Diabetic Neuropathy: Types, Symptoms, and Treatments

Written by Kendall K. Morgan
Medically Reviewed by Zilpah Sheikh, MD on January 26, 2026
9 min read

Diabetic neuropathy is nerve damage that can happen when you have diabetes that's not well controlled. It can happen in many ways, and they all seem to be related to blood sugar levels being too high for too long. 

"Although the exact mechanism of diabetic neuropathy is not known, there are a number of ways elevated blood sugar can cause neuropathy," says Laura Rosow, MD, a neurologist at the University of California San Francisco Weill Institute for Neurosciences. 

"One way is by interfering with chemical pathways within nerves that allow them to transmit signals. Another way is by causing damage to tiny blood vessels that supply the nerves with nutrients and oxygen. Longer duration of diabetes and higher average blood sugar levels are both associated with an increased risk of developing neuropathy."

To prevent it, work with your doctor to manage your blood sugar. Many people with diabetes will have this complication, but it may be prevented by taking your medicine and taking other steps to improve your health.

You may hear your doctor mention the four types of diabetes-related neuropathy: peripheral, autonomic, proximal, and focal.

Diabetic peripheral neuropathy is nerve damage in your peripheral nervous system caused by chronically high blood sugar and diabetes. Peripheral nerves include everything outside your brain and spinal cord, or the central nervous system. This type of neuropathy leads to numbness, loss of sensation, and, sometimes, pain in your feet, legs, or hands.

"Most commonly, diabetes affects the longest nerves in the body first, including the nerves in the feet," Rosow says. "This can manifest as numbness, pain, tingling, or weakness in the feet and toes and may cause issues with walking and balance. As this type of neuropathy progresses, it may creep upward towards the knees and can eventually involve the hands as well, potentially leading to issues with fine motor control."

As many as 60%-70% of all people with diabetes eventually develop diabetic peripheral neuropathy, although not all may have pain. Yet this nerve damage is not inevitable. Studies have shown that people with diabetes can lower their risk of developing nerve damage by keeping their blood sugar levels as close to normal as possible.

Symptoms of diabetic peripheral neuropathy

People describe the early symptoms of peripheral neuropathy in many ways. You may feel:

  • Tingling
  • Numbness (which may become permanent)
  • Burning (especially in the evening)
  • Pain, which can be sharp
  • Pins and needles
  • Prickling
  • Cold
  • Pinching
  • Buzzing
  • Deep stabs
  • Cramps

The symptoms are often worse at night. Be on the lookout for these changes in how you feel:

Touch sensitivity. You may feel heightened sensitivity to touch or a tingling or numbness in your toes, feet, legs, or hands.

Muscle weakness. Chronically elevated blood sugars can also damage nerves that tell muscles how to move. This can lead to muscle weakness. You may have trouble walking or getting up from a chair. You may also have trouble grabbing things or carrying things with your hands.

Balance problems. You may feel more unsteady than usual and uncoordinated when you walk. This happens when the body adapts to changes brought on by muscle damage.

How to treat diabetic peripheral neuropathy 

Early symptoms usually get better when your blood sugar is under control. There are medications to help manage the discomfort.

Other steps you can take to avoid or help with the symptoms include:

  • Check your feet and legs daily. Look for blisters, calluses, and cuts.
  • Apply lotion if your feet are dry. But avoid getting lotion in between your toes; this area should be kept dry.
  • Care for your nails regularly (go to a podiatrist if necessary).
  • Wear properly fitting footwear. Some people with bone abnormalities may need custom shoes to redistribute pressure.
  • Wear your shoes most of the time to avoid injury.
  • People with claudication may need a referral to a doctor or surgeon who specializes in poor circulation.
  • Control blood sugar, cholesterol, and high blood pressure.
  • If you smoke, quit.

Diabetic autonomic neuropathy is caused by diabetes-related nerve damage to your autonomic nervous system. Your autonomic nervous system is the part of your peripheral nervous system that controls your body's involuntary or automatic functions, including the pumping of your heart, blood pressure, digestion, and temperature. Autonomic nerves connect your brain to your internal organs. This type of diabetic neuropathy usually affects the digestive system, especially the stomach. It can also affect the heart, blood vessels, urinary system, and sex organs.

This type of diabetic neuropathy isn't well understood compared to other types. But it may come with more risk for heart-related complications and death. Some studies suggest that about 20% of people with diabetes have signs of abnormal heart function. Most people who have diabetic autonomic neuropathy will have other types of peripheral neuropathy, too.

Diabetic autonomic neuropathy can make it harder to notice signs of your blood sugar being low. You may have trouble controlling your body temperature; you may sweat a lot. You may have trouble seeing when you turn off the lights because your eyes don't adjust like they should. You may also have many other signs in your digestive system, circulatory system, bladder, and sex organs.

Symptoms of diabetic autonomic neuropathy in your digestive system

Symptoms include:

How to manage the symptoms of diabetic autonomic neuropathy in your digestive system

You may need to eat smaller meals and take medication to treat them.

Symptoms of diabetic autonomic neuropathy in blood vessels

Common symptoms may include:

How to manage the symptoms of diabetic autonomic neuropathy in blood vessels

Avoid standing up too quickly. You may also need to wear special stockings (ask your doctor about them) and take medicine.

Symptoms of diabetic autonomic neuropathy in male sex organs

People assigned male at birth may not be able to have or keep an erection, or they may have "dry" or reduced ejaculations.

How to manage the symptoms of diabetic autonomic neuropathy inpeople assigned male at birth

See your doctor, because there are other possible causes besides diabetes. Treatment may include:

  • Counseling
  • Penile implant or injections
  • Vacuum erection device
  • Medication

Symptoms of diabetic autonomic neuropathy infemale sex organs

People assigned female at birth may have less vaginal lubrication. Diabetic autonomic neuropathy also may make it hard to have an orgasm, so you may have fewer or no orgasms.

How to manage the symptoms of diabetic autonomic neuropathy inpeople assigned female at birth

See your doctor. Treatment options include:

  • Counseling
  • Estrogen
  • Vaginal estrogen creams, suppositories, and rings
  • Medications to help sex not feel painful
  • Lubricants

Symptoms of diabetic autonomic neuropathy in the urinary system

You may have:

  • Trouble emptying your bladder completely
  • Bloating
  • Incontinence (leaking urine)
  • More bathroom trips to pee at night

How to manage the symptoms of diabetic autonomic neuropathy in the urinary system

Tell your doctor. Treatments may include:

  • Medication
  • Inserting a catheter into the bladder to release urine (self-catheterization)
  • Surgery

Diabetic proximal neuropathy happens when there's damage from diabetes to nerves in your thighs, hips, buttocks, or legs. It's more common when you have type 2 diabetes and are 50 or older. 

Symptoms of diabetic proximal neuropathy

This type of neuropathy may cause pain in the thighs, hips, or buttocks. The pain is usually on one side. It can also lead to weakness in your legs. You may also notice:

  • Shrinking of the muscles in your legs
  • Trouble getting up after sitting
  • Pain in your stomach or chest
  • Weight loss
  • Loss of your reflexes

How to treat the symptoms of diabetic proximal neuropathy

Most people with this condition need treatment. Your doctor may recommend medication and physical therapy to help you with your weakness, pain, or other symptoms.

Diabetic focal neuropathy affects only one particular nerve. It's also called mononeuropathy. This type can appear suddenly, most often in the head, torso, or leg. It can cause muscle weakness or pain along with a variety of symptoms, depending on the nerve that's affected.

Symptoms of diabetic focal neuropathy

How to manage the symptoms of diabetic focal neuropathy

Tell your doctor about your symptoms. Focal neuropathy is painful and unpredictable. But it tends to improve by itself over weeks or months. It usually doesn't cause long-term damage.

People with diabetes can also get other nerve-related conditions, such as nerve compressions or "pinched" nerves (entrapment syndromes).

Carpal tunnel syndrome is a very common type of entrapment syndrome. It causes numbness and tingling feeling in the hand and, sometimes, muscle weakness or pain. You may also get ulnar neuropathy at the elbow, Rosow says.

If you think you may have any type of nerve problem, talk with your doctor. They can check for the cause.

You can't cure diabetic neuropathy or fix nerve damage that's already happened. But you can take steps to manage your symptoms and keep your nerve damage and diabetic neuropathy from getting worse. Work with your care team to control your blood sugar with medication and healthy lifestyle changes, including good nutrition.

"Once present, diabetic neuropathy is generally not considered to be reversible," Rosow says. "If it is caught in its early stages, however, progression and complications can be minimized with good and careful treatment.  The best treatment to help minimize progression of diabetic neuropathy is excellent blood sugar control."

Other treatments that can help with diabetic neuropathy pain or other symptoms include:

  • Pregabalin
  • Gabapentin
  • Capsaicin

Therapy also may help. Ask about:

  • Physical therapy
  • Occupational therapy (OT)
  • Speech therapy
  • Acupuncture

"Diabetic neuropathy is very common, but the risks of developing it can be minimized with good medical care," Rosow says. "Make sure to keep up with regular primary care appointments, stay physically active as much as possible, and stay on top of any other medical conditions that can worsen your risk of diabetic neuropathy. If you do develop diabetic neuropathy, know that this is a very manageable condition and that people with diabetic neuropathy can lead very full and active lives!"

To manage diabetic neuropathy as best you can, Rosow recommends seeking help from a variety of specialists in addition to your primary care doctor, including:

  • Endocrinologists
  • Neurologists
  • Physical therapists
  • Occupational therapists
  • Pain management specialists

Diabetic neuropathy is nerve damage from high blood sugar when you have diabetes that's not well controlled. Not everyone with diabetes will get diabetic neuropathy. Symptoms of diabetic neuropathy will depend on which nerves are affected and the type of diabetic neuropathy you have. You can't reverse nerve damage that's already happened, but you can take steps to lower your blood sugar, manage your symptoms, and keep your diabetic neuropathy from getting worse.

How long does diabetic neuropathy take to develop​?

It depends. Some people don't realize they have diabetes until they start seeing signs of diabetic neuropathy. Others might develop neuropathy 10 years after finding out they have diabetes, and many people with diabetes never get diabetic neuropathy. Your risk of getting it rises with longer-term diabetes and higher blood sugar.

What is the best treatment for diabetic neuropathy in the feet?

There's no cure or foolproof way to ease the symptoms of diabetic neuropathy in your feet. Take steps to lower your blood sugar to keep nerve damage from getting worse. Ask your doctor what oral or topical medications they recommend you try. Physical therapy, acupuncture, or other types of therapy may also help.

Can you have neuropathy without diabetes?

Yes. Diabetes is just one cause of neuropathy. Other things that can cause it include autoimmune diseases, infections, genetic disorders, cancer, bone marrow disorders, and other types of conditions that affect your metabolism. You also can get neuropathy from alcohol use disorder, toxins, chemotherapy or other medicines, injury or pressure on your nerves, or vitamin deficiencies. Sometimes, neuropathy happens for reasons that aren't known.