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Diabetic neuropathy

Diabetic neuropathy is nerve damage caused by diabetes. Over time, high blood sugar can damage nerves throughout your body. Diabetic neuropathy can lead to serious foot problems and, in time, to problems like dizziness, diarrhea or constipation, sexual problems, bladder infections, and vision problems.

The older you get, and the longer you have diabetes, the more likely you are to have nerve damage. Controlling your blood sugar can help keep neuropathy from getting worse.

  • Symptoms

    What are the symptoms of diabetic neuropathy?

    Your symptoms depend on which nerves are injured. You may not be able to feel pain, especially in your feet. This can lead to serious infections, because sores or other problems may not get treated.

    Other symptoms may include:

    • Problems with digestion, like bloating, belching, constipation, nausea and vomiting, diarrhea, and belly pain.
    • Problems with body temperature, like heavy sweating at night or when you eat certain foods. You may have reduced sweating, especially in your feet and legs.
    • Problems with urination, such as having trouble knowing when your bladder is full or finding it hard to empty your bladder completely.
    • Sexual problems, such as erection problems in men and vaginal dryness in women.
    • Heart and blood vessel problems that can lead to poor circulation or low blood pressure. This may cause dizziness, weakness, or fainting when you stand or sit up from a reclining position.
    • Trouble sensing when your blood sugar is low.
  • Causes

    What causes diabetic neuropathy?

    Over time, high blood sugar levels from diabetes can damage nerves throughout your body. The higher your blood sugar levels, the more likely you are to have nerve damage.

    Also, the older you get and the longer you have diabetes, the more likely you are to have nerve damage. People with diabetes who drink too much alcohol are also more likely to have nerve damage.

  • Diagnosis

    How is diabetic neuropathy diagnosed?

    During a physical exam, your doctor may check how well you can feel light touch, temperature, pain, vibration, and movement. Your doctor may also check your strength and reflexes. Tests such as an electromyogram and nerve conduction studies may be done to confirm the diagnosis. You may need other tests to see which type of neuropathy you have and to help guide your treatment.

    Doctors can't test for all types of nerve damage. So it's important to tell your doctor about any pain or weakness you feel. Also mention heavy sweating or dizziness and any changes in digestion, urination, and sexual function.

  • Prevention

    How can you prevent diabetic neuropathy?

    Keeping your blood sugar levels in your target range recommended by your doctor may help prevent diabetic neuropathy. The best way to do this is by checking your blood sugar and adjusting your treatment. It's also important to get to and stay at a healthy weight by exercising and eating healthy foods.

  • Treatment

    How is diabetic neuropathy treated?

    Treatment for diabetic neuropathy involves keeping blood sugar levels in your target range. This will not cure nerve damage. But it can help keep the damage from getting worse. And it may help relieve pain.

    It helps to have healthy habits, such as seeing your doctor regularly, controlling your blood pressure, eating a balanced diet, exercising regularly, not smoking, and limiting or avoiding alcohol.

    Other treatments depend on your symptoms. They may include:

    • Medicines to treat pain, digestive problems, or blood vessel problems.
    • Medicines or the use of compression stockings to treat blood pressure problems.
    • Treatments for sexual problems. Medicines or devices may help improve erections. Or lubricating creams may help vaginal dryness.
    • A splint or brace to help treat a nerve problem.

    When you have diabetes, you could have a sore or other foot problem without noticing it. So check your feet every day. An untreated problem on your foot can lead to a serious infection or even amputation.

    Work together with your doctor to find the treatment that helps you the most.

    Treatment if the condition gets worse

    If diabetic neuropathy gets worse, you may have serious problems such as severe gastroparesis, bladder infections, or foot problems. Along with keeping your blood sugars in your target range and taking good care of your feet, you may need more treatment.

    Diabetic neuropathy is a major risk factor for foot infections or foot ulcers. This may lead to amputation. It is possible to have permanent damage in one or both of your feet (such as Charcot foot) from diabetic neuropathy. Surgery is sometimes needed to repair deformed joints that can result from Charcot foot.

    Severe bladder infections or other bladder problems may require more testing and treatment. This includes medicines or surgery to improve bladder function.

    Also, it is common to have symptoms of depression with any long-term (chronic) disease. Getting help for depression may improve your overall well-being and help you treat your condition.

  • When to call

    Diabetic neuropathy: When to call

    Call your doctor now or seek immediate medical care if:

    • You have symptoms of infection, such as:
      • Increased pain, swelling, warmth, or redness.
      • Red streaks leading from the area.
      • Pus draining from the area.
      • A fever.
    • You have new or worse numbness, pain, or tingling in any part of your body.

    Watch closely for changes in your health, and be sure to contact your doctor if:

    • You have a new problem with your feet, such as:
      • A new sore or ulcer.
      • A break in the skin that is not healing after several days.
      • Bleeding corns or calluses.
      • An ingrown toenail.
    • You do not get better as expected.
  • Care

    How can you care for diabetic neuropathy?

    • Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine. It is very important that you take your insulin or diabetes pills as your doctor tells you.
    • Try to keep blood sugar at your target level.
      • Eat a variety of healthy foods, with carbohydrate spread out in your meals. A dietitian can help you plan meals.
      • Try to get at least 30 minutes of exercise on most days.
      • Check your blood sugar as many times each day as your doctor recommends.
    • Take and record your blood pressure at home if your doctor tells you to. Learn the importance of the two measures of blood pressure (such as 130 over 80, or 130/80). To take your blood pressure at home:
      • Ask your doctor to check your blood pressure monitor to be sure it is accurate and the cuff fits you. Also ask your doctor to watch you to make sure that you are using it right.
      • Do not use medicine known to raise blood pressure (such as some nasal decongestant sprays) before taking your blood pressure.
      • Avoid taking your blood pressure if you have just exercised or are nervous or upset. Rest at least 15 minutes before you take a reading.
    • Take pain medicines exactly as directed.
      • If the doctor gave you a prescription medicine for pain, take it as prescribed.
      • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
    • Do not smoke. Smoking can increase your chance for a heart attack or stroke. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
    • Limit alcohol to 2 drinks a day for men and 1 drink a day for women. Too much alcohol can cause health problems.
    • Eat small meals often, rather than 2 or 3 large meals a day.

    To care for your feet

    • Prevent injury by wearing shoes at all times, even when you are indoors.
    • Do foot care as part of your daily routine. Wash your feet and then rub lotion on your feet, but not between your toes. Use a handheld mirror or magnifying mirror to inspect your feet for blisters, cuts, cracks, or sores.
    • Have your toenails trimmed and filed straight across.
    • Wear shoes and socks that fit well. Soft shoes that have good support and that fit well (such as tennis shoes) are best for your feet.
    • Check your shoes for any loose objects or rough edges before you put them on.
    • Ask your doctor to check your feet during each visit. Your doctor may notice a foot problem you have missed.
    • Get early treatment for any foot problem, even a minor one.

    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.