Blog
Diabetic Neuropathy
Diabetic Neuropathy affects nerves, leading to pain, numbness, and organ dysfunction.
Covenant Metabolic Specialists
Physician Reviewed
Dec 3, 2025
Diabetic neuropathy encompasses a spectrum of nerve injuries caused by chronically elevated blood glucose and metabolic derangements. It affects peripheral, autonomic, proximal, and focal nerves, leading to pain, numbness, and organ dysfunction. Neuropathy reduces quality of life and increases risk of ulcers and amputations.
Symptoms
Peripheral neuropathy presents with burning, tingling, or numbness in feet and hands, often worse at night. Autonomic forms cause resting tachycardia, orthostatic hypotension, gastroparesis, bladder dysfunction, and sexual dysfunction. Proximal neuropathy triggers thigh pain and muscle weakness, while focal neuropathies strike cranial or truncal nerves suddenly.
Causes
Hyperglycemia drives oxidative stress, sorbitol accumulation, and inflammation in nerve cells, disrupting blood supply and axonal transport. High triglycerides and smoking exacerbate microvascular ischemia. Poor vitamin B12 status, especially with metformin use, can compound nerve injury.
Risk Factors
Longstanding diabetes, elevated A1c, hypertension, hyperlipidemia, obesity, smoking, alcohol misuse, and genetic predisposition all heighten neuropathy risk. Kidney disease further increases vulnerability due to toxin buildup.
Diagnosis
Diagnosis relies on detailed history, physical exam with monofilament and vibration testing, and assessment of autonomic function. Electromyography and nerve conduction studies quantify large‑fiber damage, while skin biopsy can measure small‑fiber density.
Treatments
Tight glucose control slows progression. Pain management includes duloxetine, pregabalin, or gabapentin, plus topical capsaicin. Alpha‑lipoic acid and vitamin B12 supplementation may help. Autonomic symptoms require tailored interventions—midodrine for hypotension, dietary changes for gastroparesis, and urology referral for bladder issues.
Prevention
Early achievement of near‑normal A1c, smoking cessation, regular exercise, and foot care inspections significantly reduce neuropathy onset and complications. Annual sensory testing enables prompt detection.
Our Take
Neuropathy pain can eclipse all other diabetes burdens. We employ a multidisciplinary approach, combining medication, physical therapy, and mindfulness techniques, because nerve health demands more than sugar control alone.
Diabetic neuropathy can be contained, if not fully reversed, through aggressive metabolic management, symptom‑targeted therapy, and vigilant foot care. Covenant emphasizes proactive screening and holistic pain strategies to preserve mobility and dignity.
