Diabetic peripheral neuropathy: what it looks like and what to do

Ever wake with burning feet or notice numb toes that steal your balance? That’s a common start for diabetic peripheral neuropathy — nerve damage caused by long-term high blood sugar. It doesn’t always hurt; sometimes the first clue is losing feeling so you don’t notice cuts or blisters.

This condition usually affects the feet and legs first, then moves up. You might feel tingling, sharp electric shocks, burning, or complete numbness. Symptoms often get worse at night and can make walking, sleep, and daily life harder. You can slow or stop progression in many cases, and you can treat the pain so you can sleep and move better.

How doctors check for it

Your clinician will start with questions and a simple exam: testing light touch with a 10‑gram monofilament, checking vibration with a tuning fork, and testing reflexes. They’ll want recent blood sugar records and an A1c. Blood tests may include vitamin B12, thyroid, and kidney checks because other problems can cause similar symptoms.

If the diagnosis is unclear or the weakness is severe, your doctor may order nerve conduction studies (EMG/NCS) or a small fiber skin biopsy. These tests help confirm the type and extent of nerve damage and guide treatment choices.

Practical treatments you can start now

First, get your blood sugar under control. Lowering your A1c slows nerve damage. That may mean adjusting meds, diet, or activity — talk with your diabetes team to set a safe target for you.

For nerve pain, several medicines work: gabapentin or pregabalin, and the antidepressant duloxetine are often first choices. Topical options like 5% lidocaine patches or capsaicin cream help some people without the side effects of pills. If you take metformin, ask about checking B12 — a low level can make neuropathy worse.

Non-drug steps matter a lot. Regular low-impact exercise (walking, cycling, water workouts) improves circulation and can cut pain. Keep a healthy weight, stop smoking, and limit alcohol — all of those reduce nerve damage risk. Wear well-fitting shoes, check your feet daily for cuts or blisters, and see a podiatrist if you find any sores or calluses. Simple foot care prevents infections and amputations.

For balance or severe weakness, physical therapy, orthotic insoles, or ankle braces help. Some people get relief from TENS (electrical stimulation) or referral to a pain specialist for advanced options.

See your doctor right away if you get a new open sore, spreading redness, fever, sudden weakness (like foot drop), or loss of feeling that interferes with walking. Early care keeps small problems from becoming emergencies.

Small steps — checking your feet every day, tightening blood sugar control, and asking about treatment for pain — make a big difference. If neuropathy is affecting you, start by booking a foot exam and an A1c check this week.