Complications of Diabetic Neuropathy

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Man with Wrist Pain

Diabetic neuropathy complications are long-term problems caused by diabetic nerve damage. When you have diabetes for a long time, high blood sugar causes chemical changes and inflammation in your nerves. Diabetes also damages small blood vessels that supply your nerves. These changes are diabetic neuropathy. With time, diabetic neuropathy can lead to complications.

You may be at higher risk of complications if you've had diabetes for more than 25 years and have had trouble controlling your blood sugar. You also may be at higher risk if you are elderly, are overweight, have high blood pressure, have high cholesterol, or are a smoker.

Diabetic neuropathy can affect nerves all over your body, so there are many possible complications. Here's what you should know about six common diabetic neuropathy complications.

Diabetic Foot

The nerves supplying your feet are the longest ones in your body. Diabetic neuropathy often affects these nerves, leading to diabetic nerve pain or neuropathic pain. Along with pain and tingling, you may lose feeling in your feet. You might not feel injuries other people would normally feel. You might not be aware of a stone in your shoe or a blister on your toe.

Poor blood supply can also cause your feet to crack and peel. Ulcers may form and become infected. Decreased blood supply makes it harder for you to fight infection. This means minor injuries and breaks in the skin can lead to infections, which can become severe. The tissue in your toes and feet can die. In some cases, surgical removal—or amputation—of the dying area is necessary.

Daily foot care, special shoes, not smoking, and better blood sugar control are the best ways to prevent this complication.

Charcot Joint

Charcot joint is a complication that occurs when nerves supplying a joint are damaged. Another name for this is diabetic arthropathy. This complication is most common in the foot. It can cause you to lose feeling in your foot. You can also lose strength in the muscles that support your foot. You may be unable to tell if your ankle is twisting or if you are putting too much stress on it. Over time, the bones of the joint may start to grind on each other. The problem worsens by continuing to walk and put weight on the joint. Eventually the joint may collapse and heal in an abnormal position.

You may be able to prevent this complication by looking for warning signs like swelling or redness. Treatment involves using a splint or brace to support the joint. Sometimes surgery is necessary.


Diabetic neuropathy can affect the nerves that control digestion, such as the vagus nerve. The vagus nerve controls the emptying of food from your stomach. Damage to this nerve means food stays in your stomach too long. This complication is gastroparesis.

Gastroparesis can cause heartburn, nausea, fullness, vomiting, and weight loss. It also can lead to unpredictable blood sugar levels because sugar in your food empties into your digestive system abnormally. This can make diabetes harder to control.

You may be able to manage gastroparesis by working closely with your doctor to control your blood sugar. Your doctor may prescribe medications to speed stomach emptying. Eating frequent and smaller meals may help. Some people eventually need a feeding tube to bypass their stomach.

Compression Mononeuropathy

Diabetic nerve damage combined with pressure on one nerve causes compression mononeuropathy. This complication affects the part of the body supplied by the nerve. Two common examples are carpal tunnel syndrome and foot drop:

  • Carpal tunnel is the most common form of compression mononeuropathy. It occurs when diabetic neuropathy damages the median nerve in your forearm. The damage gets worse where the nerve passes through a narrow passage in your wrist. This causes numbness and tingling in your hand or fingers. There may also be swelling and pain and it may be hard to use your hand. Surgery is often the best treatment.

  • Foot drop occurs when neuropathy compresses and damages the peroneal nerve in your lower leg. You need that nerve to lift the front of your foot at your ankle. When the nerve is damaged, the front of your foot drops downward. You have to raise your foot high off the ground to walk without tripping. Braces, splints, physical therapy, and surgery are possible treatments for this complication.

Hypoglycemia Unawareness

Diabetic neuropathy can affect nerves that automatically control body functions. This type of diabetic neuropathy is called autonomic neuropathy. It can damage nerves that control your reaction to low blood sugar, or hypoglycemia. Dangerously low blood sugar levels can cause loss of consciousness, seizure, or coma. It can even be deadly.

People who take medication for diabetes—especially insulin—may have hypoglycemia if their sugar gets too low after a treatment. This is called insulin shock. Normally there are early warning signs, including shakiness, anxiety, dizziness and hunger. These warning signs mean you need to take a sugar tablet or eat some sugary food. You don't get these warning signs if you have hypoglycemia unawareness. Your body stops producing the hormones that cause these symptoms.

This dangerous complication requires more frequent blood sugar checks and possibly changes to your diet and diabetes treatment.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jun 11
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