Early Signs of Diabetic Nerve Damage

Many people with diabetic nerve damage do not notice it at first. Some never feel pain at all. Knowing the early signs helps you catch it before it leads to a foot injury.

The most common early signs

These usually start in the toes and the balls of the feet, on both sides at about the same time:

• Tingling or “pins and needles”
• Numbness, or feeling like you are wearing socks when you are not
• Burning, sharp, stabbing or electric-shock pains
• Symptoms that are worse at night, or when the bed sheets touch your feet
• Not being able to tell hot from cold water with your feet
• Feeling unsteady, especially in the dark, because your feet are sending less information to your brain

Over months or years these symptoms can creep up the legs. When they reach about mid-calf, the fingertips often start to be affected too. Doctors call this the “stocking and glove” pattern.

Signs you might not connect to your nerves

• A blister, cut or sore on your foot that you did not feel happen
• Dry, cracked skin on the feet, or less sweating on the feet
• Changes in the shape of your toes or foot, such as hammertoes

Diabetes can also affect the nerves that run your internal organs (called autonomic neuropathy). Signs include dizziness or light-headedness when you stand up, a fast heart rate at rest, feeling full quickly, nausea, constipation or diarrhea, bladder problems, erectile dysfunction, sweating changes, and not feeling the usual warning signs of low blood sugar. Tell your doctor about any of these.

The danger of feeling nothing

Pain is unpleasant, but numbness is the bigger danger. If you cannot feel a stone in your shoe or a blister from new shoes, a small wound can turn into an ulcer or infection before you notice. Foot ulcers are a leading cause of hospital stays and amputations in people with diabetes, and most of them start with a minor injury in a foot that has lost feeling.

Why early detection matters

There is no treatment that reliably reverses established diabetic nerve damage. But finding it early lets you and your doctor improve blood sugar, blood pressure and other risk factors, start protective foot care, and treat pain if you have it. Guidelines recommend a nerve and foot screening:

• At diagnosis for type 2 diabetes
• Five years after diagnosis for type 1 diabetes
• Then at least once a year

The check is quick and painless. Your doctor touches your feet with a thin nylon filament (a monofilament) and tests vibration with a tuning fork, pinprick, or temperature sense.

When to call your doctor the same day

• A sore, blister or cut on your foot that is not healing, or that drains
• A foot that is red, hot or swollen, even if it does not hurt
• Black or blue skin, or a bad smell from a wound
• Fever along with any foot problem

Medical disclaimer: The information on this site is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always talk with your physician or other qualified healthcare provider about any medical condition or before starting any new treatment or supplement.