Diabetic Peripheral Neuropathy

What Is Peripheral Neuropathy?

Peripheral neuropathy refers to damage or dysfunction of the peripheral nerves, which are responsible for sending messages between the brain, spinal cord, and the rest of the body. This condition can affect sensation, movement, and organ function, depending on the type of nerves involved.

There are over 100 types of peripheral neuropathy, each with its own set of symptoms and causes. It can develop suddenly or progress slowly over time.

Who Is Affected?

• More than 20 million people in the U.S. are estimated to have some form of peripheral neuropathy.
• It commonly affects older adults, especially those over age 50.
• People with diabetes, autoimmune conditions, or nerve injuries are at higher risk.

What Causes Peripheral Neuropathy?

Peripheral neuropathy can be caused by injury, disease, infection, or exposure to toxins. Common causes include:

• Diabetes (the most common cause in the U.S.)
• Alcoholism
• Vitamin deficiencies (especially B1, B6, B12, and E)
• Infections (e.g., shingles, Lyme disease, HIV)
• Autoimmune diseases (e.g., lupus, rheumatoid arthritis)
• Certain medications (e.g., chemotherapy, antibiotics)
• Inherited disorders like Charcot-Marie-Tooth disease
  
  

Risk Factors

Not Controllable

• Age: Risk increases with age
• Genetic predisposition
• Family history of neuropathic disorders
• Chronic conditions like cancer or kidney disease
  
  

Controllable

• Uncontrolled diabetes
• Alcohol use
• Poor nutrition
• Exposure to toxins
• Injury or repetitive motion
  
  

Who Is Most at Risk?

You may be at increased risk if you:

• Have long-term diabetes
• Drink excessive alcohol
• Have undergone chemotherapy
• Live with an autoimmune disease
• Work in an environment with exposure to chemicals or heavy metals
  
  

How to Reduce Your Risk

• Manage blood sugar levels if you have diabetes
• Limit alcohol consumption
• Eat a balanced, nutrient-rich diet
• Exercise regularly to improve circulation
• Protect hands and feet from injury

Common Symptoms of Peripheral Neuropathy

Symptoms depend on which nerves are affected—sensory, motor, or autonomic—and may include:

• Tingling or “pins and needles” in the hands or feet
• Burning, stabbing, or shooting pain
• Numbness or reduced ability to feel temperature or touch
• Muscle weakness or cramps
• Loss of coordination or balance
• Sensitivity to touch
• Digestive problems, low blood pressure, or sexual dysfunction (autonomic nerve involvement)

How Is Peripheral Neuropathy Diagnosed?

Diagnosis is based on symptoms, physical exams, medical history, and specialized tests.

Common Diagnostic Tests

• Neurological exam: Reflexes, muscle strength, and coordination
• Blood tests: Check for vitamin deficiencies, diabetes, infections, or autoimmune disorders
• Electromyography (EMG) and nerve conduction studies: Assess nerve and muscle function
• Imaging (MRI or CT scan): Rule out tumors or herniated discs
• Nerve biopsy: Rarely used to confirm diagnosis
• Skin biopsy: May detect small fiber neuropathy

How Is Peripheral Neuropathy Treated?

Treatment depends on the cause and severity. The main goals are to address the underlying cause, relieve symptoms, and prevent further nerve damage.

Lifestyle Changes

• Manage underlying conditions like diabetes or autoimmune diseases
• Improve diet with essential nutrients (B vitamins)
• Regular exercise to improve strength and circulation
• Quit smoking and limit alcohol
  
  

Medical Treatments

• Pain relievers (NSAIDs for mild pain)
• Prescription medications for nerve pain:
• Antidepressants (e.g., amitriptyline, duloxetine)
• Anticonvulsants (e.g., gabapentin, pregabalin)
• Topical treatments (lidocaine patches or capsaicin cream)
  
  

Devices

• TENS (transcutaneous electrical nerve stimulation) for pain relief
• Orthopedic braces or footwear for foot drop or balance problems
  
  

Surgical Options

• Surgical decompression (rare): May be used for nerve entrapment, like carpal tunnel syndrome
  
  

Other Therapies

• Physical and occupational therapy
• Acupuncture
• Biofeedback and massage therapy

When to Seek Care

When to See a Doctor

Make an appointment if you experience:

• Persistent numbness, tingling, or weakness
• Pain that disrupts sleep or daily activities
• Balance problems or frequent falls
• Symptoms that worsen over time
  
  

When to Call 911

Seek emergency care if:

• Sudden onset of severe numbness or weakness
• Loss of bladder or bowel control
• Signs of autonomic crisis, such as dangerously low blood pressure or irregular heartbeat
  
  

What Should You Do Next?

• Schedule an appointment with a neurologist or primary care provider
• Track your symptoms and discuss changes at your next visit
• Get screened for underlying conditions like diabetes or vitamin deficiencies
• Begin a treatment plan that includes both medical and lifestyle approaches
• Explore support groups and resources for people with chronic nerve conditions