AI-assisted summary: 

  • With diabetes-related neuropathy, glucose levels can affect how healthy nerves function.  
  • The condition happens when elevated glucose levels damage the body’s nerves over time, causing pain, numbness, and tingling in the feet. 
  • While there are effective treatments for neuropathy, prevention is key, along with regular monofilament testing. 

 

If you live with diabetes, you’ve likely had monofilament testing to check for nerve issues (neuropathy).  

It’s a simple test. A healthcare provider uses a thin, thread-like material similar to fishing line and touches it to different parts of your feet. It’s a basic but valuable tool for identifying a loss of feeling and is often how neuropathy is found in those with type 1 (T1D) and type 2 diabetes (T2D). 

It’s best practice to test for feeling in someone’s feet because early detection allows for timely interventions — and treatments work best when started early. Newer, FDA approved spinal cord stimulation (SCS) devices may be an effective treatment option.  

Here, we’ll take a closer look at what neuropathy is, how it’s identified and treated, and ways to decrease your risk. 

 

What causes neuropathy? 

Diabetes is the most common cause of neuropathy. Why? Because when glucose levels are out of target range, it can cause damage to the body’s nerves and lead to neuropathy over time. It can also result in other issues like skin sores and infections. 

While neuropathy is common in all types of diabetes, it’s more prevalent in T2D (about 42%) than in T1D (about 29%). 

That being said, it’s not just glucose levels that matter. There are other possible causes of neuropathy, including low levels of key vitamins, other health conditions like multiple sclerosis and vasculitis, and even certain medications used to treat cancer and heart disease. 

Take B12 levels, for example. Low vitamin B12 levels can commonly cause nerve pain. While B12 is readily absorbed from foods, vegetarians or vegans may not get enough. Plus, some health conditions prevent people from absorbing B12.  

If you take metformin for diabetes, it’s good to know that it can lower your B12 levels. If this is true for you, meaning you’re deficient in B12, taking a B12 supplement may help to improve your symptoms. Your provider will let you know if you need a B12 supplement and how much to take.  

Other low levels of vitamins and minerals, such as magnesium and vitamin D, may also contribute to neuropathy symptoms. Your healthcare team can measure your blood levels and make necessary suggestions. 

 

What are the signs and symptoms of neuropathy? 

Neuropathy can be a painful condition that about 25% of people with diabetes live with, according to the American Academy of Neurology.  

While there are different types, peripheral neuropathy is most common. It can affect the feet, legs, and sometimes hands. People with neuropathy often describe it as a “pins and needles,” and at first, may confuse it with the feeling of their foot “falling asleep.” 

Unlike a foot that “falls asleep” from too much pressure placed on it or from a shoe that’s too tight, neuropathy symptoms are not relieved by position changes or loosening footwear. And when symptoms aren’t improving, it’s time to rule out a medical reason.  

Common symptoms include: 

  • burning, 
  • tingling,  
  • numbness, and  
  • pain in the feet.

If you have any of these symptoms, they can become frustrating, limit your everyday activities, and even lead to severely disrupted sleep. 

 

What are the treatments? 

Treatments work by decreasing pain signals sent from damaged nerves to the spinal cord and brain. Treatments depend on the specific cause, with the goal of lessening symptoms, or at least preventing them from getting worse. Neuropathy isn’t always a diabetes-related condition.  

Your healthcare provider may refer you to a podiatrist (foot specialist) or a neurologist (neuropathy specialist) for a more thorough exam and recommendations. Treatments may include prescribed medications, supplements, spinal cord stimulation, or a combination of these therapies. 

While there are treatments for neuropathy, the focus is on prevention. That’s because while treatments may help to ease symptoms, once neuropathy develops, it’s generally a long-term condition. With diabetes, this means having an effective management plan and working towards improved time in the glucose range. 

 

What is a spinal cord stimulator (SNS)? 

A spinal cord stimulator is an implantable device about the size of a pacemaker. It works by sending electrical pulses to disrupt pain signals between the spinal cord and the brain. They are offered by Medtronic and Abbott, to name a few. 

SNS devices may be an option for someone with chronic pain who isn’t getting relief from other non-invasive treatments. Research results on SNS are encouraging. 

If your care team thinks SNS could be helpful for you, you can “test drive” a system with temporary leads connected to a device outside of the body. If the trial period is helpful, you may consider having an implantable device.  

 

How do I decrease the risk of diabetes-related neuropathy? 

While people with T1D are less likely than those with T2D to develop neuropathy, it can still occur.  

T1D is typically diagnosed sooner than T2D. That’s because with T1D, people get sicker, quicker. On the other hand, someone can live for years with T2D and elevated glucose before receiving a diagnosis and treatment. In turn, about 35% of people are diagnosed with neuropathy and T2D simultaneously.  

Again, prevention is key. If you notice symptoms of diabetes, it’s important to seek immediate care. 

One study found that those diagnosed early with T1D who met glucose goals decreased their neuropathy risk by about 78%. Whereas, with a later T2D diagnosis and long-standing high glucose, meeting glucose goals only reduced the risk of neuropathy by about 5% to 9%. 

 

What are lifestyle factors that I can change? 

Lifestyle factors can significantly influence the development and management of neuropathy. That’s why if you smoke, now is the time to quit. It’s also a wise choice to limit or avoid alcohol altogether. 

To support a healthy lifestyle, stay active, have a nutritious diet, and incorporate the following practices into your wellness routine: 

  • Meditation 
  • Yoga 
  • Acupuncture 
  • Physical therapy 

With these steps, you’re taking an active approach to better health and improved well-being. 

 

Wrapping it up 

Neuropathy can be a literal pain, but there are treatments available, and you don’t have to suffer alone. Act quickly by reaching out to your medical provider if you notice any telltale signs of neuropathy. Early detection of neuropathy is crucial because treatments are most effective when initiated promptly.