The tingling started in your toes. At first it was just pins and needles at night. Now there are evenings when your feet burn, and mornings when they feel oddly numb, as if you were wearing thick socks you never put on. Your doctor called it diabetic neuropathy, and you want to know two things: will it get worse, and what can you do about it?
Diabetic neuropathy is nerve damage caused by diabetes, and while it usually can’t be fully undone, you can do a lot to keep it from getting worse and to protect your feet. Keeping your blood sugar in range is the foundation. Daily foot checks prevent the injuries that numb feet can’t feel. And prescription treatment can ease the pain. This guide walks you through each, plus a two-minute routine you can start tonight.
Why diabetes affects your nerves
Over time, high blood sugar can damage nerves and the small blood vessels that feed them. NIDDK estimates that one-third to one-half of people with diabetes have peripheral neuropathy, the type that affects the feet and legs first and sometimes the hands and arms.
Common symptoms include:
- Tingling, burning, or “pins and needles,” often worse at night
- Sharp or shooting pains
- Numbness, or feeling less pain or temperature in your feet
- Muscle weakness, or changes in the shape of your feet
- Sores or blisters you didn’t feel happen
If your feet burn and you haven’t been diagnosed with diabetes, our guide on why your feet might burn at night covers other causes to check.
What can ease the pain
Keep blood sugar in your target range
NIDDK notes that managing your blood glucose is the most important step to prevent nerve damage or keep it from getting worse. Work with your care team on your personal targets. Steady control matters more than any single perfect day.
Ask about treatment made for nerve pain
Mayo Clinic notes that doctors use several types of prescription medicine for diabetic nerve pain, including some anti-seizure medicines and antidepressants that also calm pain signals. Common over-the-counter pain relievers often don’t help nerve pain much. Your doctor can weigh the options with your other conditions and medicines.
Daily habits that may help
- Gentle activity, such as walking or cycling, if your doctor says your feet are safe for it
- Comfortable, well-fitting shoes and seamless socks
- A regular sleep routine, since pain often feels worse when you’re short on sleep
- Not smoking, since smoking narrows blood vessels that feed your nerves and feet
What about alpha-lipoic acid and other supplements?
You’ll see alpha-lipoic acid, B vitamins, and “nerve support” blends advertised everywhere for neuropathy. Research results on supplements for diabetic nerve pain are mixed. The National Center for Complementary and Integrative Health advises people with diabetes to talk to their health care provider before using any supplement, because some can interact with diabetes medicines or affect blood sugar.
If you are low in vitamin B12, which can happen with long-term use of metformin, your doctor can test for it and treat it.
Your 2-minute daily foot check
Numb feet can’t warn you about a pebble in your shoe or a blister that’s turning into a sore. NIDDK recommends checking your feet every day. Make it part of a routine you already have, such as right after your evening shower.
| Step | What to look for | Tip |
|---|---|---|
| 1. Look at the tops and bottoms | Cuts, blisters, red spots, swelling, calluses | Use a mirror or ask someone to help if you can’t see the soles |
| 2. Check between the toes | Cracks, peeling, moisture | Dry well between the toes after washing |
| 3. Feel for heat | One area warmer than the rest | Warmth plus redness can signal infection |
| 4. Check your nails | Ingrown or sharp edges | Trim straight across and file sharp corners |
| 5. Check your shoes | Pebbles, rough seams, torn lining | Shake out and feel inside before putting them on |
Then follow these everyday rules:
- Never walk barefoot, even at home.
- Test bath water with your elbow, not your foot, since numb feet can’t judge heat.
- Moisturize the tops and bottoms of your feet, but not between the toes.
- Don’t treat corns or calluses yourself with blades or harsh chemicals.
- Have a health care professional check your feet at least once a year, and ask at every visit if you have concerns.
Your starting point with neuropathy
If you were just diagnosed with diabetes
Start the daily foot check now, even if your feet feel fine. Building the habit early is much easier than after a problem appears.
If your feet are already numb
Choose roomy shoes with closed toes, avoid heating pads and hot water bottles on your feet, and ask about seeing a podiatrist, a foot specialist.
If the pain keeps you up at night
Tell your doctor how much it affects your sleep. That detail often changes the treatment plan. Our guide on restless legs at night covers another common nighttime leg problem worth ruling out.
Foot problems that need care fast
Call your doctor or get care promptly if you notice:
- A cut, blister, or sore that isn’t healing after a few days
- Redness, warmth, or swelling in part of your foot
- Pus, a bad smell, or a wound that is getting bigger
- A change in the color of your foot, or a foot that suddenly looks misshapen
- New weakness, or tingling that is spreading quickly
Small foot wounds can become serious fast when you have diabetes, so early care matters.
Your first step tonight
After your evening shower, sit down with good light and go through the five steps of the foot check. It takes two minutes. Then put a pair of comfortable shoes by your bed so you never walk barefoot to the bathroom at night. At your next appointment, ask two questions: “Are my blood sugar numbers where they should be?” and “Is there a treatment for my nerve pain that fits me?”
Nighttime leg symptoms don’t always come from neuropathy. If your legs feel jumpy or you can’t keep them still in bed, our next guide explains what causes restless legs at night.
