Conditions We Treat

Diabetic Peripheral Neuropathy

Diabetic Peripheral Neuropathy - APSM

What is Diabetic Peripheral Neuropathy?

Neuropathy is when nerve damage leads to pain, weakness, numbness or tingling in one or more parts of your body. The nerve damage may be because of disease, infection, injury, medicines, long-term alcohol abuse or another reason. 

There are four main types of diabetic-related neuropathy, including:

  • Peripheral neuropathy
  • Autonomic neuropathy
  • Radiculoplexus neuropathy
  • Mononeuropathy


Diabetic peripheral neuropathy is a type of nerve pain that involves the peripheral nervous system (PNS). The PNS includes all of the nerves that come from your spinal cord and spreads the nerves to the rest of your body. The central nervous system, on the other hand, is focused on your brain and spinal cord.

As with all types of neuropathy, people with diabetic peripheral neuropathy may not notice signs or symptoms of the condition until nerves are already damaged. Because of this, it’s important to keep a close eye on potential causes and early symptoms.

What causes Diabetic Peripheral Neuropathy?

Peripheral neuropathy can be caused by many conditions including:

  • Vitamin deficiencies
  • Alcoholism
  • Autoimmune diseases
  • Certain medications
  • Unknown causes
  • Diabetes


Poor blood sugar control related to diabetes is one of the more common causes of peripheral neuropathy. Excessive and fluctuating amounts of sugar in the blood injure the walls of the small blood vessels (capillaries), especially in your hands and feet, that supply your nerves. This destruction can cause nerve damage that may manifest as pain, numbness, or tingling. These symptoms usually begin in the toes and move towards the head.

What are the symptoms of Diabetic Peripheral Neuropathy?

When your peripheral nerves become damaged, they do not function properly and can eventually produce symptoms such as pain, tingling, or numbness.

Other diabetic peripheral neuropathy symptoms to look out for include:

  • Cramps
  • Hypersensitivity to touch
  • Weakness in the extremities, particularly the legs and feet
  • Poor reflexes
  • Poor balance and coordination
  • Increase in foot problems, such as infections or slow-healing wounds


Erectile dysfunction is also common in men with poorly controlled diabetes, as these blood vessels are damaged, too.

Another complication from the nerve damage produced by diabetes is neuropathy involving the gastrointestinal system. Damage to these nerves can cause problems with nausea, vomiting, diarrhea, or constipation. Postural hypotension, a form of low blood pressure that happens when standing up after sitting or lying down, and can cause dizziness or lightheadedness and possibly fainting, may also occur due to a progression of your peripheral neuropathy.

All of these symptoms – including pain – are usually located in the lower extremities and are often worse at night.

Diabetic peripheral neuropathy can be difficult to diagnose. A thorough medical history, as well as a neurological and physical exam can help rule out the possibility of other conditions. Certain lab tests may be ordered by your physician, as well, in order to rule out other potential causes of peripheral neuropathy, such as a vitamin B12 deficiency.

Other tools for diagnosis include:

  • Nerve conduction studies: Measures how quickly your nerves respond to electrical signals
  • Electromyography (EMG): Measures discharge of electricity from muscles
  • Filament test: Tests the sensitivity of your skin
  • Quantitative sensory testing: Evaluates how your nerves respond to vibration and temperature changes


It is important that you get a proper early diagnosis. If you have diabetes and are experiencing any of the above symptoms, talk to your doctor.


What are my treatment options for Diabetic Peripheral Neuropathy? 

Treating diabetic peripheral neuropathy is even more difficult than diagnosing it. While there is no cure for this condition, the goal of treatment is to relieve your symptoms and slow or stop the progression of nerve damage.

There are no quick fixes for diabetic peripheral neuropathy. Your physician may recommend several different approaches until you find which is most effective for you. Usually, you’ll use a variety of treatments to manage your symptoms. If left untreated, diabetic peripheral neuropathy is a serious complication of diabetes that can even result in amputation of the affected limb.

The most common treatment options for diabetic peripheral neuropathy are:

  1. Blood sugar control
  2. Exercise
  3. Foot care
  4. Supplements
  5. Biofeedback
  6. Acupuncture
  7. Over-the-counter pain relievers
  8. Membrane-stabilizing medications
  9. Other prescribed medications
  10. Transcutaneous electrical nerve stimulation (TENS)
  11. Spinal cord stimulation (SCS)


Blood sugar control

The first-line treatment for prevention of diabetic peripheral neuropathy is maintaining normal blood sugar levels. The main cause of peripheral neuropathy in people with diabetes is nerve damage caused by uncontrolled, wildly fluctuating blood glucose levels. Controlling your blood sugar is crucial to prevent further damage.

Besides diabetic peripheral neuropathy, diabetes also is a severe risk factor for cardiovascular disease, kidney disease, and retinopathy (affecting the eyes), so strict blood sugar control is crucial for preventing these and other diabetes-related complications.


Foot care

Foot care is not necessarily a treatment for diabetic neuropathy, but it can help diagnose the condition and monitor its progress.

If you are diabetic, you need to check your feet every day for cuts, blisters, swelling, and redness. Keeping feet clean and dry helps keep them healthy, as does applying a daily moisturizer and getting regular foot massages to increase circulation. Wearing good-fitting shoes and clean socks daily also helps.


Exercise is also extremely important in patients with diabetes.

In patients with newly-diagnosed Type 2 diabetes, diet, exercise, and weight loss can help prevent further complications and may even help avoid the need for further medication. In patients with Type 1 diabetes, who still require medication to manage their diabetes, regular exercise uses excess blood sugar for energy and also increases the body’s sensitivity to insulin.

Exercise also helps you maintain a better overall level of physical and mental health.

Nutritional and vitamin supplements

There are certain nutritional supplements that may help treat and prevent diabetic peripheral neuropathy. The more well-researched options include:

  • Alpha-lipoic acid
  • Acetyl-L-carnitine
  • Benfotiamine
  • Methylcobalamin
  • Topical capsaicin


Other potential nutritional supplements include vitamin E, glutathione, folate, pyridoxine, biotin, omega-3 and -6 fatty acids, L-arginine, L-glutamine, taurine, N-acetylcysteine, zinc, magnesium, chromium, and St. John’s wort.

Always talk to your doctor before taking any new supplements to ensure that they’ll be helpful in your case and won’t interact with any of your current medications.


Cognitive-behavioral therapies, such as biofeedback, may help to improve the quality of life in patients with neuropathic pain conditions, including diabetic peripheral neuropathy, according to studies on the psychological assessment and treatment of neuropathic pain conditions. 

Biofeedback is a non-invasive way to refocus on the body’s stress response. This can be helpful for patients with diabetes as they can recognize complications or symptoms of peripheral diabetic neuropathy.


Another treatment that may help reduce pain in patients with diabetic peripheral neuropathy is acupuncture.

There was a study in 2010 that discovered that two weeks of acupuncture completely relieved the pain and numbness of diabetic peripheral neuropathy. Another study involving acupuncture in the treatment of diabetic peripheral neuropathy found that 77% of patients had significant improvement in their symptoms, with 21% noting that their symptoms cleared completely. The study concluded that acupuncture is a safe and effective therapy for the long-term management of painful diabetic neuropathy.

Since there has been an increase in the diagnosis of Type 2 diabetes, researchers continue to study acupuncture as a safe, effective, and non-invasive treatment for the pain and numbness of diabetic peripheral neuropathy.

Over-the-counter pain relievers

Pain relievers, such as non-steroidal anti-inflammatory drugs (NSAIDs), may offer some pain relief.

However, there is concern about overuse and dependence, as well as organ damage and other side effects, it’s best to take these under your doctor’s supervision and primarily for acute pain episodes.

Membrane-stabilizing medications

Medications that calm irritated nerves are known as membrane-stabilizing medications. These medications can have a high rate of side effects, limiting their use. Because of this, these medications are best used in conjunction with other non-invasive treatment approaches and always under the supervision of your doctor.

Cymbalta, Elavil, Tramadol, and Neurontin are some of the medications that are particularly effective at treating nerve pain. These medications may relieve pain, but do not help to prevent the progression of the disease.

Other prescribed medications

Some patients also find symptom relief with anti-seizure drugs (e.g. pregabalin and gabapentin), while others find that antidepressants help by disrupting their brain chemistry. Both types of medications can come with significant side effects, so it’s important to talk to your doctor and ask about potential drug interactions.

Opioids are typically not the drug of choice when treating nerve pain and have not demonstrated effective relief of symptoms.

Transcutaneous electrical nerve stimulation (TENS)

Transcutaneous electrical nerve stimulation (TENS) uses a weak electrical current delivered to the spinal nerves to disrupt pain signals. Pain is replaced with a mild tingling sensation instead.

Since this is a non-invasive treatment approach, it can be used alongside medications or other interventions.

Spinal cord stimulation (SCS)

There has been some success treating patients with painful diabetic peripheral neuropathy using spinal cord stimulation (SCS).

With this treatment, leads are implanted next to the nerve roots in the spine and deliver a mild electrical current that disrupts pain signals. Think of it like a pacemaker for pain management. It can be a very effective long-term treatment for diabetic peripheral neuropathy (and other difficult-to-treat pain syndromes).

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