Watch: Dr. Kuwamura Explains Diabetic Neuropathy

In this video, Dr. Kuwamura discusses how diabetes can affect the nerves and explains why symptoms such as pain, tingling, numbness, and muscle changes should not be ignored. He also discusses treatment options that may help selected patients when nerve pain remains difficult to manage.

Diabetic neuropathy is an important condition to recognize because symptoms can develop gradually. Early evaluation can help identify the type of nerve problem, assess its severity, and determine what treatment and ongoing diabetes management may be appropriate.

What Is Diabetic Neuropathy?

Diabetic neuropathy is nerve damage associated with diabetes. Persistently elevated blood glucose and other metabolic changes can injure nerves and the small blood vessels that supply them. Over time, this damage may interfere with how nerves send sensory information and control certain body functions.

One common type is diabetic peripheral neuropathy, which affects nerves outside the brain and spinal cord, particularly those in the feet and legs. Some people experience burning, shooting, or electric-like pain. Others notice reduced sensation, tingling, or numbness. Symptoms can affect both feet, although the pattern varies.

Diabetic neuropathy is not limited to painful symptoms. Nerve damage can also reduce the ability to feel heat, cold, pressure, or an injury. When protective sensation is reduced, a blister, cut, or foot wound may go unnoticed and become more serious.

Diabetes can affect different groups of nerves, so not every person develops the same symptoms. A medical evaluation is important to determine whether symptoms are consistent with diabetic neuropathy or another condition that needs different treatment.

What Are the Symptoms of Diabetic Neuropathy?

Symptoms depend on which nerves are affected and how much damage has occurred. Peripheral neuropathy often starts in the toes or feet and may gradually extend upward into the legs. Some people develop symptoms in their hands as well.

When should you speak with a healthcare professional?

If you have diabetes and notice persistent burning, tingling, numbness, unexplained foot pain, or changes in sensation, arrange a medical evaluation. Do not wait for symptoms to become severe. Early assessment can help identify potential nerve damage and guide care.

Seek prompt medical attention for a new foot wound, spreading redness, swelling, drainage, or signs of infection. Sudden or rapidly worsening weakness, especially with new bladder or bowel problems or numbness around the groin, requires emergency evaluation.

How Does High Blood Sugar Damage the Nerves?

Diabetes can affect nerves through several interacting processes. High blood glucose over time can disrupt normal nerve function and damage the small blood vessels that deliver oxygen and nutrients to nerve tissue. Metabolic and inflammatory changes may also contribute to nerve injury.

The nerves carry messages between the body and the brain. Sensory nerves help you recognize pain, temperature, and touch. Motor nerves help control movement, while other nerves regulate functions such as digestion, heart rate, and blood pressure.

When nerves are damaged, they may send abnormal signals, which can create burning or shooting pain. Alternatively, they may transmit signals less effectively, causing numbness or reduced sensation.

Why can diabetic neuropathy affect the feet first?

Many peripheral nerve fibers are long, extending from the spinal cord down to the feet. These longer nerves are particularly vulnerable to certain types of metabolic injury. As a result, symptoms of diabetic peripheral neuropathy often begin in the toes or feet before moving farther up the legs.

However, not every case of foot pain, tingling, or numbness is caused by diabetes. Nerve compression, circulation problems, vitamin deficiencies, medication effects, and other medical conditions can produce similar symptoms. A clinician can help determine the likely cause.

How Is Diabetic Neuropathy Diagnosed?

Diagnosing diabetic neuropathy involves reviewing symptoms, medical history, and physical examination findings. The clinician may assess sensation, reflexes, muscle strength, balance, and the condition of the feet. Tests may be recommended when the diagnosis is uncertain or another cause needs to be considered.

An evaluation may include:

• Symptom review: When symptoms began, where they occur, how they feel, and whether they are changing.
• Sensation testing: Checking the ability to feel touch, vibration, or pressure in the feet.
• Strength and reflex assessment: Looking for signs that motor nerves or nerve pathways may be affected.
• Foot examination: Checking for skin changes, wounds, deformities, or other problems that may require attention.
• Laboratory testing: Depending on the situation, testing may help evaluate glucose control or identify other possible causes of neuropathy.
• Nerve studies or other testing: Nerve conduction studies, electromyography, or other investigations may be appropriate for selected symptoms.

Imaging is not required to diagnose every case of diabetic peripheral neuropathy. It may be considered when symptoms or examination findings suggest a structural problem, such as nerve compression in the spine, or another diagnosis that requires further investigation.

The goal is to understand what is causing the symptoms before selecting treatment. That distinction matters because diabetic peripheral neuropathy and a compressed spinal nerve can sometimes cause overlapping symptoms but may require different approaches.

What Are the Treatment Options for Diabetic Neuropathy?

Treatment depends on the type of neuropathy, symptom severity, overall health, and the patient's goals. Care often involves managing diabetes and other health risks while treating pain and protecting the feet from injury.

1. Blood sugar management and medical follow-up

Working with the healthcare professional managing your diabetes is essential. Keeping blood glucose within the individualized target range may help reduce the risk of developing or worsening some diabetes-related complications. The appropriate plan may also address blood pressure, cholesterol, smoking, nutrition, and physical activity.

Improved glucose control does not necessarily reverse established nerve damage or eliminate existing pain. Nevertheless, diabetes management remains an important part of protecting long-term health.

2. Medication for nerve pain

Certain prescription medications can help reduce painful diabetic neuropathy. The best option depends on the patient's symptoms, other medical conditions, potential side effects, and other medications. A clinician can discuss expected benefits, risks, and alternatives.

3. Foot care and injury prevention

When sensation is reduced, daily foot care becomes especially important. Inspect your feet for blisters, cuts, redness, swelling, or changes in skin condition. Wear properly fitting footwear and avoid walking barefoot if you have reduced sensation. Ask your healthcare professional how often your feet should be examined.

4. Physical activity and healthy routines

Physical activity suited to your abilities can support general health and diabetes management. A healthcare professional can help you choose safe activities, especially if you have pain, balance difficulties, reduced sensation, or foot wounds.

5. Specialized treatment for persistent nerve pain

Some patients continue to experience significant nerve pain despite medication and other treatments. For selected people with chronic, difficult-to-manage painful diabetic peripheral neuropathy, a specialist may discuss additional treatment options, including spinal cord stimulation.

Spinal cord stimulation is not a treatment for high blood sugar and does not cure diabetes. Its purpose is to help manage certain types of chronic pain. Whether it is appropriate depends on the patient's diagnosis, health, prior treatment, and evaluation by qualified clinicians.

Spinal Cord Stimulation for Diabetic Neuropathy: How Does It Work?

Spinal cord stimulation (SCS) is a treatment that uses an implanted device to deliver electrical pulses through leads positioned near the spinal cord. The stimulation is intended to change how pain signals are processed, helping some patients experience less chronic pain.

Certain spinal cord stimulation systems have FDA-approved indications to help manage chronic, difficult-to-treat pain associated with diabetic peripheral neuropathy in the lower extremities. The specific indication and stimulation method depend on the device. SCS is not suitable for everyone, and patients typically undergo a structured evaluation to determine whether it may be appropriate.

What does the device do?

A spinal cord stimulator generally includes leads that deliver electrical stimulation and a pulse generator that powers the system. The clinician programs the device according to the therapy and the patient's needs. The goal is to manage pain—not to lower blood glucose, repair every damaged nerve, or eliminate the underlying diabetes.

Who may be considered for spinal cord stimulation?

A specialist may consider SCS for certain patients with persistent, severe diabetic nerve pain that has not responded adequately to other treatments. The evaluation considers the patient's diagnosis, health status, treatment history, ability to use the device, and whether the expected benefits outweigh the risks.

For appropriate patients, a temporary stimulation trial may be used to evaluate pain relief before a permanent device is considered. The process, eligibility criteria, and expected outcomes should be discussed with the treating team.

What are the potential benefits and risks?

Some appropriately selected patients experience meaningful pain relief. Results vary, and no outcome can be guaranteed. SCS also involves procedural and device-related risks, including infection, bleeding, lead movement, device complications, and the possibility of inadequate pain relief or further procedures.

Your clinician should explain the potential benefits, limitations, alternatives, and risks specific to the device being considered. You should also continue working with your diabetes care team because spinal cord stimulation does not replace diabetes management or regular foot care.

To learn more about back and nerve-related conditions evaluated at MD Spine Care, visit the spine conditions page or contact the practice to discuss whether an evaluation is appropriate.

Can You Prevent or Slow Diabetic Neuropathy?

Not every case of diabetic neuropathy can be prevented, and existing nerve damage may not fully reverse. However, managing diabetes and other health risks can help reduce the likelihood of certain complications and support overall health.

• Follow your diabetes care plan: Work with your healthcare professional to set appropriate glucose targets and review medications regularly.
• Attend routine appointments: Regular checkups can help identify changes in sensation, foot health, and other diabetes-related complications.
• Inspect your feet daily: Look for cuts, blisters, redness, swelling, or wounds that may not be painful.
• Choose safe physical activity: Exercise can support general health, but activities should be adapted if you have foot problems, reduced sensation, or balance concerns.
• Discuss nutrition and lifestyle: Ask your diabetes care team about eating patterns, smoking cessation, and other changes that may support your health.
• Report symptoms early: Do not ignore new numbness, burning, tingling, weakness, or changes in walking.

Healthy habits are valuable, but diabetic neuropathy is not simply a matter of willpower or lifestyle choices. Diabetes-related nerve injury can occur for several reasons. If symptoms develop, medical assessment is important even if you already follow your treatment plan.

Diabetic Neuropathy vs. Nerve Compression: Why the Difference Matters

Burning, tingling, numbness, and pain can result from more than one condition. Diabetic peripheral neuropathy commonly affects the feet and legs, often in a pattern involving both sides. Nerve compression in the spine can produce symptoms that travel along a particular nerve pathway, sometimes affecting one side more than the other.

These patterns can overlap, and symptoms alone are not enough to establish a diagnosis. A healthcare professional may consider your medical history, physical examination, and testing to determine whether symptoms are related to diabetic neuropathy, a spinal condition, or another cause.

If you have back pain along with leg symptoms, or neck pain accompanied by arm symptoms, an evaluation may help determine whether a spinal problem is contributing to the discomfort. Learn more about herniated discs and spinal stenosis.

Exploring Diabetic Neuropathy Treatment in San Antonio, TX

Living with persistent nerve pain can affect sleep, mobility, and daily activities. If you are experiencing burning feet, tingling, numbness, or other symptoms, the first step is to identify the likely cause and understand the treatment options available for your situation.

MD Spine Care provides evaluation and treatment planning for back, neck, and nerve-related conditions in the San Antonio area. Depending on your symptoms and diagnosis, a clinician can help determine whether spine-related evaluation or further specialist care may be appropriate.

If you have diabetes, continue working with the clinician who manages your blood sugar and diabetic complications. A spine or pain specialist may be part of your care team when persistent nerve pain requires additional evaluation.

Frequently Asked Questions About Diabetic Neuropathy