Home > Protocols & Procedures > Diabetes > Diabetic Neuropathy

Diabetic Neuropathy Causes & Treatments

What is Neuropathy

Neuropathy is a side effect of diabetes and many other conditions. It often causes pain, tingling and numbness by affecting the nerves. This kind of neuropathy affects the nerves outside of the brain and spinal cord, also known as the peripheral nervous system. Other types of diabetic neuropathies include autonomic neuropathy, sensory neuropathy and motor neuropathy. We'll come back to these later.

Peripheral Neuropathy

Peripheral neuropathy is the result of toxicity from the exposure to elevated blood sugar over time. High blood sugar causes inflammation, weakening of the blood vessels that supply nerves with nutrients and oxygen, and damage to delicate nerve fibers. Combined, the result is pain and tingling, and eventually, increasing numbness that can lead to complete loss of protective sensation. Patients who have diabetes should not smoke or drink, as these exacerbate the symptoms of neuropathy, and should be tested annually once properly diagnosed.


A Semmes-Weinstein test provides a quick and easy solution to neuropathy testing. It is conducted using a 5.07 monofilament, which exerts a noticeable force when bowed into a C shape against the patient's skin. When performed every six months, it can identify new areas were sensation may be decreased or lost, an important first step in preventing ulcers from pressure points that can lead to infection and amputation.

A tuning fork test works through vibration rather than through pressure at a single location. This test will allow patients to indicate where numbness begins and ends.

In order for intervention to occur in a timely manner, we recommend providing these tests to foot care patients diagnosed with peripheral neuropathy regularly.

Other Neuropathies

Sensory Neuropathy results from damage to nerves from long term elevation of blood sugar. It can also be related to other issues which can damage nerves. These include: Lyme Disease; Pernicious Anemia; latent Alcohol or drug abuse; heavy metal poisoning; chemotherapy; and many others. The most common effect of sensory neuropathy is a decrease in ability to feel pain or pressure. This can lead to injuries which can be neglected and lead to ulcerations, infections, and even amputation.

Motor Neuropathy affects small "intrinsic" muscles in the feet. This can lead to deformities such as hammertoes. Since Motor Neuropathy and Sensory Neuropathy often occur at the same time, the patient is at high risk of injury. The deformed hammertoes can rub in shoes and cause blisters or even open wounds. The patient doesn't feel the pain and often will fail to seek treatment until a devastating wound has formed.

Finally, Autonomic Neuropathy affects the organs and causes digestive complications. It oftentimes exists in conjunction with other types of neuropathies, such as Motor and Sensory Neuropathy. It's most apparent effect in the lower extremity is dry, thin, fragile skin that is easily damaged.


We offer a variety of in-person and at-home learning resources for foot care nurses. This DVD is a practical learning tool for the physical examination of the legs and feet. It outlines the examination of the four organ systems represented in the lower extremity: vascular, neurological, musculoskeletal, and dermatological and provides 2.0 Nursing CEUs.

Prevention is the key to a long and healthy life. There are a variety of helpful tools and lessons you can pass on to your patients to help them delay or prevent the onset of nerve damage. Once nerve damage occurs, it is not reversible.

Monitor Blood Sugar & Administer Insulin
By eating low-glycemic foods and monitoring blood sugar regularly, patients can prevent dangerously high blood sugar levels. Administering insulin as soon as blood sugar levels fall out of normal range will prevent prolonged exposure to toxic levels of blood sugar.

Inspect Feet for Injuries at Home
One of the most devastating aspects of foot care nursing is seeing patients who are unaware of ulcerations or injuries. Patients with neuropathy should ideally complete one thorough inspection of the lower extremities daily.

Common Treatments

There are a variety of medicines and alternative treatments that may be used to delay, prevent or soothe pain from neuropathy. Patients should talk to their primary care physicians to see if any of these treatments are recommended.

Capsaicin Cream
Capsaicin is what makes hot peppers hot. It has a variety of health benefits when consumed, and can also be found in a topical cream form. Capsaicin creams work because they affect the way pain signals are sent to the brain.

Pain Relievers
Over-the-counter pain medications can help relieve mild symptoms associated with neuropathy. For severe pain symptoms, a doctor may prescribe stronger painkillers.

Anti-Seizure Medication
This type of medication works by reducing electrical activity in the neurons. Because of this, it can also relieve nerve pain from neuropathy. Common side effects of anti-seizure medicines include drowsiness and dizziness.

Certain Kinds of Antidepressants
Some older classes of antidepressants may significantly improve nerve pain because they dampen signals sent to the brain. Side effects of tricyclic antidepressants include dry mouth, drowsiness, sweating and blurred vision.

Alternative Treatments

Some alternative treatments may be worth exploring for pain relief from neuropathy.

Acupuncture works by inserting tiny needles, which can stimulate nerves. According to traditional Chinese medicine, this practice restores the proper flow of energy through the body. Acupuncture is generally considered safe when performed by a certified practitioner using sterile needles.

Alpha Lipoic Acid
Some studies suggest that alpha lipoic acid can lower blood sugar levels to prevent neuropathy. Alpha lipoic acid is an antioxidant that can be found in green foods such as broccoli, spinach, Brussels sprouts and peas, red foods like beets and tomatoes, brewer's yeast and organ meat. It can also be taken as a supplement.
It's important for patients to discuss taking alpha lipoic acid with their primary care physician as it may interfere with another treatment you're receiving.