Being diagnosed with diabetes raises a variety of concerns, but one many people aren’t aware of is this: Up to half of those with this metabolic disorder will go on to develop another condition in their lifetime, a progressive nerve disease called diabetic peripheral neuropathy, or DPN.

Although DPN can be prevented with the right care, it is not reversible, which is why proper screenings and monitoring as recommended by the American Diabetes Association (ADA) and other organizations are so important.

“We know we can be very effective at preventing complications of diabetes, including DPN,” says Kevin Peterson, MD, MPH, vice president of primary care with the ADA.

It’s estimated that up to 80% of DPN cases are undiagnosed. There are a number of reasons this disease may go undetected. The early warning signs can be easy to overlook. Additionally, regular foot screenings aren’t always implemented perfectly across the board, says Peterson, an issue the ADA is working to remedy.

“There are lots of reasons why care doesn’t get delivered,” he says, citing problems with access, the frequency of comorbidities, and limited time for checkups—often, individuals with diabetes and their medical providers are spending much of their time addressing other symptoms or complications.

For those reasons, understanding DPN and how to prevent it, knowing how to recognize the symptoms, and advocating for yourself during regular checkups is vital.

What Is DPN?

DPN is a disease that affects the long nerves that feed the feet and hands. “We sometimes refer to it as ‘glove-and-stocking’ distribution,” Peterson says.

Diabetes leads to high blood sugar, which over time can damage the lining of blood vessels, Peterson explains. Small vessels, such as those that feed nerves, are affected first, leading to DPN. Without a supply of blood, the long nerves in the hands and feet begin to die off. Depending on the nerve fibers that are affected and the extent of the disease, it can manifest as pain, numbness, or both, and symptoms may evolve.

Non-painful DPN that largely causes loss of sensation is much more common, says Dave Griffin, DPM, assistant clinical professor at Oregon Health and Science University in the Division of General Internal Medicine and Geriatrics. And it can be dangerous. The risk of falls increases, and foot injuries may go unnoticed because the warning signs from pain are lost.

“The progression of neuropathy to numbness is very dangerous,” Griffin says. “For diabetic foot disease problems like an ulcer or infection, mortality rates are almost the same and even higher than some cancers.”

One reason for those mortality rates is the fact that DPN is a leading cause of amputations. Griffin notes that up to 85% of foot amputations can be avoided with good preventive care.

Tips for Preventing and Recognizing DPN

Preventing DPN starts with knowing and managing your risk factors. These include:

• What type of diabetes you have. DPN is almost twice as common in people with type 2 diabetes as in those with type 1.
• How well controlled your disease is. If your diabetes is being managed through medication, lifestyle changes, or a combination of the two, you’re less likely to have complications, including DPN.
• Your age. DPN is more common in people over 50.

If you have one or more risk factors, it pays to be extra careful about your feet (while hands can also be affected by DPN, it affects feet much more commonly).

Make sure your shoes fit, advises Griffin. “As you get older, your feet can become wider and longer, which can affect the size shoe you wear,” he says. Improper footwear may mask some symptoms of DPN.

It’s a common belief that foot pain is normal in people with diabetes, he adds, but this is not true.

“The majority of people may not get severe symptoms in the beginning [of developing DPN], so they ignore it, or think it’s related to aging,” Griffin says. “Patients have got to tell providers if they’re having foot pain or problems.”

Early symptoms of DPN can vary, and include:

• Tingling or burning, often in the big toe or somewhere else in the foot
• Sharp, shooting pain in the feet or hands
• Numbness
• Balance issues

Any of these symptoms may come and go, or be worse during the day or at night in some individuals. Although DPN cannot be reversed once it develops, lifestyle changes such as quitting smoking, adjusting food and exercise based on doctors’ recommendations, and managing blood sugar levels can slow the disease’s progress.

“We know that if you manage your diabetes and risk factors well, your chances of things progressing are much lower,” says Griffin.

How to Have Better Checkups 

While it’s recommended that people with diabetes have an annual foot screening, one-third of them do not receive a foot exam each year from their primary health care provider. Even among those whose feet are checked, that may not be the priority of the exam, and it is often done by a primary care provider rather than a specialist.

“People with diabetes, especially older people, rarely have just one chronic disease,” says Peterson. Given that the average amount of time they get with a doctor is just 12 minutes, he explains, checking the feet may not be prioritized.

It’s often up to individuals with diabetes to know about the need for, and specifically request, a foot exam to ensure that problems are identified early.

Here are some steps to take for better foot care:

• Do daily self-exams. Check your feet every day or have a friend or family member help you, says Griffin.
• Get barefoot. Take off your socks and shoes every time you see your primary care doctor, whether they ask you to or not, and ask for a foot check to be completed, Griffin says.
• Know what a screening should include. In addition to looking at and touching your feet, your doctor may use a monofilament test, or even a tuning fork to check for sensitivity to vibration, which may be dulled or lost before other symptoms of DPN appear, Peterson says. If your doctor doesn’t do these tests, ask about them.
• See a specialist. For preventive foot care and screenings, a podiatrist can often be a helpful resource. Additionally, “if you have painful diabetic neuropathy that’s not being managed well, consider a referral to a pain specialist who can open up other options for you,” says Griffin.

For more foot care tips, download our infographic or order free print copies here.

—Jill Waldbieser

Our 2024 KNOWvember campaign is made possible through the generous support of our sponsors, Averitas and Vertex Pharmaceuticals.

The U.S. Pain Foundation independently developed the content without review from its sponsors. This information is for educational purposes only and may not be used as a substitute for advice from a health care professional.

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