Understanding Diabetes-Related Peripheral Neuropathy: Prevention, Detection, and Care for Long-Term Health

Talking about the long-term complications of diabetes can be scary, but it also empowers us to take charge of our health. Potential issues, such as problems with our feet, foot ulcers, and amputations, can be some of the scariest, but they aren’t by any means a given. By learning about neuropathy and the damage to nerves that causes these issues, we can better comprehend the underlying causes and the steps to reduce our risks. We will explore a particular type of neuropathy, diabetes-related peripheral neuropathy (DPN), and discuss how early detection and treatment are key. Through education and proactive measures, we can help reduce the risk of these complications and maintain a healthy, fulfilling life with diabetes.

What is Diabetes-Related Peripheral Neuropathy (DPN)?

The nervous system, made up of a network of nerves and nerve cells, is your body’s command center. It senses pain and controls movement and bodily functions such as digestion and breathing. The nervous system is also connected to the body’s endocrine and circulatory systems, including the heart and blood vessels. Some causes of nerve damage include alcohol overuse, vitamin deficiencies, and chemotherapy. However, diabetes is the most likely cause of nerve damage and neuropathy in those who live with diabetes. The American Diabetes Association reports that about half of those with diabetes will experience diabetes-related peripheral neuropathy (DPN) at some point in their lives. Autonomic neuropathy is another common form of diabetes-related nerve damage, affecting blood pressure, sexual function, and digestion.

DPN affects the smaller nerves in the legs and arms, known as the peripheral nervous system, impacting your hands and feet. DPN involving the feet is the most common form of neuropathy affecting people with diabetes. Having decreased feeling in your feet due to neuropathy puts you at greater risk for injuries to your feet. That is why taking steps to help reduce this risk is important. Loss of function in certain nerve fibers can change sensation and reduce strength in the foot. This, in turn, can lead to injury from shoes that don’t fit, stepping on sharp objects you can’t feel, or not knowing the sidewalk is too hot. Neuropathy can also lead to pain, burning, or other unpleasant sensations.

What Are The Signs And Symptoms Of DPN?

Nearly half of the damage to peripheral nerves can occur without symptoms. The most common early symptoms include:

• Burning
• Tingling
• Numbness
• Loss of sensation

If you do have any nerve-related signs or symptoms, make sure you discuss them with your diabetes care team as soon as possible to prevent bigger problems. Other symptoms of DPN may include sudden and severe pain in the hip, buttock, or thigh, along with weakness and loss of reflexes. Usually, symptoms of DPN start in the toes and progress upward. However, the sensations experienced with DPN differ from person to person. Some describe numbness or tingling, while others say they experience a sensation like burning. Others become sensitive to being touched and cannot bear the feeling of even a sheet covering their feet. Some report feeling like they are always wearing a sock or a glove.

DPN can lead to the loss of protective sensation, making it difficult to realize when a part of your body is hurting or injured. Even if you are still able to feel pressure (you know you are stepping on the ground with your foot), you may not be able to feel pain if you step on something hot or sharp. This is dangerous because you might not recognize the need to remove your foot from a damaging environment (like hot sand or stepping on a tack or nail). You may not be aware of the injury and thus do not take steps to protect your foot from further injury or to treat the injury.

The loss of normal pain sensation with DPN involving the feet can lead to greater skin and tissue damage. The resulting injury can lead to a foot ulcer, which, if it becomes infected, can lead to further tissue damage and amputation. Preventing, recognizing, and treating any symptoms of neuropathy is vital.

What Are The Risk Factors For DPN In The Hands And Feet?

The risk of developing DPN increases with:

• Age (more common with increasing age).
• Number of years since diabetes diagnosis (more common with longer diabetes duration). Diabetes, over time, can cause oxidative stress and chronic inflammation, contributing to further nerve damage. Glucose levels that remain elevated over time can damage the small nerves and the blood vessels in your body that bring nutrients and oxygen to your nerves. High blood pressure and abnormal levels of blood lipids (LDL cholesterol and triglycerides) over time may also increase the risk of DPN.
• Having excess weight or obesity.
• Smoking.
• Chronic kidney disease.

Are There Special Risk Factors For Women?

Hormonal fluctuations, metabolic changes, and higher incidence of obesity and autoimmune disorders in women can accelerate DPN onset. Women with diabetes are at increased risk for complications, including foot ulcers and infections due to unnoticed injuries.

What Are The Complications Of Untreated DPN?

If left unmanaged, DPN can lead to serious complications such as foot ulcers, infections, and amputations.

What Can I Do To Prevent Nerve Damage To The Limbs?

As with all diabetes complications, an ounce of prevention is worth a pound of cure. Getting and keeping your glucose levels, blood pressure, and blood lipid levels in a healthy target range can aid in the prevention of DPN. The well-known Diabetes Control and Complications Trial (DCCT) and its extended study, Epidemiology of Diabetes Interventions and Complications study (EDIC), showed that the prevalence of DPN was 64% lower among participants in the group who managed their blood glucose levels as close to target as possible. Comprehensive screenings are recommended, and you should always note and report any symptoms that may indicate nerve damage to your diabetes care team or podiatrist.

How Often Should I Be Screened For DPN?

Everyone with type 2 diabetes, and people who have had type 1 diabetes for 5 years or more, should have at least an annual comprehensive evaluation for DPN conducted by their healthcare provider.

For people who have a loss of sensation, a previous foot or leg ulcer or amputation, or for those with diabetes-related kidney disease, a comprehensive evaluation should be done at every diabetes-focused visit. Even if you don’t experience any signs or symptoms of neuropathy in your limbs, make sure your healthcare provider does annual (or more frequent) clinical checks. If not, ask for the checks to be done. These routine checks are recommended in the American Diabetes Association’s (ADA’s) Standards of Care chapter on retinopathy, neuropathy, and foot care: ADA’s Standards of Care.

What Should I Expect From The Annual Comprehensive Screening For Neuropathy?

For the foot exam, you will take off your socks and shoes so your healthcare professional can inspect your feet to check for color changes, pulses, open areas, redness, and rashes and assess the overall condition of your feet. As part of these clinical checks, your provider should assess for lack of sensation or numbness and adequate blood flow by:

• Feeling your skin temperature on your legs and feet.
• A tuning fork is used to check for diminished vibration sensation when the tuning fork is placed on different areas of the foot.
• A monofilament test uses a soft fiber to test for sensation in various parts of the feet and body. The monofilament test, as well as a pinprick test, can check to make sure you have good sensation.
• Your healthcare team can test for diminished strength, a change in your ability to know the position of your toes, and a change in sensation or sensory perception.

Ask the healthcare professional conducting the exam to let you know if they notice anything concerning during your foot exam, and whether they think you need to see a specialist, such as a podiatrist, or make changes in your overall diabetes care plan. With telehealth visits, it is possible to send a monofilament to a person’s home and teach them how to use it to determine if they have reduced sensation in different areas of their feet. It is also possible to examine a person’s foot onscreen during a video visit and ask questions about how the foot feels or looks. An in-person visit can be scheduled if anything concerning is noted.

Although living with diabetes comes with unique challenges, like diabetes-related peripheral neuropathy, you can take charge of your health by scheduling regular screenings, staying informed about the signs and symptoms, and making lifestyle changes that support nerve health. Talk to your healthcare provider about protecting your nerves and reducing your risk of serious complications.

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References:

• American Diabetes Association Professional Practice Committee. 12. Retinopathy, neuropathy, and foot care: Standards of Care in Diabetes—2024. Diabetes Care 2024;47(Supp. 1):S231-S243.

Martin CL, Albers JW, Pop-Busui R for the DCCT/EDIC Research Group. Neuropathy and Related Findings in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study In Special Collection: DCCT-EDIC Special Article Collection , DCCT/EDIC 30th Anniversary Summary FindingsDiabetes Care 2014;37(1):31–38 https://doi.org/10.2337/dc13-2114

About the Author

Janice MacLeod, MA, RD, CDCES, FADCES,  is a diabetes-cardiometabolic consultant and thought leader in digital health and chronic condition management. Janice began her career as a diabetes-focused dietitian and certified diabetes care and education specialist at Carilion Clinic in Roanoke, VA and later at the University of Maryland in Baltimore, MD. More recently, Janice led clinical advocacy at Medtronic and Companion Medical and has served in clinical leadership roles with Welldoc and Johnson and Johnson. She is past chair of the Academy of Nutrition & Dietetics Diabetes Practice Group and has been elected to the Association of Diabetes Care and Education Specialists Board of Directors (2024-2027). Janice has authored multiple publications and developed numerous programs on diabetes nutrition, digital health, and practice transformation.  Her passion is developing business-savvy solutions leveraging technology to transform care.