Diabetic Neuropathy: Symptoms, Types, Causes & Treatment

Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: September 2026

TL;DR

Diabetic neuropathy is nerve damage caused by long-term high blood sugar, and it affects up to half of all people with diabetes. It most often starts in the feet and legs with burning, tingling, and numbness that tend to be worse at night. There are four main types — peripheral, autonomic, proximal, and mononeuropathy — each affecting different nerves and causing different symptoms. There is no cure, but tight blood sugar control is the single most effective way to slow or prevent damage, and several prescription medicines can ease nerve pain. Daily foot care is critical because lost sensation can turn a minor cut into a serious infection.

Quick Answer: What Is Diabetic Neuropathy?

• Diabetic neuropathy is a type of nerve damage caused by diabetes, most often affecting the nerves in the legs and feet.

• It may affect up to half of people who have diabetes, making it one of the most common diabetes complications.

• There are four main types: peripheral, autonomic, proximal, and mononeuropathy — and you can have more than one.

• The primary cause is long-term uncontrolled high blood sugar, which damages nerves and the small blood vessels that feed them.

• Symptoms usually appear slowly over time, so many people do not notice them until significant nerve damage has occurred.

• There is no known cure, but treatment focuses on slowing progression, relieving pain, and managing complications.

• Good blood sugar control may prevent or delay it — and may even improve some current symptoms.

What Is Diabetic Neuropathy, Exactly?

Diabetic neuropathy is a type of nerve damage that can happen with diabetes. Blood sugar — also called glucose — becomes high because of diabetes. Over time, that high blood sugar can injure nerves throughout the body.

The condition most often damages the nerves in the legs and feet, but depending on which nerves are affected, it can also cause problems with the digestive system, urinary tract, blood vessels, and heart. Some people have mild symptoms. For others, diabetic neuropathy can be painful and disabling.

This is a serious health concern: diabetic neuropathy may affect up to half of people who have diabetes. But the good news is that it often can be prevented, and people who already have it can take steps to keep it from getting worse. The key is to tightly manage blood sugar and lead a healthy lifestyle.

What Does Diabetic Neuropathy Feel Like? (Symptoms by Type)

There are four main types of diabetic neuropathy. You can have one type or more than one. Symptoms depend on the type you have and which nerves are affected, and they usually appear slowly over time — you may not notice anything is wrong until a lot of nerve damage has happened.

Peripheral Sensorimotor Neuropathy (Most Common)

This type is also called distal symmetric peripheral neuropathy. It is the most common form of diabetic neuropathy. It affects the feet and legs first, followed by the hands and arms, and symptoms are often worse at night. They may include:

• Loss of feeling (numbness), or less ability to feel pain or temperature changes

• A tingling or burning feeling

• Sharp pains or cramps

• Muscle weakness

• Extreme sensitivity to touch — for some people, even the weight of a bedsheet is painful

• Serious foot problems, such as ulcers, infections, and bone and joint damage

Autonomic Neuropathy

The autonomic nervous system controls blood pressure, heart rate, sweating, pupils, bladder, digestive system, and sex organs. Diabetes can affect nerves in any of these areas, causing symptoms such as:

• A lack of the usual warning symptoms of low blood sugar — called hypoglycemia unawareness

• Blood pressure drops when rising from sitting or lying down — called orthostatic hypotension — which can cause dizziness or fainting

• A fast-beating heart while at rest

• Bladder or bowel problems

• Slow stomach emptying (gastroparesis), which can cause upset stomach, vomiting, fullness, and loss of appetite

• Trouble swallowing

• Changes in how the eyes adjust from light to dark, or far to near

• More or less sweating than usual

• Problems with sexual response, such as vaginal dryness, trouble becoming aroused, or trouble getting or keeping an erection

Proximal Neuropathy

Also called diabetic polyradiculopathy, this type often affects nerves in the thighs, hips, buttocks, or legs, and it can affect the stomach and chest areas. Symptoms are often on one side of the body, and rarely spread to the other side. They may include serious pain in the buttock, hip, or thigh; weak and shrinking thigh muscles; trouble rising from a sitting position; and pain in the chest or the walls of the stomach area.

Mononeuropathy (Focal Neuropathy)

This type damages a single, specific nerve in the face, torso, arm, or leg. It can affect single nerves in different parts of the body at the same time. Symptoms may include trouble focusing or seeing double vision; paralysis of one side of the face; numbness or tingling in the hand or fingers; hand weakness that causes dropping things; shin or foot pain; weakness that makes it hard to lift the front part of the foot (foot drop); and pain in the front of the thigh.

• Peripheral sensorimotor — Also Called: Distal symmetric peripheral neuropathy; Nerves Affected: Feet and legs first, then hands and arms; Key Symptoms: Numbness, burning, tingling, sharp pain, extreme touch sensitivity, foot ulcers; worse at night

• Autonomic — Nerves Affected: Nerves controlling blood pressure, heart, digestion, bladder, sweating, sex organs; Key Symptoms: Hypoglycemia unawareness, dizziness on standing, gastroparesis, bladder problems, sweating changes

• Proximal — Also Called: Diabetic polyradiculopathy; Nerves Affected: Thighs, hips, buttocks, legs, sometimes stomach/chest; Key Symptoms: Severe hip/thigh pain, weak shrinking thigh muscles, trouble rising from sitting

• Mononeuropathy — Also Called: Focal neuropathy; Nerves Affected: A single specific nerve (face, eye, hand, leg); Key Symptoms: Double vision, facial paralysis, hand weakness, foot drop, shin pain

When Should You See a Doctor?

Call your healthcare professional for a checkup if you have any of the following:

• A cut or sore on your foot that is infected or won't heal

• Burning, tingling, weakness, or pain in your hands or feet that makes daily activities or sleep difficult

• Changes in digestion, urination, or sexual function

• Dizziness and fainting

• Infected or non-healing foot sore: Lost sensation means a minor cut can become a serious ulcer unnoticed

• Burning, tingling, or pain that disrupts sleep or daily life: Suggests active nerve damage that needs assessment

• Changes in digestion or urination: May signal autonomic nerve damage affecting internal organs

• Dizziness or fainting on standing: Can indicate blood pressure control problems from nerve damage

Screening Before Symptoms Appear

Tests can check for diabetic neuropathy before you have any symptoms. These are called screening tests, and they can find problems early, when they are easier to treat. The American Diabetes Association recommends that screening for diabetic neuropathy start right after you learn you have type 2 diabetes, or five years after a type 1 diabetes diagnosis — and then continue once a year.

What Causes Diabetic Neuropathy?

The exact cause of each type of neuropathy is unknown. Researchers think that over time, uncontrolled high blood sugar damages nerves and interferes with their ability to send signals, and this process may lead to diabetic neuropathy.

High blood sugar also weakens the walls of the small blood vessels — called capillaries — that supply the nerves with oxygen and nutrients. When nerves are starved of oxygen and nutrients, they lose their ability to function normally.

What Increases Your Risk of Diabetic Neuropathy?

Anyone who has diabetes can get diabetic neuropathy, but certain risk factors make nerve damage more likely.

• Poor blood sugar control: Uncontrolled high blood sugar raises the risk of every diabetes complication, including nerve damage

• Longer history of diabetes: Risk rises the longer you have diabetes, especially with poor blood sugar control

• Kidney disease: Diabetes can damage the kidneys, and toxins in the blood can then cause nerve damage

• Being overweight (BMI of 25 or more): Higher body mass index may raise the risk of nerve damage

• Smoking: Narrows and hardens arteries, lowering blood flow to the legs and feet, making wounds harder to heal and damaging peripheral nerves

• High blood pressure and high cholesterol: Both are linked with a higher risk of diabetic neuropathy

What Complications Can Diabetic Neuropathy Cause?

Diabetic neuropathy can cause serious medical conditions. Understanding them explains why early detection and daily management matter so much.

• Hypoglycemia unawareness: Blood sugar below 70 mg/dL (3.9 mmol/L) normally causes shakiness, sweating, and a fast heartbeat — but autonomic neuropathy can erase these warnings

• Loss of a toe, foot, or leg: Lost feeling means minor cuts become sores or ulcers unnoticed; infection can spread to bone or cause tissue death, requiring amputation without fast treatment

• Urinary problems: A damaged bladder may not empty fully, allowing bacteria to build up (urinary tract infections), or cause leakage (incontinence)

• Sharp drops in blood pressure: Damaged blood-flow control nerves cause pressure to drop when standing, leading to lightheadedness and fainting

• Digestive problems: Nerve damage in the digestive tract causes constipation, diarrhea, or gastroparesis (stomach emptying too slowly or not at all)

• Sexual conditions: Nerves affecting the sex organs are often damaged, causing vaginal dryness, arousal problems, or erectile dysfunction

• Sweating changes: Disrupted sweat glands make it hard for the body to control its temperature

How Is Diabetic Neuropathy Diagnosed?

To determine whether you have diabetic neuropathy, your healthcare professional starts with a physical exam and questions about your symptoms and medical history. During the exam, they most often check your overall muscle strength and tone, the reflexes of your muscles and tendons, and how sensitive you are to touch, pain, temperature, and vibration.

Along with the exam, certain tests can help confirm whether or not you have diabetic neuropathy.

• Filament testing: A soft nylon fiber (monofilament) is brushed over your skin to check touch sensitivity

• Sensory testing: How your nerves respond to vibration and temperature changes

• Nerve conduction testing: How quickly the nerves in your arms and legs conduct electrical signals

• Electromyography (EMG, needle testing): Electrical activity in your muscles, usually done with nerve conduction studies

• Autonomic testing: How blood pressure and heartbeat change in different positions, and whether sweating is within the standard range

How Is Diabetic Neuropathy Treated?

Diabetic neuropathy has no known cure. The goals of treatment are to slow the disease from getting worse, relieve pain, manage health issues linked with diabetic neuropathy, and help the affected body parts work better.

Slowing the Disease: Blood Sugar Control

The key way to prevent or delay nerve damage is to keep your blood sugar within your target range. Good blood sugar control may even improve some of your current symptoms.

In general, the American Diabetes Association recommends these target blood sugar levels for most people with diabetes:

• Before meals: 80–130 mg/dL (4.4–7.2 mmol/L)

• Two hours after meals: Less than 180 mg/dL (10.0 mmol/L)

• A1C (average over 2–3 months): 7.0% or lower

Some healthcare professionals recommend slightly different before-meal targets based on age and other conditions: between 80 and 120 mg/dL (4.4–6.7 mmol/L) for people age 59 and younger with no other conditions, and between 100 and 140 mg/dL (5.6–7.8 mmol/L) for people age 60 and older or those with heart, lung, or kidney disease.

Other ways to help slow or prevent neuropathy from worsening include keeping blood pressure under control, staying at a healthy weight, and getting regular physical activity.

Relieving Pain: Prescription Medicines

Many prescription medicines are available for diabetes-related nerve pain, but they don't work for everyone.

• Anti-seizure medicines — Examples: Pregabalin (Lyrica), gabapentin (Gralise, Neurontin); Notes: ADA recommends starting with pregabalin; side effects include drowsiness, dizziness, and hand/foot swelling

• Tricyclic antidepressants — Examples: Amitriptyline, nortriptyline (Pamelor), desipramine (Norpramin); Notes: Help mild to moderate nerve pain; side effects include dry mouth, constipation, drowsiness, trouble focusing, and dizziness on standing

• SNRIs — Examples: Duloxetine (Cymbalta), venlafaxine (Effexor XR); Notes: ADA recommends duloxetine as a first treatment; side effects include nausea, sleepiness, dizziness, and constipation

• Topical lidocaine — Examples: Patches, creams, gels; Notes: Applied to the skin to block pain

• Combinations — Examples: Antidepressant + anti-seizure medicine, with or without OTC options; Notes: May be combined with OTC pain relievers such as acetaminophen (Tylenol)

If your healthcare professional recommends medicine, be sure to ask about the benefits and side effects.

Managing Complications and Restoring Function

Depending on your complications, you may need specialists — for example, a urologist for urinary tract problems or a cardiologist for heart-related conditions.

• Urinary tract problems: Change or stop medicines affecting the bladder; a strict urination schedule; gentle pressure below the bellybutton; a catheter to drain a nerve-damaged bladder

• Digestive problems (gastroparesis): Smaller, more frequent meals low in fiber and fat; diet changes and medicines for gastroparesis, diarrhea, constipation, and upset stomach

• Low blood pressure when standing: Plenty of water, physical activity, avoiding alcohol, slow position changes, sleeping with the head of the bed raised 4–6 inches, compression support (abdominal binder, compression shorts/stockings), and medicines

• Sexual challenges: Oral or injectable medicines for some men (not safe and effective for everyone); a vacuum construction device; vaginal lubricants for women

What Self-Care Steps Can You Take at Home?

Four daily measures can help you feel better overall and lower your risk of diabetic neuropathy.

Control your blood pressure. If you have high blood pressure and diabetes, you have an even higher risk of other medical problems. Keep blood pressure in your provider's recommended range and have it checked at every visit.

Make healthy food choices. Eat a balanced diet with a variety of vegetables, fruits, and whole grains, and limit portion sizes to reach or maintain a healthy weight.

Be active every day. Work up to 150 minutes of moderate aerobic exercise (or 75 minutes of vigorous exercise) per week, plus 2–3 sessions of strength training. Break from sitting every 30 minutes. Talk with your healthcare professional or a physical therapist first — if you have less feeling in your legs, walking with proper shoes is usually safe, and avoid putting weight on an injured foot.

If you smoke, quit. Tobacco in any form worsens blood flow in your feet and causes healing problems. Ask your healthcare professional about quit resources.

How Should You Care for Your Feet Every Day?

Foot problems are common with diabetic neuropathy — sores that don't heal and ulcers top the list. You can prevent many of these problems with good foot care at home, a thorough foot exam at least once a year, and having your feet checked at each office visit.

• 1. Check your feet every day: Look for blisters, cuts, bruises, cracked or peeling skin, redness, and swelling; use a mirror for hard-to-see areas

• 2. Keep feet clean and dry: Wash daily with lukewarm water and mild soap; don't soak; dry feet and between your toes thoroughly

• 3. Moisturize your feet: Prevents cracking — but keep lotion out from between the toes to avoid fungal growth

• 4. Trim toenails carefully: Cut straight across and file edges smooth; see a podiatrist if you can't do this yourself

• 5. Wear clean, dry socks: Choose cotton or moisture-wicking socks without tight bands or thick seams

• 6. Wear cushioned, well-fitting shoes: Closed-toed shoes or slippers with room for your toes; Medicare may cover one pair per year

• 7. Protect feet from heat: Wear shoes on hot pavement or at the beach; apply sunscreen to the tops of your feet if barefoot outdoors

• 8. Boost blood flow: Put your feet up while sitting; wiggle your toes and move your ankles throughout the day

Can Alternative Treatments Help Diabetic Neuropathy Pain?

Alternative treatments might help with pain relief, on their own or alongside medicines. Always check with your healthcare professional first — they need to make sure a treatment won't affect your main therapy or cause side effects.

• Capsaicin cream: Eases pain in some people when applied to the skin; can cause a burning feeling and skin irritation

• Alpha-lipoic acid: An antioxidant found in some foods; may relieve nerve pain symptoms in some people; discuss with your provider first

• Acetyl-L-carnitine: A body-made nutrient sold as a supplement; may ease nerve pain in some people; discuss with your provider first

• TENS (transcutaneous electrical nerve stimulation): Tiny electrical impulses through electrode stickers may prevent pain signals reaching the brain; safe and painless, but doesn't work for everyone or all pain types

• Acupuncture: Fine needles placed in the skin may relieve neuropathy pain, generally with no side effects; relief may not be immediate and you may need more than one session

How to Prepare for Your Appointment

Doctors who specialize in treating diabetes are called endocrinologists. If you show symptoms of diabetes complications, you'll likely be referred to one. For neuropathy symptoms, you may also see a neurologist — a specialist in brain and nervous system problems.

Before your appointment, ask how to get ready (you might be told to limit food and drink), list all your symptoms, note any major stresses or life changes, list every medicine and supplement with doses, bring a record of recent blood sugar levels, bring a family member or friend, and prepare a list of questions.

Useful questions to ask your provider include: Is diabetic neuropathy the most likely cause of my symptoms? Do I need tests to confirm the cause, and how do I prepare for them? If I manage my blood sugar, will my symptoms improve or go away? What treatments do you recommend? What side effects can I expect from treatment? I have other health conditions — how can I best manage them together? Are there printed materials or websites you recommend? Do I need a diabetes care and education specialist, a registered dietitian, or other specialists?

You can also expect your provider to ask how well you are managing your diabetes, when symptoms started, whether they come and go, how they affect daily life, and what seems to improve or worsen them.

Conclusion: Nerve Damage Is Serious — But Not Hopeless

Diabetic neuropathy is one of the most common and most serious complications of diabetes, affecting up to half of people with the condition. It can cause painful numbness, damage internal organs, and — in the worst cases — lead to amputation. But the picture is not hopeless: it is often preventable, and people who already have it can take meaningful steps to keep it from getting worse.

The single most important step is keeping your blood sugar in your target range. Add daily foot care, regular activity, smoking cessation, and good blood pressure control, and you put yourself in a strong position to protect your nerves.

Notice burning, tingling, or numbness in your hands or feet — or living with diabetes but never been screened for neuropathy? Talk to your healthcare professional about a screening test today. Early detection is the difference between reversible early damage and permanent nerve injury.

Frequently Asked Questions

What is the first sign of diabetic neuropathy?

The most common first sign is tingling, burning, or numbness in the feet (and later the hands), often worse at night. Some people also notice sharp pains, cramps, or extreme sensitivity to light touch.

What does diabetic neuropathy pain feel like?

People commonly describe it as burning, tingling, sharp or stabbing pain in the legs, feet, and hands. Some feel extreme sensitivity — even the weight of a bedsheet can be painful. Others lose sensation entirely, which is why numbness is just as dangerous as pain.

Can diabetic neuropathy be reversed or cured?

There is no known cure. However, good blood sugar control is the most effective way to prevent or delay nerve damage, and it may even improve some current symptoms.

Is diabetic neuropathy serious?

Yes. It can lead to serious complications including undetected foot ulcers that may require amputation, urinary tract infections, digestive problems, sharp blood pressure drops, and hypoglycemia unawareness.

How do doctors test for diabetic neuropathy?

Diagnosis starts with a physical exam checking muscle strength, reflexes, and sensitivity to touch, pain, temperature, and vibration. Confirming tests may include filament testing, sensory testing, nerve conduction studies, electromyography (EMG), and autonomic testing.

What are the best medications for diabetic neuropathy?

First-line options include the anti-seizure medicine pregabalin and the SNRI antidepressant duloxetine, both recommended by the American Diabetes Association. Gabapentin, tricyclic antidepressants (like amitriptyline), and lidocaine patches are also commonly used.

When should I screen for diabetic neuropathy?

The American Diabetes Association recommends screening start right after a type 2 diabetes diagnosis, five years after a type 1 diagnosis, and then once a year.

Does diabetic neuropathy affect the eyes?

Autonomic neuropathy can change the way the eyes adjust from light to dark and from far to near. Mononeuropathy can cause double vision or trouble focusing when it affects the nerves controlling eye movement.

References

1. Diabetic neuropathy — Symptoms & causes

2. Diabetic neuropathy — Diagnosis & treatment

Health information, not medical advice. This article is for general education and is not a substitute for professional diagnosis or treatment. Always consult a qualified healthcare provider about your own health, and seek emergency care for urgent symptoms.