Diabetes and arm pain

Diabetic Neuropathy Overview

Diabetic Peripheral Neuropathy and Other Types of Diabetic Neuropathy

An estimated 20 million people in the United States have some form of peripheral neuropathy. More than 100 types of peripheral neuropathy have been identified, each with its own symptoms and prognosis, according to the National Institute of Neurological Disorders and Stroke. Additionally, an estimated 23% of neuropathy patients can also be diagnosed with idiopathic neuropathy, or neuropathy coming from an unknown cause, which typically occurs in middle-aged and elderly individuals.

Diabetic neuropathy, which you may hear called diabetic nerve pain, is diabetes-related nerve damage. It develops over time; the longer you have diabetes, the more at risk you are for diabetic neuropathy. In fact, the National Institute of Diabetes and Digestive and Kidney Diseases reports that 60% to 70% of people with either type 1 diabetes or type 2 diabetes will develop a type of diabetic nerve pain.1

There are 4 types of diabetic neuropathy: diabetic peripheral neuropathy (the most common type), proximal neuropathy, autonomic neuropathy, and focal neuropathy. Peripheral neuropathy is the most likely to cause pain, but proximal neuropathy can also cause pain.

Diabetic Neuropathy Causes

Even though the exact cause of diabetic neuropathies isn’t fully understood, researchers in the medical community do know that poor blood glucose control (blood sugar) is related to the development of nerve damage.

What they don’t understand is how long-term exposure to high blood glucose levels leads to nerve damage. There is an idea that elevated blood glucose levels damage the blood vessels over time. Damaged blood vessels can’t bring oxygen and nutrients to the nerves as well as they should be able to, eventually leading to nerve damage.

Most likely, diabetic neuropathy develops because of a mix of factors:

• Lifestyle: Smoking and excessive alcohol use can contribute to diabetic neuropathy.

• Age: The longer you have diabetes, the more likely it is that you will develop diabetic neuropathy.

• Nerve Injury: Your nerves can be injured because of other conditions, such as carpal tunnel syndrome, or they may be injured because of inflammation. Injured nerves may be more likely to develop diabetic neuropathy.

• Autoimmune Factors: In autoimmune diseases, and type 1 diabetes is an autoimmune disease, the immune system, for some reason, turns against the body. An autoimmune disorder can cause inflammation, which can damage the nerves.

• Genetic Factors: You may inherit a gene that makes you more susceptible to nerve damage.

• Metabolic Factors: In addition to high blood glucose and duration of diabetes, abnormal blood fat (cholesterol) levels may contribute to neuropathy. Researchers are also looking into the role of low insulin levels.

Diabetic Neuropathy Symptoms 

The symptoms of diabetic neuropathy are dependent on which type of diabetic neuropathy you have, as well as which nerves are damaged. For many people, the first symptom is pain, tingling, or numbness in the feet, legs, arms, and hands. The lower extremeties usually are affected earlier than the upper extremeties. This may be minor at first because it takes awhile for diabetic neuropathy to develop. Gradually, as more nerves are damaged, the symptoms can become more severe.

Other symptoms of nerve damage include:

  • Pain and numbness
  • Inability to feel temperature (hot or cold)
  • Wasting of muscles of the hands and feet
  • Indigestion, nausea and vomiting
  • Diarrhea and constipation
  • Dizziness or faintness due to a drop in blood pressure
  • Problems with urination
  • Sexual dysfunction (erectile dysfunction in men, vaginal dryness in women)
  • General weakness

Peripheral neuropathy is the most common type of diabetic neuropathy. It causes pain or loss of feeling in lower legs, feet and toes, as well as in the arms and hands. When peripheral neuropathy gets worse, patients may not realize that they have hurt themselves or cut themselves. Unattended wounds can develop ulcers, which may get infected. In the worse case scenarios, this can lead to amputations in some patients with diabetes. Nearly 80% of the amputee population worldwide will then likely experienced phantom limb pain, according to the Amputee Coalition.

In one type of diabetic neuropathy—focal neuropathy—the onset of pain is usually sudden and intense. It usually affects on nerve or group of nerves in the head, torso, or legs—but any nerve in the body can be affected. However, focal neuropathy symptoms usually go away in a few weeks.

Proximal neuropathy can cause symptoms related to the motor system—your ability to move. You may, for example, have trouble standing up from a seated position. Proximal neuropathy causes pain the legs, thighs, hips, buttocks, and less frequently shoulders.

Autonomic neuropathy affects the autonomic nervous system, which controls involuntary functions—it’s what keeps your heart beating, breathing, digestion, etc. If your autonomic nerve system is affected, you may have dizziness upon standing up, feeling faint, or problems with urination.

If you have diabetes and notice pain, tingling or numbness, or other nerve-related symptoms, talk to your doctor right away. The progression of diabetic neuropathy can be slowed down with the proper treatment. The best way to prevent diabetic neuropathy is by keeping your blood glucose levels as close to normal as possible.

Updated on: 08/22/18 View Sources



Continue Reading: Diabetic Neuropathy Diagnosis

If you’re one of 29 million people living with diabetes, you’re at risk of diabetic neuropathy, a condition caused by diabetes. Diabetic neuropathy occurs for several reasons that are all related to the long-term damage caused by extended periods of high blood sugar.

Before going into the specific causes and implications of diabetic neuropathy, it’s important to first have a top-level understanding of diabetes and its effects on the body.


Diabetes, in short, is the inability to manage changing levels of blood glucose, or blood sugar levels in the body. Problems arise when the body has trouble maintaining the balance of blood glucose levels, and must be treated.

Type 1 Diabetes: The pancreas, the organ responsible for producing insulin, has difficulty producing enough insulin for the body due to damaged cells in the pancreas. Insulin is necessary for blood sugar regulation, and without it, blood sugar spikes occur causing unstable and damaging conditions in the body.

Type 2 Diabetes: The pancreas produces enough insulin, but the cells reject the insulin. When this happens, the body creates an overproduction of insulin, and eventually, the pancreas ends up overworked and damaged.

For more on Diabetes and blood sugar monitoring, read our previous blog, Blood Glucose Monitoring: Why and How?

Diabetic Neuropathy

With diabetes, the body has difficulty recovering from high blood sugar spikes (after a meal, drink, or sugary snack), leading to extended periods of high blood sugar in the bloodstream. Over time, these high levels of blood sugar can damage nerves in the body. This nerve damage caused by diabetes is called diabetic neuropathy. There are four main types of diabetic neuropathy, and the signs and symptoms vary for each one. Many people experience anywhere from one to many symptoms, and sometimes don’t have noticeable problems until substantial damage has occurred.

Peripheral Neuropathy

As the most common form of diabetic neuropathy, peripheral neuropathy often affects the legs and feet first, then moves to the arms and hands. Often, these symptoms are most painful at night.

Symptoms of peripheral neuropathy include:

  • Numbness or inability to discern temperature.
  • Tingling, burning, or sharp pain or cramps (especially at night).
  • Increased (sometimes alarming) sensitivity to touch.
  • Weakness, loss of balance and coordination.
  • Lowered reflexes.
  • Ulcers, infections, deformities, and bone and joint pain in the feet.

You can monitor these symptoms by:

  • Checking your feet and legs daily.
  • Moisturizing your feet.
  • Maintaining your toenail hygiene.
  • Wearing comfortable shoes to prevent foot injury.

In severe cases, if left untreated, even minor cuts on feet can turn into ulcers and sometimes lead to gangrenous tissue, requiring surgery or amputation. Don’t let these symptoms go untreated.

Autonomic Neuropathy

This type of diabetic neuropathy typically upsets the digestive system. Autonomic refers to the autonomic nervous system, a system of the body that comprises the heart, bladder, lungs, stomach, intestines, sex organs, and eyes. Because of this, signs of autonomic neuropathy may be evident in any of these organs. This type of neuropathy is often noticed due to changes to the blood vessels, urinary system, and sex organs.

Symptoms of autonomic neuropathy include:

  • Bloating, nausea, vomiting, loss of appetite.
  • Diarrhea, constipation, or a combination of both.
  • Heartburn and heightened heart rate.
  • Vaginal dryness, reduced ejaculations, and erectile dysfunction.
  • Inability to adjust blood pressure and heart rate after sitting or standing.
  • An unexplainable feeling of being cold or hot.
  • Feeling full after a small meal.
  • Unawareness of low blood sugar levels (hypoglycemia).

Symptoms can often be helped by making changes to your lifestyle: including the use of special stockings, changes to your diet, counseling, surgery, or medication prescribed by a physician.

Radiculoplexux/Proximal Neuropathy (Also called, Diabetic Amyotrophy)

This condition is a less common form of diabetic neuropathy, and most commonly occurs in older people, and people living with type 2 diabetes. It typically affects nerves in the thighs, buttocks, hips, and legs, and often affects just one one side of the body. This damage can lead to severe loss of muscle tone, and can be very painful. Symptoms of radioculoplexus neuropathy include:

  • Sudden or extreme pain in thighs, hips, and legs.
  • Weakened thigh muscles.
  • Difficulty standing from a seated position.
  • Swelling of the abdominals.
  • Weight loss.

You can monitor these symptoms by paying close attention to any changes in pain or weakness of one or both sides of the body on the thighs, legs, and hips. If you notice any changes, contact your physician.

Mononeuropathy/Focal Neuropathy

Mononeuropathy refers to damage to a specific nerve. Nerve damage may occur in a nerve located in the face, torso, or leg. This type of diabetic neuropathy most often occurs suddenly and is most often seen in older adults. Damage from Mononeuropathy is often not long-term, and symptoms usually disappear within a few months. Occasionally, a compressed nerve causes mononeuropathy. Symptoms of mononeuropathy vary, depending on the location of the damaged nerve, and may include:

  • Numbness, tingling, or weakness in the fingers and hand.
  • Affected vision – problems focusing, double vision, aching.
  • Facial paralysis.
  • Leg, shin, or foot pain.
  • Lower back, pelvic, or abdominal pain.

To manage symptoms, seek medical treatment if you experience symptoms of mononeuropathy, and tell your physician about all the symptoms you’re experiencing. Unfortunately, Mononeuropathy is often painful and unpredictable; the good news is that it often goes away on its own over a relatively short amount of time, without leaving long-term damage.

If you are diabetic and notice any of these symptoms, consult your physician as soon as you can. Even if your physician concludes that your symptoms are not related to diabetic neuropathy, they may indicate other health issues. As with any medical concern, early detection can increase the chances of recovering, limiting pain and suffering, managing symptoms, and preventing long-term damage.

Diabeties at WWMG

At WWMG, we have many services that are dedicated to helping patients manage their diabetic symptoms, prevent diabetes progression, and maintain a high quality of life while living with Diabetes. For more details about our diabetes services, please visit our Diabetes and Nutrition page, and don’t hesitate to reach out if you have any questions.

When Diabetes Leads to Nerve Damage

Tingling, numbness, pain in the arms, legs, hands, or feet — these are all common signs of diabetic neuropathy, or nerve damage. Up to 70 percent of people with diabetes will develop some type of neuropathy, making it one of the most common side effects of this disease.

Diabetes: Understanding Neuropathy

Although tingling, numbness, or pain in the extremities are common signs of neuropathy, others may experience no symptoms at all. Nerve damage can also occur in internal organs, such as the heart or digestive tract. Diabetes-related neuropathy can affect muscle strength, sensation in various parts of the body, and even sexual function.

People who develop diabetic neuropathy are typically those who have trouble controlling their blood glucose levels, blood pressure, cholesterol, and body weight. Although researchers haven’t quite figured out exactly why this happens, they know that neuropathy can occur due to:

  • Alcohol use and smoking
  • Genetic predisposition
  • Injuries such as carpal tunnel syndrome
  • Nerves that become inflamed related to autoimmune conditions
  • Neurovascular issues that damage the blood vessels responsible for bringing nutrients and oxygen to your nerves

Your risk also increases the older you get and the longer you have diabetes, with the highest rates of neuropathy occuring in people who have had diabetes for at least 25 years.

Diabetes: Where Neuropathy May Strike

Here are some of the specific types of neuropathy that occur in people with diabetes:

  • Autonomic neuropathy impairs the functioning of the digestive system, resulting in diarrhea or constipation as well as impaired bladder function. This type of neuropathy also affects how you perspire and even your sexual response — men may have trouble getting an erection and women may experience vaginal dryness. This neuropathy also masks the symptoms of hypoglycemia (low blood glucose).
  • Focal neuropathy can attack any nerve in the body and often causes sudden weakness.
  • Peripheral neuropathy, the most common diabetic complication, can cause numbness or pain in the legs, feet, toes, arms, and hands.
  • Proximal neuropathy may cause weakness in your legs and pain in your hips, buttocks, and thighs.

Because diabetes-related neuropathy can cause such a wide variety of symptoms, there is no single diagnostic test for the condition. Your doctor will rely heavily on a complete physical exam and your description of symptoms to diagnose this condition. In some cases, tools such as nerve conduction studies, a heart rate variability test, and ultrasound may be used to aid in the diagnosis.

Diabetes: Protect Your Feet

Peripheral neuropathy often occurs in the feet. If you start to lose feeling in your feet, you’re more likely to injure yourself, walk abnormally, and develop sores that won’t heal. These sores often become badly infected, which can lead to amputation of your feet or legs. That’s why it’s important for people with diabetes to keep a close eye on their feet.

Diabetes: Treatment Will Vary

Because each neuropathy is different, treatments vary widely and you’ll need to consult with your doctor to find the best solution for your individual condition. However, treatment for any neuropathy will start with bringing your blood glucose levels under control if they aren’t already.

Here are some treatment options that may be suggested:

  • Various medications, including some antidepressants, can be used to treat nerve pain.
  • If you have stomach problems, your doctor may suggest a change in your diet. If that doesn’t help, medications can be used to help control your digestive processes.
  • If you experience bladder problems, you may need an antibiotic to clear up any infection that results. Incontinence treatment starts with remembering to urinate at regular intervals, since you may not realize when your bladder is full.
  • Medications are available for men with erectile dysfunction, and there are mechanical options, such as vacuum devices, that can help with maintaining an erection. Women who experience vaginal dryness can try lubricants.
  • For neuropathy that causes dizziness and weakness, usually related to blood pressure or circulation, your doctor may advise you to raise the head of your bed, and to sit up or stand slowly. Medication for high blood pressure may be prescribed; for some people an increased level of salt in the diet may be recommended.

Even though diabetic neuropathy will affect the majority of people who have diabetes, you can still work to prevent it, mostly by keeping your blood glucose level within your target range. This will help protect your nerves from damage.

Silent Hypoglycemia Presenting As Dysesthesias

Hypoglycemia is not often in the differential diagnosis for dysesthesias but should be considered when involved in the care of diabetic patients. Such symptoms may herald silent hypoglycemia and resultant nerve injury, as illustrated in the following case.

A 26-year-old female with type 1 diabetes presented with a 2-month history of numbness and tingling in her hands and feet upon waking in the morning. Symptoms began when her treatment was altered from NPH 50 units q 𝒶.𝓂. to NPH 35 and Regular 3 q 𝒶.𝓂. and NPH 8 and Regular 5 at dinner. The patient monitored her glucose more than four times each day and reported three to four glucose values a week that were <60 mg/dl without symptoms. Her morning glucose levels averaged 60 mg/dl. The symptoms were more pronounced in her hands than feet and resolved within minutes. On exam, she showed no objective sensory loss, possessed good muscle tone, bulk, and strength, had intact reflexes (2+) bilaterally, and had no focal neurological signs. HbA1c was 6.8%.

Symptoms were attributed to peripheral neuropathy secondary to hypoglycemia. Her insulin regimen was adjusted to NPH 35 and Regular 3 q 𝒶.𝓂., NPH 4 q HS, and Regular 5 before dinner for glucose >200 mg/dl. One month later, she reported the disappearance of the symptoms and a reduction in the frequency of values <60 mg/dl to once a week.

Hypoglycemia has been proposed to induce nerve injury by several mechanisms. Lack of substrate leads to a reduction in axonal transport, causing an accumulation of intraneural metabolites and neuronal injury (1). Hypoglycemia can induce a reduction in blood flow, leading to neural hypoxia (2–4). These mechanisms may all play a role in nerve injury; disturbance in neural blood flow may be the initial manifestation of hypoglycemia, while prolonged hypoglycemia may induce axonal damage (2).

Peripheral neural injury has been reported in patients with hypoglycemia due to insulinomas (5). These patients displayed paresthesias and/or muscle wasting and weakness. After tumor resection, patients showed resolution of sensory symptoms, while muscle wasting persisted.

We propose that practitioners consider undetected hypoglycemia as a possible cause of paresthesias in diabetic subjects. Frequent episodes of hypoglycemia can hinder patients’ efforts to achieve normoglycemia. Early measures taken to reduce such episodes will promote normoglycemia.


  1. ↵ Sidenius P, Jakobsen J: Anterograde fast component of axonal transport during insulin-induced hypoglycemia in nondiabetic and diabetic rats. Diabetes 36:853–858, 1987
  2. ↵ Ohshima J, Nukada H: Hypoglycaemic neuropathy: microvascular changes due to recurrent hypoglycaemic episodes in rat sciatic nerve. Brain Res 947:84–89, 2002
  3. Kihara M, Zollman PJ, Smithson IL, Lagerlund TD, Low PA: Hypoxic effect of exogenous insulin on normal and diabetic peripheral nerve. Am J Physiol 266:E980–E985, 1994
  4. ↵ Hilsted J, Bonde-Petersen F, Norgaard MB, Greniman M, Christensen NJ, Parving HH, Suzuki M: Haemodynamic changes in insulin-induced hypoglycaemia in normal man. Diabetologia 26:328–332, 1984
  5. ↵ Jaspan JB, Wollman RL, Bernstein L, Rubenstein AH: Hypoglycemic peripheral neuropathy in association with insulinoma: implication of glucopenia rather than hyperinsulinism. Medicine 61:33–44, 1982

Peripheral neuropathy is nerve damage caused by chronically high blood sugar and diabetes. It leads to numbness, loss of sensation, and sometimes pain in your feet, legs, or hands. It is the most common complication of diabetes.

About 60% to 70% of all people with diabetes will eventually develop peripheral neuropathy, although not all suffer pain. Yet this nerve damage is not inevitable. Studies have shown that people with diabetes can reduce their risk of developing nerve damage by keeping their blood sugar levels as close to normal as possible.

What causes peripheral neuropathy? Chronically high blood sugar levels damage nerves not only in your extremities but also in other parts of your body. These damaged nerves cannot effectively carry messages between the brain and other parts of the body.

This means you may not feel heat, cold, or pain in your feet, legs, or hands. If you get a cut or sore on your foot, you may not know it, which is why it’s so important to inspect your feet daily. If a shoe doesn’t fit properly, you could even develop a foot ulcer and not know it.

The consequences can be life-threatening. An infection that won’t heal because of poor blood flow causes risk for developing ulcers and can lead to amputation, even death.

This nerve damage shows itself differently in each person. Some people feel tingling, then later feel pain. Other people lose the feeling in fingers and toes; they have numbness. These changes happen slowly over a period of years, so you might not even notice it.

Because the changes are subtle and happen as people get older, people tend to ignore the signs of nerve damage, thinking it’s just part of getting older.

But there are treatments that can help slow the progression of this condition and limit the damage. Talk to your doctors about what your options are, and don’t ignore the signs because with time, it can get worse.

Nerves (neuropathy)

Neuropathy is one of the long-term complications of diabetes.

What is neuropathy?

Neuropathy is one of the long-term complications which affects the nerves. Nerves carry messages between the brain and every part of our bodies, making it possible to see, hear, feel and move. Nerves also carry signals that we are not aware of to parts of the body such as the heart, altering the rate it beats at, and the lungs, so we can breathe. Therefore, damage to the nerves can cause problems in various parts of the body.

Diabetes can cause neuropathy as a result of high blood glucose levels damaging the small blood vessels which supply the nerves. This prevents essential nutrients reaching the nerves. The nerve fibres are then damaged or disappear.

There are three different types of neuropathy: sensory, autonomic and motor.

Sensory neuropathy

Sensory neuropathy affects the nerves that carry messages of touch, temperature, pain and other sensations from the skin, bones and muscles to the brain. It mainly affects the nerves in the feet and the legs, but people can also develop this type of neuropathy in their arms and hands.

Symptoms can include:

  • Tingling and numbness
  • Loss of ability to feel pain
  • Loss of ability to detect changes in temperature
  • Loss of coordination – when you lose your joint position sense
  • Burning or shooting pains – these may be worse at night time.

The main danger of sensory neuropathy for someone with diabetes is loss of feeling in the feet, especially if you don’t realise that this has happened. This is dangerous because you may not notice minor injuries caused by:

  • Walking around barefoot
  • Sharp objects in shoes
  • Friction from badly fitting shoes
  • Burns from radiators of hot water bottles.

If ignored, minor injuries may develop into infections or ulcers. People with diabetes are more likely to be admitted to hospital with a foot ulcer than with any other diabetes complication.

Charcot joint is a rare complication of people with diabetes who have severe neuropathy. It happens when an injury to the foot causes a broken bone, which may go unnoticed because of the existing neuropathy. The bone then heals abnormally, causing the foot to be come deformed and misshapen. Treatment includes immobilizing the foot in a plaster cast and in some cases surgery.

Autonomic neuropathy

Autonomic neuropathy affects nerves that carry information to your organs and glands. They help to control some functions without you consciously directing them, such as stomach emptying, bowel control, heart beating and sexual organs working.

Damage to these nerves can result in:

  • Gastroparesis – when food can’t move through the digestive system efficiently. Symptoms of this can include bloating, constipation or diarrhoea
  • Loss of bladder control, leading to incontinence
  • Irregular heart beats
  • Problems with sweating, either a reduced ability to sweat and intolerance to heat or sweating related to eating food (gustatory)
  • Impotence (inability to keep an erection).

Motor neuropathy

Motor neuropathy affects the nerves which control movement. Damage to these nerves leads to weakness and wasting of the muscles that receive messages from the affected nerves. This can lead to problems such as:

  • muscle weakness, which could cause falls or problems with tasks such as fastening buttons.
  • muscle wasting, where muscle tissue is lost due to lack of activity
  • muscle twitching and cramps.

How is neuropathy treated?

There are many treatments available to relieve the symptoms caused by neuropathy. This may include medication for nausea and vomiting, painkillers for sensory neuropathy or treatment to help with erectile dysfunction. Good control of blood glucose levels can improve the symptoms of neuropathy and can reduce the progression of the nerve damage.

Steps you can take to avoid neuropathy

  • Keep your blood glucose levels within your target range.
  • Have your feet checked at least once a year.
  • Tell your diabetes healthcare team if you think you’re developing any signs of neuropathy.
  • If you think you’ve lost sensation in your feet, protect them from injury and check them every day.
  • And talk to your diabetes healthcare team.

About a month ago I was driving to Santa Cruz and noticed a tingling in my fingers. It got worse when I put my hands up on the steering wheel and better when I rested them on the bottom. During this two-hour drive, it was a struggle to keep my fingers from falling asleep. Soon after, I began to wake up often during the night, having to reposition my hands so they would stop tingling.

My first fear was of neuropathy. I asked myself, “Is this how it starts?”

Before I confronted that possibility, I wanted to rule out other things. I went to my chiropractor who thought one of my cervical neck vertebra was out of alignment. He adjusted my back and neck, but it provided no relief.

Diagnosis From a Friend

I finally told a friend about how, when I push down on my wrist, sparkles and fireworks seem to run up to my fingers. He said, “That sounds just like carpal tunnel syndrome.”

His words hit me hard. “Don’t I have enough to deal with with diabetes?” I thought. “This can’t be happening to me.”

He told me what carpal tunnel syndrome (CTS) means. CTS occurs when the median nerve is compressed where it passes through a narrow tunnel of bone and ligament in the wrist. The tendons in the carpal tunnel may swell, pinching this nerve. It can be caused by a number of things, like performing repetitive motions such as typing. People with diabetes are 15 times more prone to CTS than the general population. (Journal of Hand Surgery, January 1995).

CTS is most common in insulin-dependent patients and is not associated with neuropathy.

I called my doctor and got an appointment for the very next morning. He strongly suspected CTS, but referred me to a neurologist for the actual diagnosis. He suggested wrist splints and vitamin B6 at 100 mg/day.

Bracing Myself

His nurse was sure I wouldn’t want to walk through the waiting room wearing my new wrist splints-she just handed them to me. I had to ask her to show me how to use them. Splints in place, my next stop, several days later, was with the neurologist.


The neurologist had me lie down, and responded to my questions with short answers while he ran electrical currents through my nerves. I asked him about my doctor’s recommendation, and the neurologist told me there is no evidence to support the idea that vitamin B6 helps CTS, and that overuse can actually cause neuropathy. He also told me there are no exercises that will help. “Overflexing the hand can actually make things worse.”

I asked about injections of cortisone, a steroid which reduces inflammation. He replied, “Why would you want to introduce more fluid into a spot that is already tight?”

He cautioned that if the splints don’t work, I will need surgery. He said that most people with CTS don’t need surgery, but people with diabetes need it more often because neuropathy is more prevalent. No one knows why people with diabetes get neuropathy, but he told me it has “something to do with blood deficiencies in the sheath around the nerves.”

I Saw the Physiatrist

I gave the physiatrist, who is also an osteopath, permission to re-run all the tests the neurologist had done while a resident intern watched. He was very comfortable with my many questions, and he answered them all cheerfully.

Although he ran electric currents through my nerves much like the neurologist did, these new tests hurt much more. I had to yell “Ouch!” very loud before he turned down the voltage and stopped the test. Then he stuck a large needle into the muscle of my thumb and hooked me up to his computer. He wiggled the needle around until he got what he needed. I yelled “Ouch!” again, and he finally stopped.

Nerves Heal Slowly

His diagnosis was the harshest yet. He determined that my left hand is in worse shape than my right, and that the nerve damage started long before I felt the tingling. (I remember feeling prickling in my fingers two years ago, but it went away by itself that time.) He told me that it takes a nerve a month to heal one inch, and that people with diabetes heal even slower. Unfortunately, the healing begins only after the trauma to the nerve has stopped. He said surgery is a real possibility if I don’t see some improvement soon.

Contrary to what the neurologist said, the physiatrist recommended a shot of cortisone in my worse hand. He said it might help, so I watched as he brought out a big fat syringe. Even though I looked away while he slowly plunged the cortisone directly into my wrist, I almost passed out. I had to lie back on the examining table while my world went from color to patchy black and white. This was especially surprising for a guy who gives himself four or more insulin injections every day. The cortisone also caused my blood sugar to shoot up for two days.

A New Regimen

He wrote out instructions for me, and went over them carefully:

  • In spite of the neurologist’s grim assessment of exercise for CTS, the physiatrist prescribed exercises for the hand and taught me how to do them.
  • He told me to put ice on the wrist three times a day for 15 minutes, and even drew me a diagram showing how to freeze water in Dixie cups and peel down the sides of the cups to expose the ice.
  • He said to wear my wrist splints at night and as much as I could stand during the day for two weeks and to come back and see him in six weeks.

All in all, I really like this doctor. We’re in a partnership, and although he was the teacher, he treated me like an equal.

The Home Front

When I told Nadia about the possibility of surgery, I could see the worry in her eyes. I felt bad about having to tell her, and wondered to myself what she must be thinking: “Is he falling apart?”

She said later that maybe this is what getting old is all about.

As it turns out, the fact that I have two small kids may be part of why I have CTS. I hold them in my left arm while I do other tasks with my right hand, like opening a door with a key. I’m sure you can picture the angle your wrist is in when you’ve got a 20 or 30 pound baby in one arm.

Where I Stand

This has all happened so quickly. It’s been less than a month since I first noticed my tingling fingers. Because I have diabetes, everything is more complicated-nerve damage, my ability to heal, the emotional toll of one more health concern. If my nerves are being damaged, I don’t want to wait too long for surgery.

I am doing as the physiatrist told me, and I am taking multiple vitamins along with C, zinc, and B complex, including 100 mg/day of vitamin B6.

If anyone has any tips or suggestions, or has experiences to share about CTS and diabetes, please call us at (415)488-4526

Pain and numbness or tingling in your legs and feet should be not be taken lightly as this can be one of the first signs or symptoms that someone with diabetes may experience. Medically referred to as “Diabetic Neuropathy”, pain and numbness can be a sign of nerve damage that can occur as a complication of both uncontrolled type 1 and type 2 diabetes.

While nerve fibers anywhere in the body can be damaged by uncontrolled blood glucose control, diabetic neuropathy most often affects the nerves in both your feet and legs. Read on how diabetic neuropathy (pain and numbness) can be an alarming sign of undiagnosed diabetes.

What Causes Pain and Numbness to Occur Due to Diabetes?

Depending on the location of the nerves affected by diabetic neuropathy, the symptoms of it can range from pain and numbness, most often in lower extremities to issues with your heart, digestive system, blood vessels and urinary tract.

Diabetic Neuropathy is the most common complication that can arise from uncontrolled and undiagnosed diabetes. However, the progression of this complication can be slowed by tightening blood glucose control.

Understanding How Pain and Numbness Can Be a Symptom of Diabetes

Uncontrolled diabetes, both type 1 and type 2, can lead to the progression of diabetic neuropathy. Those who develop symptoms of pain and numbness typically have a difficult time controlling their blood glucose levels, such as those who may not have yet realized they have diabetes (undiagnosed). This can also be caused from improper control of blood pressure levels, body weight and cholesterol levels as well in collaboration with higher blood glucose levels.

Recognizing the Signs and Symptoms

There are a few different types of diabetic neuropathy that can occur in those with both type 1 and type 2 diabetes. This is where recognizing the signs and symptoms may become a little challenging. The specific types include:

  • Autonomic Neuropathy: It impairs your digestive system, causing it to function improperly. This can result in constipation, diarrhea or even an impaired bladder. Most commonly, it can cause you to have changes in the way you perspire and even have an effect on your sex drive. For men, this may cause a decrease in sexual arousal and erection challenges. Women may notice they are experiencing more vaginal dryness than usual.One thing to watch out for with autonomic neuropathy is that it can also mask the symptoms of low blood sugar, hypoglycemia.
  • Focal Neuropathy: FN doesn’t discriminate, it will attack any nerve in the body and cause a sudden onset of weakness.
  • Peripheral Neuropathy: PN is one of the more common types of neuropathy that occurs with those who have diabetes. This can cause numbness and even pain in your feet, arms, hands, toes and leg
  • Proximal Neuropathy: Proximal neuropathy can cause weakness to occur in your hips, butt, thighs and legs.

Diagnosing pain and numbness

Because neuropathy caused by diabetes can cause a large variety of symptoms, there isn’t one key test or diagnostic tool to help a doctor diagnose you with the condition. They will relay greatly on doing a complete exam along with the description of your symptoms to help diagnose the condition.

Some tests doctors can use to help diagnose the condition are as follows:

  • Nerve conduction study
  • Heart rate variability test
  • Ultrasound

What Increases the Risk of Pain and Numbness

Virtually anyone who has diabetes, both type 1 or type 2, can develop pain and numbness. But the following risk factors can increase your chances of developing the condition:

  • How Long You’ve Had Diabetes: The risk increases the longer you have diabetes. You are at an even greater risk if your blood glucose control during this time has been uncontrolled.
  • Being Overweight: Having a BMI above 24 can increase your risk.
  • Poor Control of Blood Glucose Numbers: One of the biggest risk factors is having poor blood glucose control. Keeping your blood glucose numbers within a target range is important for decreasing your risk of most complications but especially diabetic neuropathy.
  • Kidney Disease: Diabetes causes damage to your kidneys which in turn will increase the number of toxins in your blood and contribute to a higher than normal risk of nerve damage.
  • Smoking: Smoking can decrease the space in your arteries as well as harden them. The narrowing of your arteries can decrease the flow of blood to your legs and feet. This can make it much more challenging for wounds to heal including any damage to your peripheral nerves.

Long Term Complications Associated with Pain and Numbness

Not dealing with treating your situation can increase your chances of developing many serious complications which include:

  • Charcot Joint: This condition is marked with a loss of sensation in your joints, most commonly the foot because it deteriorates due to nerve damage. Swelling, instability and even deformity in the joint can occur. Early treatment is important because it can promote much healthier healing and prevent any future damage.
  • Hypoglycemic Unawareness: Hypoglycemia happens when your blood glucose levels drop below a certain number typically 70 mg/dL. When hypoglycemic unawareness occurs, you dont feel your body dropping to these dangerously low levels, which can be potentially fatal if a low blood glucose level is not treated in a timely manner.
  • Digestive Issues: Nerve damage that occurs in the digestive region can cause severe complications such as diarrhea, constipation or alternating bouts of both. Neuropathy can also lead to an increased risk of developing a condition called gastroparesis. Gastroparesis is when the stomach empties very slowly or doesn’t empty at all. This can cause interference with your digestion and lead to vomiting, bloating, nausea, malnutrition and unmanaged blood glucose levels.
  • Urinary Tract Infections or Incontinence: Damage to the nerves which control your bladder can cause it to empty slowly or not quite completely. This will allow bacteria to enter your bladder or kidneys which can lead to urinary tract infections and even kidney infections. Nerve damage can also affect your body’s ability for you to feel when it’s time to urinate, leading to incontinence.
  • Sexual Dysfunction: Autonomic Neuropathy causes damage to the nerves that control your sex organs. This can lead to erectile dysfunction in me as well as problems in arousal or lubrication in women.
  • Increase or Decrease Sweating: When the glands that control sweating don’t work properly because of nerve damage, the body cannot regulate its temperature correctly. The complete lack of the body to perspire can be life-threatening if not treated promptly. Nerve damage in this area can also lead to an increase in sweating which can be embarrassing at times.

How to Decrease the Risk and Treatment of Pain and Numbness

You can prevent or decrease the risks and any complications that come with neuropathy, but first keeping your blood glucose levels within your target range and well controlled is the most important step. Following a healthy diabetic lifestyle consists of the following to help decrease your risk:

Blood Glucose Control

Keeping your levels within a tight controlled target range will require constant monitoring while taking all prescriptions properly, including insulin if needed. Keeping your levels within a controlled target range is one of the best ways you can prevent and decrease your risk of developing neuropathy as well as other diabetic complications. Consistency in your blood glucose levels is important because any shift or change in these levels can increase and even accelerate the rate that nerve damage may occur.

The American Diabetes Association recommends people to make sure they have an A1c test done at least 2 to 3 times a year to find out what their overall average blood glucose levels are for the past few months. If your control isn’t quite where it needs to be, speak with your diabetic care team and doctor to determine if a change in medications or treatment plan is necessary.

Your doctor can help to determine what the best target range for your blood glucose levels should be based on a few different factors such as age, length of diagnosis, health, and other medical conditions. But a common ‘controlled’ range of blood glucose levels with those with both type 1 and type 2 diabetes is:

  • Between 80 to 120 or 4.4 to 6.7 for those age 59 and younger that have not other medical conditions.
  • Between 100 to 140 or 5.6 to 7.8 for those age 60 and older with other underlying conditions such as lung, kidney and heart disease.

To slow progression it is recommended that you do the following consistently:

  • Follow all recommendations from your doctor for both blood glucose control and preventative foot care
  • Keep blood pressure levels within a healthy range
  • Follow a good eating plan
  • Get up and active with a frequent physical exercise
  • Quit smoking
  • Avoid any alcohol or only drink in moderation
  • Maintain a heathy weight level

Treatment for Relieving Pain

There are many different medications available that can help to relieve nerve pain, but it is important to check with your doctor as they are always effective for everyone. The side effects of the medication must be compared to the overall benefits. This is something your doctor can help to determine for you.

Alternative treatment therapies include capsaicin cream, acupuncture, chiropractic care, and physical therapy. These treatments are often used in collaboration with other traditional treatments such as medication.

Pain relieving medications for pain and numbness can include:

  • Anti-Seizure medications: Such as gabapentin (Neurotin), pregabalin (lyrica) and Carbamazepin (Carbatrol).
  • Antidepressants: Antidepressants such as desipramine (norpramin) and imipramine (tofranil) can help with some nerve pain management, but they also increase your risk of side effects such as weight gain, dry mouth, constipation and dizziness.
  • Some SNRIs such as duloxetine (Cymbalta) may relieve nerve pain but they also present increased side effects such as insomnia, fatigue, dizziness, decreased appetite, lightning or ice pick headaches and nausea.

Caring for Your Feet

Foot problems are one of the biggest complaints among those with type 1 or type 2 diabetes. This includes sores that don’t heal properly, ulcers and unfortunately, sometimes leading to amputation. You can prevent and decrease your risk of this happening by making sure you get a complete foot exam from a podiatrist at least one a year along with checking your feet frequently at home. To help protect your feet do the following:

  • Check Daily: Look for any cuts, bruises, peeling, red skin, swelling and blisters. Use a mirror if you cannot see or ask someone to help examine those hard to see regions.
  • Keep Feet Clean and Dry. Wash your feet properly each day with soap and water. Dry them between the toes but blotting them with a soft towel.
  • Moisturize your feet after to prevent any dryness and cracking from occurring. Don’t get lotion between your toes this can lead to an increase in fungal growth.


Are there other causes of pain and numbness besides diabetes?

While poorly controlled diabetes is one of the most common causes of pain and numbness, there are other conditions that can lead to the increased risk of developing the condition including:

  • Alcoholism
  • Vitamin Deficiency
  • Shingles
  • Kidney Failure
  • Certain medications
  • AIDS
  • Autoimmune conditions such as Lupus, RA, Gillian Barre syndrome
  • Inherited Disorders Like Amyloid Polyneuropathy

When should I contact my doctor?

Prompt and proper treatment is important when it comes to reducing the symptoms of pain and numbness. If you notice any changes in the sensations of your hands, feet, legs and arms, you may want to speak with your doctor immediately to determine the cause and avoid any drastic measures which can happen if you wait too long.

Can I cause permanent damage if I don’t treat it?

Early detection and prompt treatment are the main ways to prevent any further damage. Keeping your blood glucose levels within your target range is also very important as part of your treatment plan. Its important to develop this plan with the help of your doctor or diabetic care team and not to do any type of prevention on your own without their consent.

How common are they with people with diabetes?

Pain and numbness or neuropathy is one of the most common complications in those with both type 1 and type 2 diabetes. This is why keeping your blood glucose levels within the discussed target range your doctor has included in your management plan is extremely important.


It’s important, first and foremost, to discuss with your doctor if you feel you are experiencing any symptoms associated with pain and numbness or diabetic neuropathy. They can help to determine if in fact this is the condition you have and how to proceed with treatment. Keeping your blood glucose levels within your target range is your first line of defense when it comes to preventing the condition from occurring in the first place.

TheDiabetesCouncil Article | Reviewed by Dr. Jerry Ramos MD on August 15, 2018

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Last Updated: Saturday, September 8, 2018 Last Reviewed: Saturday, September 8, 2018

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What is diabetic neuropathy?

A neuropathy is a condition in which the nerves have become damaged. Diabetic neuropathy is a type of neuropathy in people either with type 1 or type 2 diabetes.

You have three types of nerves:

  • sensory nerves carry signals about touch, taste, sight, hearing and smell
  • motor nerves carry signals to help you move
  • autonomic nerves carry signals to help with balance, sweating, digestion and many of the things you do without thinking.

Diabetic neuropathy often affects sensory nerves to the feet and hands, but can also affect both the autonomic and motor nerves.

Symptoms of diabetic neuropathy

The most common symptoms of diabetic neuropathy are numbness, tingling, a burning sensation, aching, cramps and weakness. Most people find symptoms usually begin in their hands or feet. These symptoms may later spread to their arms and legs.

Diabetic neuropathy can also cause:

  • pain and discomfort in yours arms or legs, especially at night
  • sleep problems
  • bloating and digestion
  • heat intolerance
  • problems with walking.

If you suspect you might have diabetes, talk to your doctor or call the Diabetes Australia Helpline on 1300 136 588.

Check your symptoms using healthdirect’s online Symptom Checker.

What causes diabetic neuropathy?

It seems that having high levels of sugar in the blood for a long time damages the nerves. High levels of triglycerides, a type of fat found in the blood, can also cause nerve damage.

Other conditions can play a part, including:

  • high blood pressure
  • vitamin B deficiency
  • alcohol abuse
  • smoking
  • kidney disease or liver disease
  • some medicines, including some drugs used against cancer.

The longer you have had diabetes, the more likely you are to develop diabetic neuropathy.

Preventing diabetic neuropathy

Getting your blood sugar levels under control, and keeping them there, is the most effective way to prevent diabetic neuropathy.

Diagnosis of diabetic neuropathy

Your doctor will talk to you, examine you, and you will have some blood tests. They will look at your medical records, especially to check for blood sugar levels in the past. You might be referred to a neurologist, an endocrinologist or another health professional.

Prepare for your doctor’s appointment by using healthdirect’s Question Builder tool.

Preventing and treating diabetic neuropathy

Whether you’re trying to prevent diabetic neuropathy, or trying to stop it getting worse, the most important thing to do is to control your blood sugar levels. That means:

  • sorting out any medical problems (with the help of your doctor if necessary)
  • following the right diet for you
  • exercising regularly
  • taking or using any medication prescribed
  • avoiding things that can cause problems, such as smoking and excessive drinking.

If you have diabetic neuropathy, discuss with your doctor or diabetes nurse how to protect your skin and deal with pain. The usual pain relief, such as paracetamol and ibuprofen, might not work with the pain of diabetic neuropathy. If so, talk to your doctor about other forms of pain relief.

More information

Read more about diabetes on the Diabetes Australia website.

Everyone with diabetes has to be careful about their feet. Read more on the Diabetes NSW & ACT website.

Diabetic Neuropathy Symptoms

The symptoms of diabetic neuropathy depend on what type of neuropathy you have. Symptoms are dependent on which nerves have been damaged. In general, diabetic neuropathy symptoms develop gradually; they may seem like minor and infrequent pains or problems at first, but as the nerves become more damaged, symptoms may grow.

Don’t overlook mild symptoms. They can indicate the beginning of neuropathy. Talk to your doctor about anything you notice—such as any pain, numbness, weakness, or tingling—even if it seems insignificant. Your pain may mean the control of your diabetes could be improved, which will can help slow down the progression of your neuropathy. Pain and numbness are also important warning signs to take very good care of your feet, so you can avoid wounds and infections that can be difficult to heal and even raise risk for amputation. 1

Peripheral Neuropathy Symptoms

Peripheral neuropathy affects nerves leading to your extremities—the feet, legs, hands, and arms. The nerves leading to your feet are the longest in your body, so they are the most often affected nerves (simply because there’s more of them to be damaged). Peripheral neuropathy is the most common form of diabetic neuropathy.

Peripheral neuropathy symptoms include:

  • Pain
  • Burning, stabbing or electric-shock sensations
  • Numbness (loss of feeling)
  • Tingling
  • Muscle weakness
  • Poor coordination
  • Muscle cramping and/or twitching
  • Insensitivity to pain and/or temperature
  • Extreme sensitivity to even the lightest touch
  • Symptoms get worse at night. 2, 3

Autonomic Neuropathy Symptoms

The autonomic nervous system is in charge of the “involuntary” functions of your body. It keeps your heart pumping and makes sure you digest your food right—without you needing to think about it.

Autonomic neuropathy symptoms include:

Cardiovascular System

  • Dizziness just after standing
  • Fainting just after standing
  • Irregular heart rate
  • Quickly feeling tired and weak when you exercise. 4

Digestive System

  • Bloating
  • Constipation
  • Diarrhea
  • Nausea
  • Vomiting
  • Feeling full soon after you start eating.
  • The feeling that food isn’t moving through your digestive system – called gastroparesis.
  • Big blood-sugar swings (because digested food is reaching your intestines, where glucose is absorbed into the bloodstream, at irregular times). 5


  • Vision trouble at night or during sudden light changes (e.g., when stepping into a dark building from the sunlight)

Reproductive System

  • Sexual problems—erectile dysfunction in men; vaginal dryness in women; difficulty reaching orgasm for both.

Sweat Glands

  • Profuse sweating, especially at night or when eating particular foods (cheese commonly causes excessive sweating, for example, although that’s not true for every person with diabetic neuropathy)
  • Reduced sweating, especially in the legs and feet
  • Dry, flaky, thinning skin
  • Hair loss. 6

Urinary System

  • Incontinence
  • Frequent or urgent urination
  • Waking up often during the night to urinate
  • Trouble urinating.

People with autonomic neuropathy may also have trouble figuring out when their blood sugar level is too low—which is particularly dangerous for people with diabetes. This is called “hypoglycemia unawareness,” and it occurs when the normal responses to low blood sugar (sweating, shakiness, etc.) don’t kick in because of nerve damage.

Again, your symptoms depend on which autonomic nerves are damaged and which part of the body’s autonomic system they control.

Proximal Neuropathy Symptoms

Proximal neuropathy affects the buttocks, hips, thighs, and legs. Its symptoms aren’t usually long-term; they may go away after several weeks or months.

Symptoms include:

  • Weakness in the legs
  • Trouble standing up from a seated position without help
  • Sudden, severe pain pain in your hip, upper thigh and/or buttock on one side of the body
  • Pain or weakness in your arms after symptoms in your legs start improving

Focal Neuropathy Symptoms

Unlike the other types of diabetic nerve pain, focal neuropathy comes on suddenly, and it usually affects the head, torso, or legs. Symptoms usually go away after a few weeks; these aren’t long-term symptoms.

Possible focal neuropathy symptoms:


  • Vision trouble—double vision, ache behind an eye, difficulty focusing
  • Sudden paralysis of one side of the face (Bell’s palsy)


  • Pain in the chest
  • Pain in the stomach
  • Pain on the side
  • Pain in the low back


  • Pain in the front of the thigh
  • Pain on the outside of the shin
  • Pain on the inside of the foot

Updated on: 05/15/17 Continue Reading Diabetic Neuropathy: Causes and Symptoms View Sources

Steroid medicines and immunosuppressant medicines have recently been used to help speed recovery. However, as yet there is not enough evidence to be certain that this treatment is always effective.

How long the treatment is prescribed for depends on the course of the condition and the amount of nerve damage.

What is the outlook for patients with diabetic amyotrophy?

The outlook (prognosis) is usually good. Most patients recover well, although some symptoms may remain. The chances of making a good recovery – and remaining well (as the condition can relapse) – are improved by maintaining good diabetes control.

How do I prevent diabetic amyotrophy?

The best way to reduce your risk of developing this condition, as for many of the complications of diabetes, is to:

  • Avoid smoking.
  • Eat well but sensibly.
  • Maintain a healthy body weight.
  • Most importantly, retain as tight a control of your diabetes as is possible.

Diabetic amyotrophy can still occur. However, it is likely that recovery will be faster and easier if these elements are already in control.

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