Expert-reviewed by Ashwini S.Kanade, Registered Dietician and Certified Diabetes Educator with 17 years of experience
Nerve damage in diabetes is characterised by tingling and pinprick-like sensations, and pain and numbness in the hands and feet. More commonly known as diabetic neuropathy, it is, in fact, one of the most common complications of diabetes caused by sustained high levels of blood sugar in your body.
What is diabetic neuropathy?
Diabetic neuropathy is a term for nerve disorders associated with diabetes. Depending upon the part of the body affected, diabetic neuropathy is classified into:
- Peripheral neuropathy
- Sensory neuropathy
- Autonomic neuropathy
- Focal neuropathy
In this article, we will talk in detail about peripheral neuropathy.
Peripheral neuropathy is damage that affects the nerves in the peripheries, which are your arms and legs, causing tingling, pain and numbness.
These symptoms first affect the feet and then the hands, and gradually spread to the entire limb. The sensation is similar to that of wearing stockings or gloves. Physicians also call this the ‘stocking-glove’ pattern. Some people may become overly sensitive to touch.
If not attended to, the nerve damage may worsen over the years (10 to 20 years), and additional symptoms could include:
- Weakness and dizziness
- Weight loss, as you may lose muscle mass
- Loss of balance and co-ordination
- Problems with digestion
- Problems with sexual functioning
- Ulcers in the feet
As the symptoms develop gradually, you may not even notice them until they become severe or complicated.
As many as 10.5%-32.2% of people with diabetes in India already have peripheral neuropathy, and almost 50% will develop the condition during the course of their disease. 
Who is at risk for peripheral neuropathy?
Anyone with diabetes can develop peripheral neuropathy. However, you are at an increased risk of developing the condition if you:
- are more than 55 years of age
- have a longer duration of diabetes
- have problems managing your blood sugar
- have high blood pressure
- are overweight
How does peripheral neuropathy develop?
Researchers are yet to conclusively determine the exact mechanism of how peripheral neuropathy develops. However, there is no doubt that high blood sugar levels are the main culprit. Recent studies show that apart from high blood sugar levels, metabolic disorders and changes in blood vessels high blood pressure, excess body fat especially around the waist, and high cholesterol levels also contribute to the development of peripheral neuropathy.
Furthermore, high sugar levels in the blood damage blood vessels, affecting the blood supply to the nerve tissues in the limbs. This causes a shortage of oxygen supply to the nerve tissues, resulting in irreversible damage. 
Care and management for peripheral neuropathy
Unfortunately, there is no cure for diabetic neuropathy. Your doctor may prescribe medications to relieve the symptoms, such as pain relievers, anti-seizure medication or antidepressants. Topical treatments in the form of creams or ointments such as capsaicin cream can help relieve the symptoms.
The best way to prevent further nerve damage is to manage your blood sugar levels.
The following tips may also help control the condition:
- Get as much exercise as you can. Exercise will not only relieve pain but also improve your mood. Walking, gardening, doing house chores, and any moderate activity counts as exercise.
- Take good care of your feet. Gently cleanse your feet every evening; dry them thoroughly and moisturize them. Check for cuts, blisters, or wounds on your feet regularly; if present, get in touch with your doctor immediately if there is a delay in their healing.
- Smoking is a big no-no if you are suffering from diabetic neuropathy as it can increase the risk of feet problems. Smoking also increases pain perception. 
- Cut back on alcohol.
- Invest in a pair of good shoes. Your shoes have to be comfortable and roomy. Avoid heels and flip-flops.
A healthy diet is also necessary to keep blood sugar levels under control:
- Limit sugary and fatty foods.
- Eat smaller portions but eat frequently; have at least five meals a day.
- Eat lots of fruits and vegetables.
- Avoid fruit juices as they have less fibre and high sugars.
- Fruits such as fresh berries, oranges, and apple in limited quantities are beneficial.
- Avoid high carb vegetables such as potatoes and corn, and have greens such as lettuce or spinach as they are high in fibre. But no vegetable is completely off limits.
- Shift to whole grain foods.
- Avoid processed foods, like chips, biscuits, ready-to-eat meals, etc., as much as possible.
To further manage peripheral neuropathy, your doctor may recommend certain therapies:
- Transcutaneous Electrical Nerve Stimulation (TENS) is a procedure in which a gentle electric current is delivered via electrodes attached to the body.
- Physiotherapy is also helpful in relieving neuropathic pain. You may ask your doctor for suggestions.
Apart from these, some yoga asanas can help increase blood circulation in the body, especially to the feet. If you don’t have any experience with yoga, it is best to take guidance from a certified yoga instructor. Yoga will not only help with pain relief, but it will also help in keeping you active, relieve stress as well as increase your self-awareness.
- S.Trivedi, A. Pandit, A., G. Ganguly, G., & Das, S. K. (2017). Epidemiology of Peripheral Neuropathy: An Indian Perspective. Annals of Indian Academy of Neurology, 20(3), 173–184.
- M. Zychowska, E. Rojewska, B. Przewlocka, J. Mika. Mechanisms and pharmacology of diabetic neuropathy – experimental and clinical studies. Pharmacological Reports. (2013) 65, 1601-1610. ISSN 1734-1140.
- American Academy of Neurology. Understanding Peripheral Neurology.