Peripheral Neuropathy (Including Diabetic Neuropathy)

Peripheral neuropathy is common, especially in older adults. Up to half of people with diabetes develop nerve damage over time.

• Diabetic peripheral neuropathy: the most common type, usually in both feet and legs, sometimes the hands.
• Sensory neuropathy: affects feeling (numbness, tingling, pain).
• Motor neuropathy: affects muscles (weakness, cramps).
• Autonomic neuropathy: affects nerves that control blood pressure, heart rate, digestion, bladder and sweating.
• Mononeuropathy: damage to one nerve, such as carpal tunnel syndrome in the wrist.

• Diabetes or prediabetes, especially with blood sugar that's been high for years
• Heavy alcohol use
• Low vitamin B12 (including from long-term Glucophage (metformin) or acid-reducing medicines) or other vitamin problems
• Low thyroid
• Kidney disease
• Some medicines, including some chemotherapy
• Infections such as shingles, HIV or hepatitis C; autoimmune diseases
• Inherited nerve conditions; sometimes no cause is found

• Numbness, tingling or "pins and needles" in the feet or hands
• Burning, sharp or electric-like pain, often worse at night
• Feeling like you're wearing socks or gloves when you aren't
• Poor balance or falls
• Muscle weakness or cramps
• Sores on the feet you didn't feel
• Dizziness when standing, stomach or bladder problems, or sweating changes (autonomic nerves)
• At your visit, your provider checks feeling in your feet with a soft thread (monofilament), a tuning fork and a pin, tests your reflexes, strength and balance, and looks closely at your feet for sores, calluses and skin changes.

Diagnosis starts with your symptoms and a careful exam.

Lab tests your provider may order include: A1C or fasting glucose, vitamin B12, thyroid tests (TSH), a comprehensive metabolic panel (kidney and liver function), and a complete blood count (CBC). Other tests are added only if needed.

Some people need nerve conduction studies and EMG (tests of how nerves and muscles work), done by a neurology partner. We refer you for these and review the results with you.

• Treat the cause: keep blood sugar near goal, treat low B12 or thyroid, limit alcohol, and review medicines.
• Medicines for nerve pain, such as certain antidepressants or anti-seizure medicines. These can take weeks to help.
• Check your feet every day for cuts, blisters, redness or swelling. Use a mirror or ask for help.
• Wear well-fitting shoes and socks; don't walk barefoot.
• Test bath water with your elbow or a thermometer, not your feet.
• Physical therapy and balance exercises to prevent falls.
• Regular foot exams with your provider or a podiatrist.

Some neuropathy improves when the cause is treated, especially if found early. Nerve damage from long-term diabetes often doesn't fully go away, but good care can slow it down and ease symptoms.

Protecting your feet lowers the risk of sores and infections. Results vary from person to person.

Your primary care team at Moaddel Medical orders labs to look for causes, checks your feet at visits, helps control blood sugar and manages nerve pain.

We refer you to a neurology partner for nerve testing when needed. For foot wounds that are slow to heal, Royal Wound Care, part of Moaddel Medical, specializes in chronic, non-healing wounds.

We're at 7230 Medical Center Dr, Suite 100, West Hills, CA 91307.