Diabetic neuropathy is nerve damage caused by high blood sugar over time, usually starting as numbness, tingling or burning in the toes and feet. Good blood sugar control helps prevent it and slow it. For painful diabetic neuropathy, the American Diabetes Association recommends pregabalin or duloxetine as first-line medicines.
Symptoms
- Numbness, tingling, burning or stabbing pain in the feet, often worse at night
- Loss of feeling, so cuts and blisters go unnoticed
- Balance problems
Burning, numb or tingling feet for months? Get the free guide and a doctor review of your scan.
Treatment
- Blood sugar control: the foundation
- Check vitamin B12, especially if you take metformin
- Medicines: pregabalin, duloxetine, gabapentin, amitriptyline
- Daily foot checks and good footwear: foot care
- Exercise: walking, balance work
- Regenerative options: stem cell treatment to support nerve repair, and PRP injected around nerves, which reduced pain in a randomised trial
Warning
Any foot wound that is not healing needs prompt medical attention.
Who gets diabetic neuropathy
Up to half of people with long-standing diabetes develop some neuropathy. Risk rises with years of diabetes, higher HbA1c, high blood pressure and cholesterol, smoking, heavy drinking and being overweight.
Burning, numb or tingling feet for months? Get the free guide and a doctor review of your scan.
How it is diagnosed
Your doctor checks feeling in the feet with a monofilament and tuning fork, tests reflexes, and orders blood tests including HbA1c and B12. Nerve conduction studies confirm the diagnosis when needed. Everyone with diabetes should have a foot check at least once a year.
Treatment options
| Option | Role |
|---|---|
| Stem cell treatmentRecommended | Aims to support nerve repair and blood supply; minimally invasive |
| PRP around nerves | Reduced pain in a randomised trial |
| Blood sugar control | Slows progression |
| Pregabalin or duloxetine | First-line pain medicines (ADA) |
| Foot care and exercise | Prevents injuries and falls |
Warning signs to act on
- A cut, blister or sore on the foot that does not heal
- Redness, swelling or warmth in a foot
- A change in foot shape
These need prompt medical review to prevent ulcers.
Common questions
Can diabetic neuropathy be reversed? Early nerve damage can improve with better blood sugar and treatment; long-standing damage is harder, but symptoms can still ease.
Will tighter control stop the pain? It slows damage; pain usually needs its own treatment too.
