Written by Dr. Matthew Capozzi, DPM, FACFAS, CWS (board-certified foot surgeon and wound specialist) · Medically reviewed by the CircuFiber Scientific Advisory Board · Updated: October 27, 2026

Diabetic neuropathy is nerve damage caused by prolonged high blood sugar, and it affects up to half of all people with diabetes. It can occur in type 1 or type 2 diabetes and most often affects the nerves in the legs and feet, causing numbness, tingling, burning, or pain. There are four main types: peripheral, autonomic, proximal, and focal neuropathy. Nerve damage cannot usually be undone, but keeping blood sugar in your target range, caring for your feet daily, and reporting symptoms early can slow its progression and prevent the sores, ulcers, and infections that lead to amputation.

Key Takeaways

• Diabetic neuropathy is nerve damage from diabetes. Prolonged high blood sugar, reduced blood flow, and high blood fats weaken nerve fibers and interfere with their ability to transmit signals.
• There are four types: peripheral (feet, legs, hands), autonomic (internal organs), proximal (hips, thighs, buttocks), and focal (a single nerve). Peripheral neuropathy is by far the most common.
• Typical symptoms are numbness, tingling, burning, sharp pain, sensitivity to touch, and loss of the ability to feel temperature in the feet.
• The biggest risk factors are how long you have had diabetes and how well blood sugar is controlled, plus kidney disease, smoking, alcohol, high blood pressure, and obesity.
• Treatment centers on blood sugar control, medications for nerve pain, lifestyle changes, and daily foot care. Early detection gives you the best chance of slowing progression.
• See a doctor for new numbness, tingling, or pain in the feet, and call your podiatrist the same day for any cut, blister, or sore that is not healing.

What is diabetic neuropathy?

Diabetic neuropathy is a type of nerve damage that can occur if you have type 1 or type 2 diabetes. High blood sugar levels harm nerves throughout the body, though diabetic neuropathy most often affects nerves in the legs and feet. It is a common and concerning complication of diabetes that affects millions of people worldwide, and up to 50% of people with diabetes develop some form of it.

Although diabetic neuropathy can affect any nerve in the body, it most commonly impacts the nerves in the legs and feet. Symptoms can include numbness, tingling, pain, and weakness in the affected areas. In severe cases, individuals may lose sensation in their feet and develop sores, ulcers, or infections, which can ultimately lead to amputation. It's crucial to monitor and manage blood sugar levels closely, as well as maintain a healthy lifestyle to minimize the risk of this often-debilitating condition. If you are not sure whether your symptoms are nerve-related, a diabetic neuropathy test by your doctor can confirm it.

What are the four types of diabetic neuropathy?

The four types of diabetic neuropathy are peripheral neuropathy, autonomic neuropathy, proximal neuropathy (also called diabetic amyotrophy or radiculoplexus neuropathy), and focal neuropathy (mononeuropathy). Each type affects different nerves and can present varying symptoms, ranging from mild to severe. The table below compares them.

Peripheral neuropathy

Peripheral neuropathy is the most common type and affects the nerves in the feet, legs, hands, or arms. Watch for these symptoms:

• Numbness, tingling, burning sensation
• Increased sensitivity to touch
• Decreased sensation or inability to feel temperature changes
• Sharp, stabbing pain

People with diabetes should routinely inspect their feet for signs of peripheral neuropathy and wear comfortable, supportive footwear. Loss of feeling is the most dangerous symptom because an injury can go unnoticed; read more about numb feet and diabetes and see diabetic neuropathy pictures of what the feet can look like.

Autonomic neuropathy

Autonomic neuropathy targets the nerves controlling involuntary body functions, such as digestion, blood pressure, and sexual function. Common symptoms include:

• Nausea, vomiting, or bloating after meals
• Diarrhea or constipation
• Erectile dysfunction in men, vaginal dryness in women
• Dizziness, lightheadedness, or fainting due to drops in blood pressure
• Difficulty recognizing low blood sugar symptoms
• Difficulty urinating or heat intolerance

Proximal neuropathy (diabetic amyotrophy)

Proximal neuropathy, also known as diabetic amyotrophy, primarily affects the hip, thigh, or buttock muscles, typically on one side of the body. Here are the common symptoms:

• Muscle weakness, pain
• Abdominal swelling (in some cases)
• Weight loss

While pain can be severe, it often improves with time and proper treatment.

Focal neuropathy (mononeuropathy)

Focal neuropathy causes sudden weakness or pain in specific nerves. The symptoms vary depending on the affected nerves:

• Severe pain in the lower back or pelvis
• Chest, abdominal, or eye pain
• Double vision or difficulty focusing

It's essential to address any unusual symptoms immediately, as early intervention can prevent further complications.

What are the symptoms of diabetic neuropathy?

The symptoms of diabetic neuropathy depend on the type and severity, and can range from mild to debilitating. Peripheral neuropathy often causes tingling, numbness, or pain in hands, feet, or legs. Autonomic neuropathy may lead to digestive issues, difficulty urinating, or even heat intolerance. Focal neuropathy can bring sudden pain in the face, chest, or limbs, while proximal neuropathy targets pain in the hips, thighs, or buttocks.

Because the feet are usually affected first, the earliest signs most people notice are tingling or "pins and needles" in the toes, burning feet at night, and a gradual loss of feeling. Symptoms can be stronger at night and are often described as wearing an invisible sock. Any change in sensation is a reason to report it to your healthcare provider.

What causes diabetic neuropathy?

Diabetic neuropathy is caused by prolonged high blood sugar, which damages nerves and interferes with their ability to transmit signals. Additionally, reduced blood flow and high levels of blood fats can weaken nerve fibers, making it harder for nerves to function. Diabetic neuropathy can develop as a result of uncontrolled blood sugar levels, which can damage nerve fibers throughout the body.

One primary factor is prolonged elevated blood sugar levels. When blood sugar remains too high for too long, it can damage the nerves and impair their ability to transmit signals. This is particularly harmful to nerves in the feet and legs, which is why diabetic neuropathy is often experienced there first.

Another contributor is age. As we age, our nerves become more susceptible to damage, particularly if we've had diabetes for a long time. The longer we live with diabetes, the greater the risk of developing neuropathy.

The type of diabetes also influences the onset of neuropathy. Those with type 2 diabetes are more likely to develop nerve damage, as they typically have the condition for a longer period before diagnosis.

Risk factors for diabetic neuropathy

The risk factors for developing diabetic neuropathy include:

• Duration of diabetes: Longer duration increases the likelihood of nerve damage.
• Poor blood sugar control: Consistently high blood sugar levels exacerbate nerve damage.
• Kidney disease: Diabetes can lead to kidney damage, affecting nerve function.
• Smoking and alcohol abuse: Both can impair blood flow and contribute to neuropathy. Tobacco use decreases blood circulation, leading to potential nerve damage.
• Obesity: A body mass index (BMI) of 25 or higher increases the risk of neuropathy.
• High blood pressure: Consistently high blood pressure can harm blood vessels and nerves.
• Nerve inflammation: Inflammation can cause direct damage to nerves or hinder their ability to function.
• Inherited genetic factors: Certain genes may predispose individuals to neuropathy.

How do you treat diabetic neuropathy?

Diabetic neuropathy is treated by controlling blood sugar to slow further nerve damage, using medications to relieve pain, making lifestyle changes, and protecting the feet from injury. It's important to recognize that treatment may vary for different individuals, and your healthcare provider will help you develop the best course of action for your unique situation. For a deeper look at each option, read our guide to diabetic neuropathy treatment.

Blood sugar control

Blood sugar control is paramount when it comes to diabetic neuropathy management. Consistently maintaining blood sugar levels within the target range can slow the progression of the condition and improve nerve function.

• Medication adjustments: If you're already on medication for blood sugar control, consult your doctor to assess whether your current treatment plan is effectively controlling your blood sugar levels.
• Diet and exercise: Incorporating a well-balanced diet and engaging in regular physical activity are essential for managing blood sugar.

Medications for nerve pain

Medications can be prescribed to help alleviate pain and discomfort. There are several options available, and your healthcare provider will help determine which is most appropriate for your situation. Some common medication types include:

• Antidepressants
• Anticonvulsants
• Pain relievers
• Topical treatments, such as creams and patches

Lifestyle modifications and foot care

Lifestyle modifications can also help manage symptoms and enhance overall well-being. Here are some suggestions:

• Quit smoking: Smoking can worsen diabetic neuropathy as it constricts blood vessels, further reducing blood flow to nerves.
• Limit alcohol consumption: Excessive alcohol intake can exacerbate nerve damage.
• Foot care: Regularly inspect your feet for sores, ulcers, or infection. Proper footwear and quality diabetic socks provide added support and protection. See our guide to shoes for diabetic neuropathy.

Alternative and complementary therapies

Some individuals may benefit from alternative therapies. These treatments can complement traditional options and should be discussed with your healthcare provider before starting. Some examples include:

• Acupuncture
• Biofeedback
• Massage therapy
• Transcutaneous electrical nerve stimulation (TENS)

Read more about natural treatment for diabetic neuropathy. Implementing these treatment options can have a significant impact on managing diabetic neuropathy symptoms and promoting a higher quality of life. As with any medical condition, it's crucial to adhere to the advice and guidance of your healthcare provider.

Can diabetic socks help with diabetic neuropathy?

Diabetic socks do not treat neuropathy, but they are a practical daily tool for protecting feet that have reduced sensation. A good diabetic sock is seamless so there is nothing to rub a blister on skin you cannot feel, has a non-binding top that does not squeeze the calf or restrict blood flow, wicks moisture to keep skin dry, and keeps feet warm. Because neuropathy can make it hard to feel temperature, warm socks are a safer way to keep feet comfortable than heating pads or hot water.

CircuFiber diabetic socks add a circulation mechanism. The fabric is woven with Circulight® IR fibers containing thermoreactive mineral particles that absorb your own body heat and reflect it back into the foot as far-infrared energy, which promotes a temporary increase in local blood flow and circulation. In a randomized, double-blinded, placebo-controlled trial at Yale School of Medicine (ClinicalTrials.gov NCT04460612, published in Diabetes & Vascular Disease Research, 2023), the active textile significantly increased transcutaneous oxygen in the feet of people with diabetes compared with a placebo sock, with the difference visible at 40 minutes and significant at 60 minutes. CircuFiber socks also carry the APMA Seal of Acceptance.

What this means in practice: treat socks as one part of a foot-care routine alongside blood sugar control, daily foot checks, and your doctor's treatment plan, not as a substitute for any of them.

How can you prevent diabetic neuropathy from getting worse?

You can slow diabetic neuropathy by keeping blood sugar in your target range, managing blood pressure, not smoking, limiting alcohol, and caring for your feet every day. It's important to note that while managing these factors might not guarantee prevention of neuropathy, it can significantly reduce the risk and slow its progression. Our guide to diabetic neuropathy self-care goes into the daily routine in detail.

Keep blood sugar in your target range

Achieving proper blood sugar control can help prevent the development of diabetic neuropathy. Here's a breakdown of recommended targets for blood sugar levels:

To maintain healthy blood sugar levels, consider these strategies:

• Always take your medication as prescribed
• Keep a balanced diet and incorporate regular exercise
• Regularly monitor your blood glucose levels
• Consult with your healthcare team about adjusting insulin doses
• Control blood pressure through lifestyle changes, and if needed, medications

Protect your feet every day

Taking care of your feet is another crucial aspect of preventing foot-related complications in diabetic neuropathy. We recommend the following ways to protect and care for your feet:

• Inspect your feet daily for cuts, blisters, or signs of infection
• Keep your feet clean and dry, especially between your toes
• Moisturize your feet to prevent dryness and cracking, but avoid applying lotion between your toes
• Trim your toenails carefully, straight across, to avoid ingrown toenails
• Wear well-fitted shoes and diabetic socks
• Avoid walking barefoot and ensure your feet are protected
• Never use heating pads, hot water bottles, or hot soaks on feet with reduced sensation, because you can burn skin you cannot feel

An untreated cut or blister on a numb foot is how most diabetic foot ulcers begin, which is why daily inspection matters so much.

Healthy lifestyle habits

Additionally, healthy lifestyle habits can contribute to overall health and wellbeing:

• Get adequate sleep and manage stress levels
• Avoid smoking and limit alcohol intake
• Seek guidance from healthcare professionals for optimal mental health support

Remember, consistency in self-care plays a significant role in managing diabetic neuropathy. By making the right choices and working closely with your healthcare team, you can take control and live a healthy life with diabetes.

When should you see a doctor about diabetic neuropathy?

See a doctor if you notice new numbness, tingling, burning, or pain in your feet or hands, dizziness when you stand, digestive changes, or sudden weakness or pain in one part of the body. Call your podiatrist the same day for any cut, blister, or sore on the foot that is not healing, and seek urgent care for a wound that is red, swollen, warm, or draining. It's crucial for people with diabetes to visit their healthcare providers frequently and report any changes in their symptoms. Early detection and management of diabetic neuropathy increase the chances of slowing its progression and preventing complications that can drastically impact a person's quality of life. Everyone with diabetes should have a comprehensive diabetic foot exam at least once a year. Not sure which specialist to call? Read who treats diabetic neuropathy.

Frequently asked questions about diabetic neuropathy

What does diabetic neuropathy feel like?

Diabetic neuropathy most often feels like tingling, "pins and needles," burning, or sharp stabbing pain in the toes and feet, sometimes spreading up the legs or into the hands. Many people also notice numbness, a feeling of wearing a sock when barefoot, or extreme sensitivity to touch so that even a bedsheet is uncomfortable. Symptoms are frequently worse at night.

What are the 5 main symptoms of diabetic neuropathy?

The five symptoms doctors look for most often are numbness or reduced ability to feel pain and temperature, tingling or burning, sharp pain or cramps, increased sensitivity to touch, and muscle weakness. In the feet, these are usually joined by foot problems such as blisters, calluses, or sores that you did not feel happening.

Can diabetic neuropathy be reversed?

Established nerve damage usually cannot be reversed, but its progression can be slowed and symptoms can improve substantially with good blood sugar control, medication, and lifestyle changes. Early-stage neuropathy and some types, such as focal and proximal neuropathy, often improve over time. Read our full answer on whether diabetic neuropathy can be reversed.

What is the best treatment for diabetic neuropathy in the feet?

The best treatment for diabetic neuropathy in the feet combines tight blood sugar control to slow further damage, prescription medications such as anticonvulsants or antidepressants for pain, daily foot inspection and protective footwear to prevent injury, and lifestyle changes like quitting smoking. Your doctor will tailor the plan to your symptoms and other health conditions.

What does early-stage diabetic neuropathy in the feet look like?

Early-stage diabetic neuropathy in the feet usually starts as intermittent tingling or numbness in the toes, mild burning at night, or trouble feeling hot and cold. The feet may look normal at this stage, which is why a yearly foot exam with a monofilament or tuning-fork test is the most reliable way to catch it before sensation is lost.

Which type of diabetes causes neuropathy?

Both type 1 and type 2 diabetes cause neuropathy. It is more often seen in type 2 diabetes because type 2 is more common and typically goes undiagnosed for years, allowing nerve damage to begin before treatment starts. The risk in either type rises with the duration of diabetes and with higher average blood sugar.

References, studies and sources

• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Diabetic Neuropathy (Nerve Damage). https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Peripheral Neuropathy. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies/peripheral-neuropathy
• Mayo Clinic. Diabetic neuropathy: Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580
• American Diabetes Association. Neuropathy. https://diabetes.org/about-diabetes/complications/neuropathy
• Yale School of Medicine. Randomized, double-blinded, placebo-controlled trial of an infrared textile on transcutaneous oxygen in people with diabetes. ClinicalTrials.gov NCT04460612. https://clinicaltrials.gov/study/NCT04460612

About the author: Dr. Matthew Capozzi, DPM, FACFAS, CWS, is a board-certified foot surgeon through the American Board of Foot and Ankle Surgery. He is a Diplomate of the American Academy of Wound Management and Fellow of the American College of Foot and Ankle Surgeons. He completed a three-year residency program in Foot and Ankle Reconstructive Surgery at St. Francis Hospital & Medical Center in Hartford, CT in 2010. Dr. Capozzi is a board-certified Wound Specialist® granted by the American Academy of Wound Management.

Healthcare disclaimer: Always consult your physician before beginning any program. This general information is not intended to diagnose any medical condition or to replace your healthcare professional. If you experience any pain or difficulty, stop and consult your healthcare provider. CircuFiber socks are a general wellness product intended to promote a temporary increase in local blood flow and circulation; they are not intended to diagnose, treat, cure, or prevent any disease. Individual results vary.