Diabetic Neuropathy

Diabetic neuropathy is the most common form of peripheral neuropathy, affecting up to 60–70% of people with diabetes over their lifetime. It can take several forms, with peripheral (feet first) being the most common. Tight blood sugar control is the cornerstone of prevention and slowing progression.

Key Takeaways

  • Up to 70% of diabetics develop some form of neuropathy.
  • There are four main types: peripheral, autonomic, proximal, and focal.
  • HbA1c targets generally aim for under 7% (or as advised individually).
  • Annual foot exams are essential for everyone with diabetes.
  • Early intervention dramatically reduces ulceration and amputation risk.

Frequently Asked Questions

What causes diabetic neuropathy?
Sustained high blood sugar damages small blood vessels that supply nerves, and produces metabolic byproducts (such as advanced glycation end-products and sorbitol) that injure nerve fibers directly. Risk increases with longer duration of diabetes, higher HbA1c, smoking, high blood pressure, and high cholesterol.
What HbA1c is needed to prevent diabetic neuropathy?
Most guidelines target HbA1c below 7% for most adults with diabetes, individualized based on age, comorbidities, and hypoglycemia risk. Landmark trials (DCCT and UKPDS) showed that tight control reduces the risk of new neuropathy by roughly 60% in type 1 and significantly in type 2 diabetes.
What are the warning signs of diabetic foot complications?
Seek prompt care for any new foot ulcer, blister, redness, swelling, warmth, drainage, foul odor, blackened tissue, sudden change in foot shape (possible Charcot foot), or fever in combination with foot symptoms. Diabetic foot infections can progress quickly.
How often should I have a diabetic foot exam?
All adults with diabetes should have a comprehensive foot exam at least once a year, and more often if neuropathy, foot deformity, prior ulcer, or peripheral artery disease is present. Examine your own feet daily, including the soles and between the toes.
Can diabetic neuropathy be reversed?
Established diabetic neuropathy is generally not reversible, but tight glucose control can slow or halt progression and may modestly improve symptoms. Restoring normal glucose after a relatively short duration of disease offers the best chance of partial recovery.