What is Diabetic Neuropathy?

Authored by The Rx Advocates, / Medically Reviewed by Dr. Conor Sheehy, PharmD, BCPS


Diabetic neuropathy is nerve damage that can occur if you have uncontrolled diabetes. This damage usually occurs in the nerves in the legs and feet but can occur in the arms and hands as well.

It can occur in as much as 50% of the diabetic population of those who have type 2 diabetes.

There are ways to reduce the risk of developing this disorder.

Type 2 Diabetes

Type 2 diabetes is the most common type of diabetes. Type 2 develops when the body no longer regulates insulin as it should. The pancreas can still produce insulin, but the cells of the body have become resistant to it.

Type 2 diabetes can be managed by exercising and eating the right foods to maintain a stable blood sugar level.

When blood sugar levels are not properly regulated, the body is stressed and other systems can suffer and not function properly. One of the systems that can be affected is the nervous system.

Causes of Diabetic Neuropathy

Many factors can lead to diabetic neuropathy. One thing that is still being studied is how diabetes harms nerve cells.

High blood sugar is a big cause of diabetic neuropathy, but there are also others.

Some of the big risk factors are:

  • Obesity and high triglycerides or fats in the blood.
  • Smoking can increase the risk by as much as 42%.
  • Low levels of HDL cholesterol and high levels of LDLs increase the risk by up to 67%.
  • High blood pressure.

Type 2 diabetics have a greater risk of neuropathy than Type 1 diabetics. It’s thought to be due to the early diagnosis of Type 1. Often, those with Type 1 diabetes were diagnosed as children. Those with Type 2 usually don’t receive a diagnosis until later in life.

Type 2 diabetes is usually only diagnosed after one has had the condition for years and cell and nerve damage has already occurred.

What are the Types of Diabetic Neuropathy?

There are different types of diabetic neuropathy but all involve a loss or inability for the brain to communicate properly with certain areas of the body.

Peripheral neuropathy is nerve damage that usually affects the hands, arms, feet, and legs.

Autonomic neuropathy occurs when danger happens to the nerves that control your internal organs like your bladder, sweat glands, and eyes.

Focal neuropathy occurs when there is damage to single nerves usually in the hand, head, torso, or leg.

Proximal neuropathy is rare and disabling and typically affects one side of the body.

Signs and Symptoms of Diabetic Neuropathy

As mentioned previously, Type 2 diabetes may not be diagnosed until the disease has caused nerve damage. The same applies to diabetic neuropathy. Due to its slow progression, signs and symptoms are very important to take note of and report to your doctor.

Peripheral Neuropathy Signs and Symptoms

  • Numbness or lack of ability to feel pain or temperature in your feet or toes. 
  • Tingling or burning feeling in extremities.
  • Muscle weakness.
  • Sharp, jabbing pains that may be worse at night.
  • Loss of reflex response.
  • Foot problems such as infections, ulcers, or deformities.
  • Extreme sensitivity to the lightest touch.

Autonomic Neuropathy Signs and Symptoms

  • Difficulty swallowing
  • Constipation or uncontrolled diarrhea
  • Bladder problems; frequent urinary tract infections or urinary incontinence
  • Slow stomach emptying
  • Changes in sweat production
  • Problems regulating your body temperature
  • Increased heart rate at rest
  • Changes in the way eyes adjust

Proximal Neuropathy

  • Sudden weakness in the hip, thigh, or buttocks
  • Weakening and shrinking of thigh muscles
  • Difficulty getting up from a sitting position

Focal Neuropathy

  • Bell’s palsy
  • Pain in shin or foot
  • Chest or stomach pain
  • Difficulty focusing your eyes
  • Double vision

If you have type 2 diabetes and have any of these symptoms, it’s important to monitor them and talk to your health care professional right away.

The sooner they can be treated, the better the odds of preventing further complications.

Testing for Neuropathy

Several tests can be performed to check for diabetic neuropathy.

Pinprick test – this test involves light touches on the feet and toes with a pin-like object. This test will determine whether the nerves still react to painful stimuli.

Ankle reflex – This test checks the reflexes in both ankles with a reflex hammer.

Vibration perception – this test involves the doctor using a tuning fork on your feet to see if any vibrations can be felt.

Pressure sensation – This test uses flexible nylon filaments to determine how much pressure can be felt on the possibly affected areas of the body.

Nerve Conduction Velocity – this test measures how long it takes nerves to transmit an electrical signal.

Electromyography test – this test checks the muscle response when a stimulus is placed on the nerves. If the muscle does not respond well, the nerve could be damaged.

Living with Diabetic Neuropathy

If you have been diagnosed with diabetic neuropathy, it’s still possible to manage the symptoms and live a full life.

It’s important to set up daily priorities and tasks and not overdo things. Being overly tired and stressed can cause symptoms to flare up.

When severe pain happens, a good way to deal with this would be to get outside and take a walk. Sometimes changing one’s environment helps to alleviate the symptoms.

Finding a support group and being able to share stories of hope and encouragement can be a wonderful tool to keep a positive mindset.

Some people find that talking to a counselor or therapist can help avoid feelings of depression and frustration.

Medications for Managing Symptoms

There are medications available to manage diabetes-related nerve pain.

Some anti-seizure drugs have been found to ease nerve pain. These medications include Lyrica and Gabapentin (Gralise, Neurontin).

Some anti-depressants can help ease nerve pain as well. Some of these include Cymbalta, Effexor, Tofranil, Norpramin, and amitriptyline.

Some people find topical creams can help reduce pain sensations. Capsaicin cream is sold over the counter at most drug stores.

Acupuncture may also help relieve some of the side effects and pain of neuropathy symptoms.

A transcutaneous electrical nerve stimulation (TENS) unit may also provide some relief for some people as well. The TENS unit delivers electrical impulses to specific nerve pathways. It’s painless and the electrodes are placed on your skin.

Be sure to consult your doctor before any therapies or supplements are used to avoid any interaction with medications you may be on.

Paying for Medications

Your doctor may prescribe medications for you to help alleviate your diabetic neuropathy symptoms. Some prescriptions can be costly.

At The Rx Advocates, we work with doctors, patients, and pharmaceutical companies to make these prescriptions more affordable.

We will help you and your doctor prepare applications for any medications you are taking. We then file these applications with the pharmaceutical companies.

We will handle all the follow-ups. We will ensure that your application has been received and is being processed.

Once the application has been approved, we will handle any ongoing work such as refills.

We work with patient assistance programs to make medications more affordable. We are not an insurance company and members pay only for our services. The medications are delivered at no extra cost. We charge a one-time fee to enroll in our program.

If for some reason you are not approved, you will be reimbursed any monthly service fees that have been paid. The one-time enrollment fee is not refundable.

The monthly service fee varies depending on how many medications you are approved for and is a month-to-month fee. You can cancel at any time.

We have helped people save hundreds of dollars on their monthly medications. If paying for medications is a hardship, please contact us today so we can see what we can do to help.

Mayo Clinic. Diabetic Neuropathy. https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580. March 3, 2020.

Diabetic Neuropathy: Causes and Symptoms. https://www.endocrineweb.com/guides/diabetic-neuropathy/diabetic-neuropathy-causes. Feb. 5, 2020.

American Diabetes Association. Type 2 Diabetes. https://www.diabetes.org/diabetes/type-2?&ada_source=WWP211001LW001M001CC&ada_sub_source=google&utm_source=google&utm_medium=search&utm_campaign=awareness-campaign&utm_term=one-time&utm_content=ad&autologin=true&s_src=AAP181101LXXXXM001CC%E2%80%9D&gclsrc=aw.ds&gclid=Cj0KCQiAq7COBhC2ARIsANsPATH1Gu1QZpYiPK4t0wVaQUSElb3oGiODyAv2ndc1CX8lwz-6k9DyjQoaAj8VEALw_wcB. 1995-2021.

National Institute of Diabetes and DIgestive Kidney DIseases. What is Diabetic Neuropathy? https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/what-is-diabetic-neuropathy#causes. Feb 2018.

National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Peripheral-Neuropathy-Fact-Sheet#3208_1. Nov. 15, 2021.

Mayo Clinic. Autonomic Neuropathy. https://www.mayoclinic.org/diseases-conditions/autonomic-neuropathy/symptoms-causes/syc-20369829#:~:text=Autonomic%20neuropathy%20occurs%20when%20the,function%20and%20even%20sexual%20function.. Aug 21, 2020.

National Institute of Diabetes, Digestive and Kidney Disease. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/proximal-neuropathy. Feb 2018.

Mayo Clinic. Diabetic Neuropathy types. https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/in-depth/diabetic-neuropathy-types/art-20094456. May 20, 2020.

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