Diabetic neuropathy: symptoms, tests, care and which doctor to see
How high blood sugar damages nerves, the early signs in the feet, the tests that pick it up, how pain is treated, and why daily foot care matters.
Also known as: Diabetic neuropathy; Neuropathy
What diabetic nerve problems are
Diabetic neuropathy is nerve damage caused by diabetes. When blood glucose stays high for years, it harms the nerves directly and damages the tiny blood vessels that feed them. Damaged nerves may stop carrying messages, carry them slowly, or send signals at the wrong time — so a person may feel pain from nothing, or feel nothing when they step on a stone.
It is one of the most common long-term complications of both type 2 diabetes and type 1 diabetes. It develops slowly, often over many years, and early damage may cause no symptoms at all. That is why regular checks matter. Nerve damage that has already happened is often hard to reverse, but good diabetes control can slow it down, and treatment can ease symptoms and prevent its most serious consequence: foot ulcers and amputation.
The main types
- Peripheral neuropathy — the most common type, affecting the feet and legs first, and later the hands
- Autonomic neuropathy — affects the nerves that control the stomach, bowel, bladder, sexual function, sweating, heart rate and blood pressure
- Proximal neuropathy — less common, causing pain and weakness in the hip, buttock or thigh, usually on one side
- Focal neuropathy — sudden damage to a single nerve, for example in the face, eye muscles or wrist, as in carpal tunnel syndrome
Symptoms
Peripheral neuropathy usually starts in the toes and spreads upwards, in both feet, in a 'stocking' pattern:
- Numbness or reduced feeling, so that injuries, burns or tight footwear go unnoticed
- Tingling or 'pins and needles'
- Burning pain or sharp, shooting pains, often worse at night
- Feet that feel cold, or very sensitive to the touch of a bedsheet
- Loss of balance and unsteadiness, especially in the dark
- Muscle weakness and changes in the shape of the foot
Autonomic neuropathy can cause:
- Dizziness on standing, from a drop in blood pressure
- Bloating, nausea, vomiting or feeling full quickly because the stomach empties slowly
- Constipation, diarrhoea (often at night) or loss of bowel control
- Difficulty emptying the bladder, or repeated urine infections
- Erectile problems in men and vaginal dryness in women
- Sweating too much or too little
- Not noticing the warning signs of low blood sugar
Causes and risk factors
The main cause is blood sugar that has been high over a long time. The risk is higher in people who:
- Have had diabetes for many years, or whose diabetes was diagnosed late after years without symptoms
- Have poorly controlled blood sugar
- Also have high blood pressure, high cholesterol or are overweight
- Smoke or drink alcohol heavily
- Already have diabetic kidney or eye disease
Not every numb foot in a person with diabetes is diabetic neuropathy. Low vitamin B12 (which can occur with long-term use of metformin), thyroid problems, kidney disease, alcohol, some medicines and spinal problems can cause similar symptoms, and your doctor may test for them.
How it is diagnosed
Everyone with diabetes should have their feet checked at least once a year, and more often if problems are found. The checks are quick and painless:
- Monofilament test — a thin nylon thread is pressed against several points on the sole to see if you can feel it
- Tuning fork test — a vibrating tuning fork is placed on the big toe to test vibration sense
- Checking ankle reflexes, pulses, skin, nails and footwear
- Nerve conduction studies — small electrical signals measure how well nerves carry messages; used when the diagnosis is unclear or symptoms are unusual
- Blood pressure lying and standing, and other tests if autonomic neuropathy is suspected
- Blood tests such as HbA1c (average sugar over recent months), vitamin B12, thyroid and kidney function
Treatment
Blood sugar control
Blood sugar control is the foundation. Keeping glucose, blood pressure and cholesterol within the targets your doctor sets can slow nerve damage and may improve some symptoms. Very rapid lowering of long-standing high sugar can occasionally make nerve pain flare for a while, which is one reason changes are made under supervision. Stopping smoking and cutting down alcohol help too.
Treating nerve pain
Ordinary painkillers often do little for nerve pain. Doctors usually use nerve pain medicines from a few groups, including certain antidepressants and certain anti-seizure medicines, which calm overactive nerves; they are used for pain, not because you are depressed or have epilepsy. Skin creams are sometimes added. These medicines can cause drowsiness or dizziness, so your doctor will start low, adjust slowly and review whether they are helping.
Other symptoms
Stomach, bowel, bladder, blood pressure and sexual symptoms each have their own treatments, from diet changes and medicines to bladder training. Physiotherapy and balance exercises can reduce the risk of falls. Tell your doctor about every symptom, even ones that feel embarrassing, as many are treatable.
Daily foot care
Numb feet cannot warn you of injury, and a small cut can turn into an infected ulcer. Daily foot care is the single most important habit for preventing a diabetic foot problem:
- Look at both feet every day, including the soles and between the toes; use a mirror or ask a family member
- Wash in lukewarm water — test it with your elbow, not your foot — and dry well between the toes
- Moisturise dry, cracked heels, but not between the toes
- Avoid walking barefoot, even at home, on hot floors or terraces, and on visits to temples or other places where footwear is removed
- Wear soft, well-fitting footwear with closed toes and socks; check inside shoes for stones before putting them on
- Cut nails straight across; get corns and calluses treated by a professional rather than with blades or corn plasters
- Do not use hot water bottles, heating pads or sit close to a heater with numb feet
When to see a doctor, and when it is an emergency
See your doctor soon if you notice new numbness, burning or tingling, a cut or blister on the foot that is not healing, a change in the colour or shape of the foot, dizziness when standing, or repeated vomiting after meals.
Seek same-day care for a foot that is red, hot, swollen or oozing, or has a wound with a bad smell. Call 112 or 108, or go to the nearest emergency department, if there is a foot infection with fever, confusion or feeling very unwell, if a foot turns cold, pale or black, or if you have a fall with injury, fainting or symptoms of very low sugar that do not improve.
Which doctor to see
A diabetologist or endocrinologist leads diabetes care and neuropathy screening, and many general physicians do too. A neurologist is involved when the diagnosis is uncertain, symptoms are unusual or one-sided, or nerve tests are needed. Foot wounds may also need a surgeon or a specialist foot clinic.
You can find diabetologists in Bengaluru or neurologists in Bengaluru on The Doctor Index, each with a registration you can check. Related conditions to read about include diabetic eye problems and diabetic kidney problems.
Common questions
Questions people ask
- Can diabetic neuropathy be reversed?
- Nerve damage that has been present for a long time usually cannot be fully reversed. But good control of blood sugar, blood pressure and cholesterol can slow it or stop it getting worse, symptoms such as pain can often be eased, and careful foot care prevents most serious complications.
- Why do my feet burn at night?
- Burning or shooting pain that is worse at night is a common symptom of peripheral neuropathy, possibly because there are fewer distractions. Your doctor can check your feet, look for other causes such as low vitamin B12, and suggest medicines that target nerve pain.
- Is it safe to walk barefoot if I have diabetes?
- It is safer not to. With reduced feeling you may not notice a cut, a burn from a hot floor or a thorn until it has become infected. Wear comfortable footwear indoors and outdoors, and check your feet every day.
- Does metformin cause nerve damage?
- Metformin does not damage nerves directly, but long-term use can lower vitamin B12 levels, and low B12 can cause numbness and tingling similar to diabetic neuropathy. Do not stop metformin on your own; ask your doctor whether a B12 test is needed.
This condition is usually assessed by a diabetologist. Every profile shows the doctor’s registration and what has been checked.
Diabetologists in Bangalore
A few diabetologists listed on The Doctor Index. They are shown because of their speciality, not a stated interest in Diabetic Nerve Problems; ask the clinic whether the doctor sees it.
Related conditions
- Diabetes Type 1
- Diabetes Type 2
- Diabetic Eye Problems
- Diabetic Foot
- Diabetic Heart Disease
- Diabetic Kidney Problems
- Hyperglycemia
- Hypoglycemia
Practical reading
All postsSources
- MedlinePlus, National Library of Medicine — Diabetic Nerve Problems
- Government of India — Emergency Response Support System (112)
- MedlinePlus, National Library of Medicine — Diabetic Nerve Problems — Public-domain health-topic summary
- Human Phenotype Ontology Consortium — terminology definitions — HPO licence; definitions reproduced without alteration
Diabetic neuropathy: symptoms, tests, care and which doctor to see is original text by The Doctor Index; the compiled source draft was used for research. Source: MedlinePlus, National Library of Medicine. Orphadata Science: Free access data from Orphanet. © INSERM 1999; July 2026 data, CC BY 4.0. This product uses the Human Phenotype Ontology (hp/releases/2026-09-01). Only sources listed for this article apply. Source material has been selected and arranged; HPO definitions are reproduced without alteration. No source organisation endorses this compilation. Köhler S et al. The Human Phenotype Ontology project: linking molecular biology and disease through phenotype data. Nucleic Acids Research 2014;42(D1):D966–D974. doi:10.1093/nar/gkt1026.
General information, not advice about your situation. Errors can be reported through the corrections process. Reference TDI-C-0739.