EP035: Neuropathies in Diabetes
Neuropathies in Diabetes: Real Talk, Real Science, Real Hope
“Smoother glucose curves equal calmer nerves.”
If you’re dealing with burning feet at night, numb toes, electric shock pains, or the feeling that your socks are bunched up when they aren’t, this is for you. Neuropathies in diabetes are common—but not hopeless. When we stabilize blood sugars, improve metabolic health, and lower inflammation, we can slow neuropathy. In early stages, we can sometimes improve it.
This post breaks down:
How healthy nerves work
What drives neuropathies in diabetes
The four types of neuropathy
What symptoms feel like (physically and emotionally)
What actually helps: daily habits, nutrition, movement, and meds
Foot care that can prevent big problems
How Healthy Nerves Work
Think of a nerve like an electric cable:
Axon = the wire
Myelin sheath = insulation
Tiny blood vessels (capillaries) = power and oxygen
Nerves help you move, feel the ground, digest food, control heart rate, and support sexual function. They need:
Oxygen and steady blood flow
A stable energy supply (glucose)
Low inflammation
Healthy mitochondria (your cells’ “power plants”)
What Goes Wrong in Neuropathies in Diabetes
Neuropathy isn’t “just nerves.” It’s a storm of four problems:
Vascular: High glucose stiffens and narrows tiny vessels. Nerves get less oxygen and nutrients.
Metabolic: Big swings in blood sugar stress the whole system. Nerves suffer from that stress.
Mitochondrial: High or swinging glucose makes mitochondria produce less clean energy and more “exhaust” (oxidative stress).
Inflammatory: Chronic inflammation stays “on” and damages nerves, myelin, and capillaries.
There’s also the sorbitol pathway. When glucose can’t enter cells well, it shifts into a backup path that pulls water into nerves. Nerves swell inside tight spaces (like a finger stuck in a small ring). Swollen nerves get irritated and painful. Myelin can get damaged. Signals slow down or misfire.
Bottom line: high and unstable glucose harms the nerve, the insulation, and the blood supply around it. Stabilizing glucose calms this entire environment.
The Four Types of Neuropathies in Diabetes
Peripheral neuropathy (most common—about 90%)
Where: toes, feet, calves, fingers, hands (the “periphery”)
Why these first: they are long nerves with tiny blood vessels
Common symptoms:
Burning, tingling, numbness
Pins and needles, “walking on pebbles”
Electric zaps, stabbing pains
Feels like socks are bunched (when they aren’t)
Balance problems from low sensation
Autonomic neuropathy
Affects nerves you don’t control: heart rate, blood pressure, digestion, bladder, sexual function, sweating
Symptoms:
Gastroparesis (slow stomach emptying): nausea, fullness, constipation
Lightheadedness when standing
Bladder issues (beyond high-sugar frequent urination)
Erectile dysfunction or vaginal dryness
Changes in sweating
Proximal neuropathy (rarer)
Sudden pain or weakness in hip, thigh, or butt
Trouble rising from a chair or climbing stairs
Often one-sided
Scary at first, but many improve with time and glucose control
Focal neuropathy (rarest)
Single nerve problems: face, hand, leg, or eye
Sudden pain or weakness (e.g., wrist drop, trouble focusing an eye)
Often improves as blood sugars stabilize
What It Feels Like—And Why That Matters
Pain is real. The nerves are injured and misfiring. That can mean:
Burning at night that keeps you from sleeping
Feeling like you walk on rocks
Fear of falling because you can’t feel your feet
Missing walks with family or your dog
Worry about independence and sexual function
You’re not weak. You’re not making it up. The signals are faulty—but the experience is real. You’re not alone, and it’s not your fault.
A Hard Story—and a Hopeful One
Hard truth: Diabetes is the top cause of non-accidental amputations in the U.S. Neuropathy + poor circulation + unnoticed injuries can escalate fast.
Important point: Podiatrists who “cut into” a callus often reveal a deep ulcer that already existed. They didn’t cause the damage; they uncovered it so it can be treated.
Hope story: Another person noticed a tiny dark spot under a callus and went in early. It was removed, no infection, no tissue loss. He improved diet quality, fiber, and glucose control—and over months, nerve function improved.
Early action = better outcomes.
Daily Foot Care That Prevents Big Problems
Do these every day:
Check your feet daily. Use a mirror or magnifier if needed.
Moisturize tops, bottoms, and heels. Not between toes. Let lotion fully dry before socks/shoes.
Wear good shoes:
Wide toe box
No pinching or rubbing
Protects from debris (avoid flimsy sandals outside)
If a shoe always blisters you, retire it
Avoid going barefoot outside
Don’t ignore swelling, color changes, hot spots, or wounds. See a podiatrist quickly or go to the ER if severe.
What Actually Helps: Evidence and Action
Key trials show stable glucose matters for neuropathies in diabetes:
DCCT (type 1, but very relevant biology): lower glucose variability = less neuropathy even 20 years later
UKPDS: better glycemic control lowers neuropathy risk
STENO-2: intensive lifestyle + metabolic control = less neuropathy
LOOK AHEAD: diet + exercise improved nerve function
Nutrition That Supports Nerves (“Nutrinterventions”)
High fiber eating: lowers glucose swings and inflammation
Aim for 25–40g/day (step up gradually)
Great options: beans, lentils, oats, chia, flax, berries, veggies
Mediterranean-style pattern: supports vessel lining (endothelium) and heart health
Plant omega-3s: flaxseed, chia, walnuts, or third-party-tested algae oil
Reduce ultra-processed foods and sugary drinks: lowers inflammatory load
Note: This is not “cut all carbs forever.” It’s about stabilizing glucose, choosing quality carbs, balancing meals, and portioning wisely.
Movement That Helps Nerves
Walk, especially after meals:
Even 2–5 minutes helps
10–15 minutes after meals can lower glucose by ~20–40 points
Rowing (great low-impact blood flow)
Strength training: improves nerve-to-muscle signaling and glucose control
Balance and proprioception drills: help prevent falls
Movement “snacks”: 3–5 minutes at a time throughout the day
Sleep 7–9 hours: nerves need night-time repair
Targets to Aim For (start from where you are)
Lower the highs and the lows; smoother curves calm nerves
Post-meal glucose: aim toward 140–160 mg/dL as a near-term step if you’re currently higher; under 140 is ideal over time
Reduce variability: protein and non-starchy veggies first, then carbs; add fiber; move post-meal
Medications: Tools, Not Magic
Symptom relievers (help pain; don’t fix root cause):
Gabapentin
Pregabalin
Duloxetine
Tricyclic antidepressants (certain ones)
Capsaicin patches
Metabolic meds (help the drivers of high glucose):
GLP-1 receptor agonists (e.g., semaglutide), dual agonists (e.g., tirzepatide)
SGLT2 inhibitors
Metformin
These can be very helpful scaffolding. Best results come when you pair meds with nutrition, movement, sleep, and weight loss if needed (even 5–10% makes a difference).
A Real-World Win
One listener could barely walk to the mailbox. Night pain was awful. We stabilized her glucose, added fiber, cut back ultra-processed foods, and added short walks after meals and water aerobics. In under three months:
A1C dropped by 1 point while reducing insulin
Night pain down 60%
Better sleep and mood
At six months, burning pain was gone and sensation improved. Not guaranteed, but absolutely possible.
Quick Action Checklist
Daily foot checks with a mirror
Moisturize (not between toes), let dry before socks/shoes
Wide toe box, no rubbing; no barefoot outside
Don’t ignore color changes, swelling, or wounds—seek care early
Eat more fiber (beans/lentils/oats/veggies/berries)
Mediterranean-style meals; add plant omega-3s
Cut ultra-processed foods and sugary drinks
Walk 5–15 minutes after meals; add movement snacks
Strength train 2–3 days/week; practice balance
Sleep 7–9 hours
Talk with your clinician about symptom and metabolic meds
Final Word
Neuropathies in diabetes are common—and influenceable. When you stabilize blood sugars, lower inflammation, and improve circulation and energy inside the nerve, things can get better. Early neuropathy can sometimes improve. Later neuropathy can be slowed. Your pain is real. Your progress can be real, too. You don’t have to do it alone. If you need additional support, reach out to us at [email protected].
Disclaimer
The information in this blog post and podcast is for educational and informational purposes only. It is not medical advice, diagnosis, or treatment, and it does not replace a one-on-one relationship with your physician or qualified healthcare professional. Always talk with your doctor, pharmacist, or care team before starting, stopping, or changing any medication, supplement, exercise plan, or nutrition plan—especially if you have diabetes, prediabetes, heart, liver, or kidney conditions, or take prescription drugs like metformin or insulin.
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