Can diabetes cause peripheral neuropathy (nerve damage) with symptoms of tingling in hands and legs?

Yes, Diabetes Can Definitely Cause Tingling in Both Hands and Legs

Diabetes is a well-established cause of peripheral neuropathy, which directly causes tingling sensations in the hands and legs, and this patient's symptoms are highly consistent with diabetic peripheral neuropathy (DPN). 1

Understanding the Connection

Diabetic peripheral neuropathy occurs in up to 50% of patients with diabetes and is one of the most common chronic complications of the disease. 2, 3 The tingling your patient describes represents dysesthesia (unpleasant sensations of burning and tingling), which is caused by small nerve fiber involvement and is among the most common early symptoms of DPN. 1

Key Clinical Features

• Small fiber involvement causes the tingling, burning, and pain sensations your patient is experiencing 1
• Large fiber involvement (which may develop later) causes numbness and loss of protective sensation 1
• Up to 50% of DPN cases can be asymptomatic, but your patient's symptomatic presentation makes the diagnosis more straightforward 1, 4

Immediate Assessment Required

All patients with newly diagnosed type 2 diabetes should be assessed for diabetic peripheral neuropathy at the time of diagnosis. 1, 4 This is critical because:

Clinical Testing You Should Perform Now

1. Small-fiber function tests: Assess pinprick and temperature sensation 1, 4
2. Large-fiber function tests: Check vibration sensation using a 128-Hz tuning fork and assess lower-extremity reflexes 1, 4
3. Protective sensation: Perform 10-g monofilament testing to identify feet at risk for ulceration and amputation 1, 4

Critical Pitfall to Avoid

Diabetic neuropathy is a diagnosis of exclusion. 1 Before confirming DPN, you must rule out other treatable causes of neuropathy including:

• Vitamin B12 deficiency (especially if the patient is on metformin) 4, 2
• Hypothyroidism 4
• Alcohol toxicity 4
• Cervical and lumbar spine disease (nerve root compression) 1
• Medication-induced neuropathy (chemotherapy drugs) 1

Management Strategy

Primary Prevention Through Glycemic Control

Optimizing blood glucose control is the cornerstone of preventing progression of diabetic neuropathy. 1, 4 While glycemic control has stronger evidence in type 1 diabetes, it remains important in type 2 diabetes, though benefits may be more modest due to comorbidities. 5

Address Modifiable Risk Factors

Beyond glucose control, target these factors to reduce neuropathy progression:

• Elevated blood pressure 2
• Obesity 2
• Metabolic syndrome components 5

Symptomatic Treatment for Tingling/Pain

First-line pharmacologic options (if the tingling is painful or bothersome):

• Pregabalin (start at lower doses and titrate up) 4, 2
• Duloxetine 60 mg once daily 4, 2
• Gabapentin 300-1,200 mg three times daily 4, 2
• Amitriptyline (tricyclic antidepressant) 1, 2

Important caveat: These medications provide symptom relief but do not restore sensation to affected extremities. 2 Start with lower doses and titrate slowly, monitoring for adverse effects. 4

Foot Care Education is Non-Negotiable

Patients with DPN are at significant risk for foot ulcers (25% lifetime risk) and amputation. 3 Provide clear instructions on:

• Daily foot inspection 4
• Proper footwear 1
• Immediate reporting of any wounds or changes 1

Ongoing Monitoring

Annual comprehensive neurologic evaluations are mandatory going forward, including repeated assessment of small-fiber function, large-fiber function, and protective sensation. 1, 4 This patient should also be screened annually for autonomic neuropathy manifestations (cardiovascular, gastrointestinal, genitourinary symptoms). 1

The bottom line: This patient's tingling is most likely diabetic peripheral neuropathy, but you must exclude other causes, optimize glycemic control, consider symptomatic treatment if needed, and implement aggressive foot care education to prevent devastating complications like ulceration and amputation.