These are all symptoms of peripheral nerve damage. It generally starts in the feet, usually in both feet at once. Sometimes amputation removal by surgery is necessary. Finding and treating foot problems early can lower your chances of developing a serious infection.

Learn how to care for your feet , including how to check them yourself and what kind of shoes to wear. Nerve damage can cause muscles in your digestive tract to slow down or stop working. Learn more about how diabetes can affect your digestion.

Autonomic nerve damage affects your heart, bladder, stomach, intestines, sex organs, or eyes. Symptoms may include:. Proximal nerve damage affects nerves in the thighs, hips, buttocks, or legs.

It can also affect the stomach and chest area. Focal nerve damage affects single nerves, most often in your hand, head, torso, or leg.

Keeping your blood sugar as close to your target range as possible is the best way to help prevent or delay nerve damage. Other things you can do are:. Most people with diabetes can prevent serious nerve damage complications. Stay on schedule with all of your self-checks, exams, and appointments with a diabetes care schedule.

Skip directly to site content Skip directly to page options Skip directly to A-Z link. Español Other Languages. Diabetes and Nerve Damage. Español Spanish. Minus Related Pages. Nerve damage can affect your hands, feet, legs, and arms.

Nerve Damage and Digestion. Risk Factors for Nerve Damage. Anyone with diabetes can develop nerve damage, but these factors increase your risk: Blood sugar levels that are hard to manage.

Having diabetes for a long time, especially if your blood sugar is often higher than your target levels. Being overweight. Being older than Foot examinations are described in detail separately. See "Patient education: Foot care for people with diabetes Beyond the Basics ".

Control pain — Neuropathic pain can be difficult to control and can seriously affect your quality of life. Neuropathic pain is often worse at night, seriously disrupting sleep.

Fortunately, only a small percentage of people with diabetic neuropathy experience pain. Pain resolves without treatment in some people over a period of weeks to months, especially if the episode of pain developed after a sudden change in health eg, an episode of diabetic ketoacidosis, a significant weight loss, or a significant change in blood glucose control.

There are several medications that are useful for the treatment of diabetic neuropathy and have been approved by the US Food and Drug Administration FDA , including duloxetine and pregabalin. Other medications are also useful, including tricyclic medications eg, amitriptyline , gabapentin, tramadol, and alpha-lipoic acid [ 5 ].

Tricyclic antidepressants — There are several tricyclic antidepressants available for the treatment of chronic pain, including amitriptyline, nortriptyline, and desipramine. Clinical trials have shown that tricyclic antidepressant drugs are effective for patients with painful diabetic neuropathy.

The dose of tricyclic antidepressants used to treat diabetic neuropathy is typically much lower than that used to treat depression. These medications are usually taken at bedtime, starting with a low dose and gradually increasing over a period of several weeks.

People with heart disease should not take amitriptyline or nortriptyline. Tricyclic medications can be taken with gabapentin and pregabalin but should not be taken with duloxetine. Side effects can include dry mouth, sleepiness, dizziness, and constipation.

Duloxetine — Duloxetine is an antidepressant that is often effective in relieving pain caused by diabetic neuropathy. In short-term clinical trials, duloxetine was more effective than placebo. However, the long-term effectiveness and safety of duloxetine for diabetic neuropathy is uncertain [ 6 ].

There are no trials comparing duloxetine with other drugs for the treatment of diabetic polyneuropathy. Duloxetine is usually taken by mouth once per day on a full stomach, although in some cases it is taken twice per day. It should not be taken by people who take other antidepressant medications see 'Tricyclic antidepressants' above.

Side effects can include nausea, sleepiness, dizziness, decreased appetite, and constipation. Gabapentin — Gabapentin is an anti-seizure medication.

It is usually taken by mouth three times per day. Side effects can include dizziness and confusion. Gabapentin can be taken with a tricyclic antidepressant or duloxetine. In some cases, gabapentin can be taken at night to prevent pain during sleep.

Pregabalin — Pregabalin is an anti-seizure medication, similar to gabapentin. Pregabalin is taken by mouth, starting at bedtime at a low dose and then gradually increasing to three times per day over a period of several weeks.

Side effects can include dizziness, sleepiness, confusion, swelling in the feet and ankles, and weight gain. It may be possible to become addicted to pregabalin, and changes in dosing should be monitored carefully.

Pregabalin can be taken with duloxetine or tricyclic antidepressants but not with gabapentin. Anesthetic drugs — Lidocaine is an anesthetic drug that may be recommended if other treatments have not improved pain. It is applied to the painful area in a patch, which slowly releases the medication over time.

Patches should stay in place for no more than 12 hours in any hour period. Alpha-lipoic acid — Alpha-lipoic acid ALA is an antioxidant medication. Several short-term trials showed that it was helpful in relieving pain caused by diabetic neuropathy.

Thus, ALA may be recommended to people with diabetic neuropathy who do not improve with or who cannot tolerate other treatments. However, longer-term studies are still needed to confirm its safety and effectiveness. In the United States, ALA is available without a prescription as a dietary supplement.

It is usually taken by mouth once per day. Your healthcare provider is the best source of information for questions and concerns related to your medical problem. This article will be updated as needed on our web site www.

Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below. Patient level information — UpToDate offers two types of patient education materials. The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition.

These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Patient education: Type 2 diabetes The Basics Patient education: Nerve damage caused by diabetes The Basics Patient education: The ABCs of diabetes The Basics Patient education: Neuropathic pain The Basics Patient education: Diabetes and infections The Basics.

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed.

These articles are best for patients who want in-depth information and are comfortable with some medical jargon. Patient education: Foot care for people with diabetes Beyond the Basics Patient education: Glucose monitoring in diabetes Beyond the Basics Patient education: Type 1 diabetes: Insulin treatment Beyond the Basics Patient education: Type 2 diabetes: Treatment Beyond the Basics.

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings.

These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Screening for diabetic polyneuropathy Diabetic autonomic neuropathy Diabetic autonomic neuropathy of the gastrointestinal tract Epidemiology and classification of diabetic neuropathy Evaluation of the diabetic foot Pathogenesis of diabetic polyneuropathy Management of diabetic neuropathy The following organizations also provide reliable health information.

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Font Size Small Normal Large. Patient education: Diabetic neuropathy Beyond the Basics. Formulary drug information for this topic. No drug references linked in this topic. Find in topic Formulary Print Share. Author: Eva L Feldman, MD, PhD Section Editor: Jeremy M Shefner, MD, PhD Deputy Editor: Richard P Goddeau, Jr, DO, FAHA Contributor Disclosures.

While there are many potential causes of peripheral neuropathy, uncontrolled diabetes is by far the most common. Having uncontrolled blood sugar for a long time can cause irreversible nerve damage, usually presenting most severely in the toes, feet, and legs, as well as the fingers, hands, and arms.

There are several lifestyle changes you can make to help manage your peripheral neuropathy symptoms. We list four of them here:. While nerve damage involved with peripheral neuropathy is irreversible, you can help prevent further damage and reduce your symptoms by keeping your blood sugar levels under control.

This might mean watching what you eat, using portion control, taking oral medications, or possibly injecting insulin.

Keeping moving can improve circulation and may be able to help you reduce neuropathy symptoms. Additionally, it may be able to lower your blood sugar. Try taking a short, but brisk, walk several times a day, and flex your hands and fingers frequently to keep blood moving.

During the winter, it can be more difficult to maintain feeling in the extremities due to the cold, and this can be especially true if you have peripheral neuropathy.

Make sure you keep your hands and feet warm by having proper protection. And if you get cold while sleeping, consider placing warm water bottles near you to help maintain warmth throughout the night.

A dangerous effect of diabetes and peripheral neuropathy is the fact that you may not notice small wounds to your extremities. If left untreated, these injuries can get infected and even result in the need for amputation. Make it a habit to wash and check your feet each night, and wear protective footwear.

Our providers can perform a thorough evaluation to ascertain the level of nerve damage and discuss your next steps.

Our Maryland offices are located in Hyattsville, Gaithersburg, Lanham, Dundalk, Oxon Hill, Rosedale, and Olney, and we have two offices in Baltimore.

You Might Also Enjoy You can have more than one type. Symptoms depend on the type of nerve damage you have and which nerves are affected.

Your feet may be very sensitive to touch—even a bed sheet can hurt. These are all symptoms of peripheral nerve damage. It generally starts in the feet, usually in both feet at once. Sometimes amputation removal by surgery is necessary. Finding and treating foot problems early can lower your chances of developing a serious infection.

Learn how to care for your feet , including how to check them yourself and what kind of shoes to wear. Nerve damage can cause muscles in your digestive tract to slow down or stop working. Learn more about how diabetes can affect your digestion.

Autonomic nerve damage affects your heart, bladder, stomach, intestines, sex organs, or eyes. Symptoms may include:. Proximal nerve damage affects nerves in the thighs, hips, buttocks, or legs.

It can also affect the stomach and chest area. Focal nerve damage affects single nerves, most often in your hand, head, torso, or leg. Keeping your blood sugar as close to your target range as possible is the best way to help prevent or delay nerve damage.

Other things you can do are:. Most people with diabetes can prevent serious nerve damage complications. Stay on schedule with all of your self-checks, exams, and appointments with a diabetes care schedule.

Skip directly to site content Skip directly to page options Skip directly to A-Z link. Español Other Languages. Diabetes and Nerve Damage. Español Spanish. Minus Related Pages.

Nerve damage can affect your hands, feet, legs, and arms. Nerve Damage and Digestion. Risk Factors for Nerve Damage. Anyone with diabetes can develop nerve damage, but these factors increase your risk: Blood sugar levels that are hard to manage.