Diabetes and nerve damage: Do you know the cause of leg pain?

Diabetes is a common health problem that can affect many organs in the body. Another system that is most damaged by this disease, due to the body's blood sugar levels remaining high for a long time, is our nervous system. Damage to the nerves, especially those outside the brain and spinal cord, is medically known as diabetic peripheral neuropathy .

Let's learn scientifically about the symptoms, risk factors, and ways to protect our feet from diabetic nerve damage through a discussion with Dr. Priya, 58-year-old Somapala, who has been suffering from diabetes for 15 years and has been suffering from burning sensation under the feet, numbness, and a strange sensation of walking on sand when walking on cement.

Doctor-patient dialogue: "Doctor, are my legs tingling because of diabetes?"

Mr. Somapala: "Dr. Priya, I have been diabetic for 15 years. Recently, I have had a severe burning sensation under my legs. My legs are tingling and I feel like ants are running around. This pain is especially severe at night, so I can't sleep. When I walk on cement, it feels like I'm walking on sand. Will my legs be in danger, doctor?"

Dr. Priya (comforting Mr. Somapala): "Mr. Somapala, the symptoms you are describing are signs of a serious condition called diabetic peripheral neuropathy, which is caused by diabetes. About 50% of diabetics may experience this condition at some point in their lives."

Prolonged high blood sugar levels damage the delicate nerve cells in the legs and feet. Although this cannot be cured completely, the pain can be controlled by controlling blood sugar and using specific anticonvulsants such as Gabapentin or Pregabalin, which are prescribed by a doctor. Taking care of your feet is essential as diabetics are at risk of developing diabetic foot ulcers due to the inability to feel pain in their feet.

🚨 Red Flags that require immediate medical attention

Symptoms that indicate a serious complication of diabetic nerve damage in the foot include:

1. A non-healing foot wound: A cut, scrape, blister, or sore on the foot that does not heal within a few weeks.
2. Signs of infection: redness around a wound, severe swelling, a feeling of warmth, or pus draining from the wound.
3. Change in skin color on the foot: A part of the skin on the foot turns blue, red, or black (this is a sign of tissue death/gangrene).
4. Complete loss of pain or sensation in the legs: Feeling of numbness in the legs to the point of not being able to feel a prick or heat/cold.
5. High fever with the wound: When there is a wound on the foot, the body develops a fever (a sign of the spread of the germs into the body).

🛠️ Action Steps to Prevent Diabetic Nerve Damage

• Step 1: Keep your blood sugar levels (especially HbA1c) within the prescribed range through medication, proper diet, and exercise as directed by your doctor.
• Step Two: Every night before bed, use a mirror to check the soles of your feet and between your toes for any cuts, sores, blisters, or dry, cracked skin (foot self-inspection).
• Step Three: As soon as symptoms appear, see a diabetes specialist and have a nerve sensation test, such as the Monofilament Test, performed.
• Step Four: Take medications as prescribed by your doctor, such as Gabapentin, Pregabalin, or some antidepressants such as Nortriptyline or Duloxetine.
• Step Five: Apply a moisturizer to your feet to relieve dryness (but don't apply between your toes).

📊 Do's & Don'ts

❓ Frequently Asked Questions (FAQ)

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#### Can diabetic neuropathy be completely cured?

No. Medically, current medications cannot restore nerve cells damaged by diabetes. However, good blood sugar control can stop further nerve damage from spreading, and medications can effectively control pain and inflammation.

#### Why does it feel like walking on sand when you walk on cement?

This is because the delicate sensory nerve cells in the feet are damaged. The nerve damage prevents the brain from sending true sensations, which the brain misinterprets as walking on sand, running on ants, or numbness.

#### Why is foot care so important for diabetics?

When nerves are damaged due to diabetes, the feet lose their ability to feel pain. As a result, even if a nail is stuck in the foot or a cut occurs, the patient does not feel pain. These unnoticed wounds can later develop into diabetic foot ulcers, which can become infected and even lead to amputation.

#### Why are antidepressants prescribed for nerve pain?

Some antidepressants, such as duloxetine and nortriptyline, work by blocking the pathways that send pain signals to the brain and spinal cord. That's why doctors prescribe these drugs to control nerve pain, even if you don't have depression.

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📖 Sources and Scientific References

• NHS (UK) Guidance on Peripheral Neuropathy: NHS Peripheral Neuropathy Overview (Accessed 2026)
• PubMed Central (PMC) Clinical Review: Diabetic Peripheral Neuropathy Management Review (PMC10697960)