What is diabetic neuropathy?
Diabetic neuropathy is when diabetes causes damage to your nerves. It can affect different types of nerves in your body, including in your feet, organs and muscles.
Nerves carry messages between the brain and every part of our bodies so that we can see, hear, feel and move. They also carry signals to parts of the body such as the heart, making it beat at different speeds, and the lungs, so we can breathe.
Damage to the nerves can cause serious problems in different parts of the body for people with type 1, type 2 or other types of diabetes.
On this page we cover:
Causes of diabetic neuropathy
Types of diabetic neuropathy
Why can diabetic neuropathy be so painful
Screening for diabetic neuropathy
Treatment for diabetic neropathy
Can diabetic neuropathy be reversed?
Causes of diabetic neuropathy
Neuropathy is one of the long-term complications of diabetes.
Over time, high blood glucose levels, also known as blood sugar levels can damage the small blood vessels that supply the nerves in your body. This stops essential nutrients reaching the nerves. This means the nerve fibres can become damaged, and they may disappear. This can cause problems in many different parts of your body, depending on the type of nerve affected.
Types of diabetic neuropathy
There are four main types of diabetic neuropathy - see below.
People with the condition could have just one or any combination of the types.
Your healthcare team should tell you which areas are affected and give advice on what to do about any symptoms you are having. The type of treatment you need will depend on the type of neuropathy.
Diabetic peripheral neuropathy
Diabetic sensory neuropathy
Diabetic autonomic neuropathy
Diabetic motor neuropathy
Symptoms of diabetic neuropathy
The symptoms you have will depend on the type of nerves that have been damaged but more common symptoms include:
- altered sensation such as numbness, tingling or burning
- pain
- changes to normal body functions, like constipation or diarrhoea, bladder leaking or difficulty getting an erection
- weakness
- loss of reflexes.
You can read more about the symptoms of the four types of neuropathy below.
Diabetic neuropathy pain
Why can diabetic neuropathy be so painful?
The nerves carry chemical messages to and from the brain about what we can feel. When the nerves are damaged these messages can’t be sent properly which leads to a change in sensation or feeling. This can lead to feelings of numbness, tingling, burning, discomfort or shooting pains.
Sometimes these sensations can be worse at night. We’re not sure exactly why this is, but it could be to do with cooler temperatures in the evening, stress at the end of a long day and fewer distractions in the evening meaning you notice the pain more.
Living with any type of long-term pain, whether you can always feel it, or you regularly get periods of pain, can be very distressing. It can also have a negative impact on your mental health and general wellbeing. If you are having regular or frequent pain which you are struggling to cope with, you should contact your GP for advice and support. You can also contact our helpline or reach out on our forum.
Screening for diabetic neuropathy
Your doctor or diabetes nurse will screen you for the signs of diabetic neuropathy during your annual review.This will include:
- checking the feeling in your feet and your reflexes with special equipment
- checking blood fats, known as cholesterol, and blood pressure which can affect your risk of developing neuropathy
- asking questions about other symptoms you may be having.
But not all types of neuropathy are screened for, so it’s important that you talk to your GP about any new or worsened symptoms you are getting.
Treatment for diabetic neuropathy
There are many treatments available to relieve the symptoms caused by neuropathy.
This may include medication for feeling or being sick, painkillers for sensory neuropathy or treatment to help with erectile dysfunction.
There’s also ongoing research into whether the use of electrical stimulation (TENS - transcutaneous electrical nerve stimulation) can help in the treatment of diabetic neuropathy.
The treatment will depend on the type of nerves that have been damaged.
Keeping your diabetes well managed and your cholesterol and blood pressure within your target range can also help to improve the symptoms of neuropathy and help stop the nerve damage from getting worse.
Can diabetic neuropathy be reversed?
Sometimes neuropathy can get better over time if the cause is treated, but in some people the damage may be permanent or get worse over time. Often treatment for neuropathy is for the symptoms not the nerve damage itself.
Once the nerves have been badly damaged, they usually can’t repair themselves, but scientists continue to research how this damage happens and whether new treatments can help repair it. For example, our research has shown that chilli can help to treat foot complications.
How to prevent diabetic neuropathy
You can help avoid diabetic neuropathy by getting support to be physically active and eat a healthy balanced diet. Your diet should include all the essential vitamins and minerals, as these can help protect against, and repair early nerve damage.
Careful diabetes management including keeping your blood sugars as close to target as possible, and managing cholesterol and blood pressure can help protect the blood vessels that supply the nerves. It can also help improve your symptoms and prevent further damage if you already have some of the symptoms.
You should also check your feet every day and have your feet checked by a healthcare professional once a year. This is particularly important if you think you’ve lost the feeling in your feet. Speak to your diabetes healthcare team for advice if you think you’re developing any signs of neuropathy.
Diabetic peripheral neuropathy
Peripheral neuropathy is the most common type of neuropathy and is damage to the nerves outside the brain and spinal cord. It affects the nerves particularly in the feet and hands and can be motor neuropathy, sensory neuropathy or both. Nerves in your feet should be checked during your routine annual diabetes check-up.
For more information on peripheral neuropathy including treatment and symptoms, go to the NHS website.
Diabetic sensory neuropathy
Sensory neuropathy is damage to the nerves that tell us how things feel, smell and look. It affects the nerves that carry messages of touch, temperature, pain and other sensations from the skin, bones and muscles to the brain. It mainly affects the nerves in the feet and the legs, but people can also develop this type of neuropathy in their arms and hands.
The main concern of sensory neuropathy for someone with diabetes is loss of feeling in the feet, especially if you don’t realise that this has happened.
Loss of feeling is dangerous because you may not notice minor injuries, for example if you step on something sharp while barefoot or get a blister from badly-fitting shoes.
If ignored, minor injuries may develop into infections or ulcers. That's why it's important to look after your feet when you have diabetes.
Symptoms of sensory neuropathy in feet, legs, hands and arms
- tingling and numbness
- loss of ability to feel pain
- loss of ability to feel changes in temperature
- loss of coordination – when you can’t feel the position of your joints
- burning or shooting pains – these may be worse at night.
People with diabetes are more likely to be admitted to hospital with a foot ulcer than with any other diabetes complication.
If you have neuropathy, you’re more at risk of developing Charcot foot. This is one of the serious foot complications caused by diabetes. We've got more information about what causes Charcot foot, as well as how to treat and prevent it.
Diabetic autonomic neuropathy
Autonomic neuropathy is damage to the nerves that carry information to your organs and glands. They help to control functions we don’t even have to think about like your stomach emptying, how regularly your heart beats, and how your sexual organs work.
Examples of autonomic neuropathy:
- gastroparesis – when food can’t move through the digestive system efficiently. Symptoms of this can include bloating, constipation or diarrhoea.
- loss of bladder control, leading to not being able to control when you wee, called incontinence.
- irregular heart beats
- problems with sweating - either not being able to sweat properly and intolerance to heat, or sweating related to eating food, called gustatory sweating
- inability to keep an erection, also known as impotence
- dizziness when moving from lying down to standing up.
Motor neuropathy
Motor neuropathy affects the nerves that control movement. Damage to these nerves leads to weakness and wasting of the muscles that receive messages from the affected nerves.
Motor neuropathy symptoms
Nerve damage can lead to problems such as muscle weakness, and incoordination. This could cause falls or problems with doing tasks like fastening buttons, and muscles wasting where muscle tissue is lost because it’s less active. It can also lead to muscle twitching and cramps.
Getting help and support
If you are concerned about any aspect of managing diabetes, you can always call our helpline for support on 0345 123 2399. Alternatively, you can head over to our forum where there are many people willing to offer support and share their experiences of diabetes.
