MADE-IT T1D

Peripheral Neuropathy in Type 1 Diabetes

Last updated: 14 Aug 2025

Understanding Peripheral Neuropathy in Type 1 Diabetes

placeholder: Image depicting nerve pathways in the feet and hands, or an older person carefully examining their foot

Introduction

Peripheral neuropathy is the most common type of nerve damage experienced by individuals with Type 1 Diabetes (T1D), particularly affecting older adults.[11] It primarily impacts the peripheral nerves, which are the nerves outside of the brain and spinal cord. Most often, it affects the longest nerves first – those extending to the feet and legs, and sometimes later to the hands and arms.[11, 12]

This condition can lead to a range of uncomfortable and sometimes debilitating symptoms, and significantly increases the risk of foot problems. Understanding its causes, symptoms, and management strategies is crucial for older Victorians with T1D to maintain their foot health, mobility, and overall quality of life.

What Causes Peripheral Neuropathy?

The primary cause of diabetic peripheral neuropathy is prolonged exposure to high blood sugar levels.[11, 12] Over time, excess glucose in the blood can damage nerve fibres and the small blood vessels that supply nutrients and oxygen to the nerves.[1, 12] Other contributing factors include [11, 12]:

Symptoms of Peripheral Neuropathy

Symptoms of peripheral neuropathy often develop gradually and can vary from person to person. They typically begin in the toes or fingers and can spread upwards.[1] Common symptoms include [1, 11, 13]:

In severe cases, individuals may lose all sense of feeling in the affected limbs.[1]

Diagnosis

Diagnosing peripheral neuropathy involves:

Regular screening for neuropathy, typically annually, is recommended for all individuals with diabetes.[4, 6]

Management and Treatment

While existing nerve damage may not be fully reversible, management focuses on several key areas [13]:

  1. Blood Glucose Control: This is the cornerstone of preventing neuropathy or slowing its progression. Maintaining blood glucose levels within the target range is crucial.[13]
  2. Pain Management:
    • Medications: Several types of medications can help relieve neuropathic pain, including certain antidepressants (like duloxetine, amitriptyline), anti-seizure medications (like pregabalin, gabapentin), and topical treatments (like capsaicin cream or lidocaine patches).[12, 13] Opioids and tramadol may be considered for severe pain but are used cautiously due to side effects and risk of dependence.[13]
    • Non-pharmacological therapies: Physical therapy, transcutaneous electrical nerve stimulation (TENS), acupuncture, and massage therapy may provide relief for some individuals.[13]
  3. Foot Care: Meticulous foot care is essential to prevent complications if sensation is reduced. This includes daily foot inspection, proper hygiene, wearing appropriate footwear, and regular podiatry visits.[10, 13] (See the “Feet” page for detailed foot care advice).
  4. Lifestyle Modifications:
    • Healthy diet and weight management.[13]
    • Regular exercise: Weight-bearing exercises and activities like Tai Chi can be beneficial.[13]
    • Smoking cessation.[5]
  5. Managing Comorbidities: Controlling blood pressure and cholesterol levels.[5]
  6. Preventing Falls: If weakness or balance issues are present, strategies to prevent falls are important. This may include using mobility aids and home safety modifications.

Complications of Peripheral Neuropathy

If not managed effectively, peripheral neuropathy can lead to serious complications, particularly in the feet [13]:

Key Takeaways

Where to Get Help in Victoria

References