Diabetic neuropathy is nerve damage associated with diabetes. It can occur after years of high glucose, but risk is also influenced by blood pressure, cholesterol, smoking, weight, duration of diabetes and individual predisposition.
The best-known form affects the feet: tingling, numbness, burning, pain or altered sensation. Sometimes the problem is not pain, but its absence: a small wound can go unnoticed.
Early signs worth discussing
- tingling or pins and needles in the soles;
- burning, especially in the evening or at night;
- numbness, cold feet or reduced sensation;
- pain from a light touch;
- cramps, imbalance or a feeling that you cannot sense the ground properly;
- calluses, wounds, cracks or infections that heal poorly.
These symptoms are not always caused by diabetes. Vitamin deficiencies, spine, circulation or thyroid problems, or other causes, may be involved. However, if you have diabetes, they need assessment.
Why glucose control matters
Long-term high glucose can damage small vessels and nerves. Monitoring HbA1c, glucose and hypoglycaemic episodes helps guide treatment adjustments. For context, see the article on HbA1c and the guide to glucose before and after meals.
It is not only about sugar. Blood pressure, smoking, cholesterol and weight affect vascular risk. A good diabetes plan therefore includes several goals, not just “lower glucose”.
Foot care is not optional
If sensation decreases, check your feet daily. Look for redness, blisters, cuts, ingrown nails, pressure areas or colour changes. Wear comfortable footwear and avoid walking barefoot if you have neuropathy or a risk of injuries. Trim nails carefully and seek medical help for difficult calluses rather than treating them aggressively at home.
A small wound can become serious when neuropathy and poor circulation are present. Signs of infection, discharge, an unpleasant smell, fever, spreading redness or new pain require prompt assessment.
What can be done at a consultation?
The doctor can examine sensation, foot pulses, skin, reflexes and footwear. They may recommend tests, adjustment of diabetes treatment, vascular assessment, neurology, podiatry or treatment for neuropathic pain. Do not take neuropathic pain medicines without a consultation, especially with kidney disease, drowsiness, other medicines or a risk of falling.
To improve glucose control and meals, you can start with an online diabetes consultation. If you also have excess weight, see the article on sleep apnoea, obesity and diabetes, because sleep can affect metabolic control.
Long-term prevention
Prevention includes individualised glucose control, stopping smoking, safe physical activity, treatment of blood pressure and cholesterol, balanced nutrition and regular checks. Exercise is useful, but with loss of sensation you need suitable footwear and foot checks after activity.
If you do not know where to start, also read about after-meal exercise and glucose, then discuss with the doctor which activity suits you.
What to monitor at home
A simple routine can prevent major problems: check your soles in the evening, look between your toes, notice red areas caused by footwear and record any wound that does not heal. If you cannot see the sole easily, use a mirror or ask for help. Moisturise dry skin, but avoid too much cream between the toes, where moisture can promote irritation.
Do not test hot water with your foot if sensation is reduced. Do not use corrosive corn plasters without advice. Do not ignore an ingrown nail or a crack because “it does not hurt”. In neuropathy, no pain does not mean no risk.
Nutrition and neuropathy
Nutrition does not repair nerves overnight, but helps address factors that sustain risk: glucose, weight, cholesterol and blood pressure. Regular meals, fibre and enough protein can reduce large glucose fluctuations. If vitamin B12 deficiency or other problems are present, they need targeted treatment rather than randomly chosen supplements.
