Diabetic nerve pain in feet - will burning and numbness ever go away?
Patient's Query
Doctor, I have diabetes for only 5 years, but I have burning pain in my feet, tingling, and numbness. Sometimes my chappals slip off because I do not feel the grip properly.
My sugars are better now, but the symptoms are still there, even after taking nerve pain tablets. My father has diabetes for 10 years and his sugars are not well controlled, but he does not have this problem like me. That is why I am worried.
Why is it happening to me so early? Will this neuropathy go away if my sugars stay controlled, or is it permanent? How do I know if it is reversible or not? What tests should I do, and what else can cause these symptoms apart from diabetes?
Doctor Answers
What you describe fits peripheral neuropathy, but one important point first. Diabetic neuropathy is a diagnosis of exclusion. We must also look for other treatable causes.
Why you can have more symptoms than your father:
- People feel pain differently. Some get severe burning early, others stay numb without much pain.
- You may have vitamin B12 deficiency (common with long-term metformin), thyroid issues, alcohol use, smoking, low vitamin intake, or nerve compression.
- Sometimes neuropathy appears even in prediabetes, because small nerve fibres can get affected early.
Can it improve? Yes, but it depends on which symptom.
- Burning pain and tingling often improve over months when glucose is stable and triggers are treated.
- Numbness improves slowly, and sometimes does not fully reverse, because nerve fibre loss is harder to rebuild.
- If symptoms started after a rapid fall in HbA1c, it can be treatment-induced neuropathy (also called insulin neuritis). It is painful, sudden, and can improve gradually with stable control.
A simple way to think of it is your pipe example. High sugar is like hard water that damages the inside. Medicines and lifestyle reduce further damage, but the old damage takes time to settle.
What to do next:
- Check B12, TSH, kidney function, and consider nerve testing if needed.
- Aim for steady sugars, avoid big ups and downs.
- Daily foot care, proper footwear, and treat pain with evidence-based medicines as advised.
References:
- https://diabetesjournals.org/care/article/40/1/136/37160/Diabetic-Neuropathy-A-Position-Statement-by-the
- https://diabetesjournals.org/care/article/49/Supplement_1/S261/163919/12-Retinopathy-Neuropathy-and-Foot-Care-Standards
- https://pubmed.ncbi.nlm.nih.gov/25392197/
- https://diabetesjournals.org/care/article-abstract/38/5/793/37475/Peripheral-Neuropathy-and-Nerve-Dysfunction-in
- https://www.nejm.org/doi/full/10.1056/NEJM199309303291401
Disclaimer: The information provided in this Q&A is for educational purposes only and should not be considered as medical advice. Always consult with a qualified healthcare professional for personalized medical guidance and treatment recommendations.