “My feet have been numb and burning at night for [how long]. Can you check my protective feeling and reflexes, and tell me whether I need nerve tests?”

Your next step is to book your yearly foot exam, or ask for one sooner if you have numbness in your feet, and bring this list with you.

By the Primary Care Visit Guide Team

This article is for general information purposes only and does not constitute medical advice. Consult your doctor or qualified healthcare provider before making changes to your health routine.