Diabetic Neuropathy

January 16, 2018

Diabetic neuropathy is nerve damage due to diabetes. Over time, high blood sugar (glucose) can damage the tiny blood vessels that supply your nerves, especially in the legs. 

Nerves send messages to and from your brain about pain, temperature, and touch. They tell your muscles when and how to move. They also control the systems in the body that digest food and pass urine.

If you have diabetes, you can develop nerve problems at any time. Serious nerve problems can develop within the first 10 years after being diagnosed with diabetes. The risk of getting neuropathy grows the longer you have diabetes. About half of people with diabetes have some form of nerve damage.

The exact cause of diabetic neuropathy is unknown. Several things may contribute to it, including:

  • High blood sugar. High blood sugar (glucose) causes chemical changes in nerves. This impairs the nerves' ability to send signals. It can also damage blood vessels that carry oxygen and nutrients to the nerves.
  • Your genes. Certain genetic traits can increase risk for nerve disease.

These are the most common symptoms of diabetic neuropathy:

  • Numbness in the hands or feet, often on both sides
  • Pain in the hands, feet, or legs
  • Multiple foot problems. These include calluses, dry skin and skin breaks, claw toes, and collapse of the ankles
  • Problems with your internal organs, such as the digestive tract, heart, sex organs, or eyes. This can lead to:
    • Indigestion
    • Diarrhea or constipation
    • Dizziness, especially when first standing up
    • Bladder infections
    • Erectile dysfunction
    • Vaginal dryness
    • Weakness
    • Weight loss
    • Depression
    • Visual changes, including inability to see or drive in the dark

The symptoms of diabetic neuropathy may look like other conditions or medical problems. See your healthcare provider for a diagnosis.

To diagnose neuropathy, you will need a physical exam and other special tests. For example, ultrasound is used to check urinary issues. Ultrasound uses sound waves to visualize your bladder. Stomach issues can be identified with X-rays and other diagnostic tests. An electrocardiogram (EKG) can detect changes in your heart's rhythm due to neuropathy.

In addition, your healthcare provider may:

  • Check muscle strength
  • Check muscle reflexes

Check how your nerves respond to:

  • Position
  • Vibration
  • Temperature
  • Light touch

Request more tests, such as:

  • Nerve conduction studies to check flow of electrical current through a nerve
  • Electromyography (EMG) to see how muscles respond to electrical impulses
  • Ultrasound to determine how parts of the urinary tract are working
  • Nerve biopsy to remove a sample of nerve for testing

Your healthcare provider will figure out the best treatment for you based on:

  • How old you are
  • Your overall health and past health
  • How sick you are
  • How well you can handle specific medicines, procedures, or therapies
  • How long the condition is expected to last
  • Your opinion or preference

The goal of treatment is to ease pain and discomfort. It’s also important to prevent more tissue damage. Treatment may include:

  • Pain medicines
  • Antidepressants that act on the nervous system to ease pain and discomfort
  • Creams you apply to the skin
  • Transcutaneous electronic nerve stimulation (TENS) therapy
  • Hypnosis
  • Relaxation training
  • Biofeedback
  • Acupuncture
  • Special shoes to give extra protection to your feet to avoid injuries

Treatment may also be prescribed for complications of neuropathy. This could be GI (gastrointestinal) problems, dizziness and weakness, and urinary or sexual problems.

Bladder problems

One complication of neuropathy can happen when the bladder becomes paralyzed.  When this happens, the nerves of the bladder no longer respond normally as the bladder fills with urine. As a result, urine remains in the bladder, leading to urinary tract infections.

Erectile dysfunction

Neuropathy may cause erectile dysfunction (ED) when it affects the nerves that control erection. However, the desire for sex does not usually fall.


Diarrhea may happen when the nerves that control the small intestine are damaged. The diarrhea happens mostly at night. Constipation is another result of damage to nerves in the intestines.

Sometimes, the stomach is also affected. It may lose the ability to move food easily through the digestive system. This causes vomiting and bloating and is called gastroparesis. It changes how fast the body absorbs food. It can make it more difficult to match insulin doses to food portions.


Dizziness and fainting can happen when the nerves to the heart no longer assist in maintaining adequate blood pressure with changes in posture.


Vision can also be affected by retinopathy. This begins with changes in blood vessels of the retina. This affects the light-sensitive tissues at the back of the eye. In some cases, the blood vessels can swell or leak fluid. In other cases, there is abnormal growth of new blood vessels on the surface of the retina. Over time, this can lead to vision loss and blindness. 

Your eye healthcare provider may treat retinopathy by using a laser to make tiny burns. These burns seal the blood vessels and stop them from growing and leaking.

Hypoglycemia unawareness

You may lose the protective warnings signals of low blood sugar, such as nervousness and shakiness.

  • Diabetic neuropathy is nerve damage due to diabetes.
  • Nerve problems can develop within the first 10 years after being diagnosed with diabetes. The risk of developing neuropathy grows the longer you have diabetes. About half of people with diabetes have some form of nerve damage.
  • Common symptoms of diabetic neuropathy include numbness in the hands or feet, and pain in the hands, feet, or legs. Problems with internal organs, such as the digestive tract, heart, sex organs, or your eyes may also happen.
  • If you have high blood sugar or diabetes, see a healthcare provider who specializes in diabetes and its complications.

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your provider if you have questions.


January 16, 2018


Standards of Medical Care in Diabetes. American Diabetes Association. Diabetes Care. 2016;39(1):s1-112., Clinical manifestations and diagnosis of diabetic polyneuropathy. UpToDate, Diabetic neuropathies. Endotext

Reviewed By:  

Hurd, Robert MD,Walton-Ziegler, Olivia, MS, PA-C