From the Guidelines
Numbness and tingling are most commonly caused by diabetic peripheral neuropathy, nerve compression, or vitamin deficiencies, and the most effective treatment approach is to identify and address the underlying cause. According to the most recent and highest quality study 1, individuals with type 1 diabetes for 5 or more years and all individuals with type 2 diabetes should be assessed annually for diabetic peripheral neuropathy (DPN) using medical history and simple clinical tests. The most common early symptoms of DPN are induced by the involvement of small fibers and include pain and dysesthesia (unpleasant sensations of burning and tingling), while the involvement of large fibers may cause numbness and loss of protective sensation (LOPS) 1.
Some key causes of numbness and tingling include:
- Diabetic peripheral neuropathy
- Nerve compression (like carpal tunnel syndrome, pinched nerves in the spine)
- Vitamin deficiencies (such as vitamin B12 deficiency)
- Medications (such as chemotherapy drugs)
- Infections (like Lyme disease or shingles)
- Autoimmune disorders
- Injuries
Treatment depends on identifying the underlying cause. For temporary numbness from pressure on a nerve, symptoms typically resolve once the pressure is relieved. For conditions like diabetic neuropathy, managing blood sugar levels is essential, while vitamin deficiencies require appropriate supplementation (B12, folate, or B6) 1. Medications such as gabapentin (300-1200mg daily), pregabalin (150-600mg daily), or amitriptyline (10-50mg at bedtime) may help manage nerve pain. It is crucial to seek immediate medical attention if numbness is accompanied by weakness, confusion, difficulty speaking, or occurs suddenly on one side of the body, as these could indicate a stroke requiring emergency treatment.
In terms of specific tests for assessing small- and large-fiber function and protective sensation, the following can be used:
- Small-fiber function: pinprick and temperature sensation
- Large-fiber function: lower-extremity reflexes, vibration perception, and 10-g monofilament
- Protective sensation: 10-g monofilament 1. Electrophysiological testing or referral to a neurologist is rarely needed, except in situations where the clinical features are atypical or the diagnosis is unclear.
From the Research
Numbness and Tingling Causes
- Numbness and tingling can be caused by various factors, including vitamin deficiencies 2, 3, 4, 5.
- Vitamin B12 deficiency has been associated with significant neurological pathology, especially peripheral neuropathy 2.
- Deficiencies of almost all vitamins are associated with diabetic neuropathy, and vitamin supplementation may serve as an effective therapeutic strategy 3.
- Vitamin D deficiency is a risk factor for diabetic peripheral neuropathy, and supplementation may help reduce the severity of symptoms 5.
- Other vitamins, such as biotin and thiamine, may also play a role in neuropathy, although more research is needed to fully understand their effects 4, 6.
Vitamin Deficiencies and Neuropathy
- Vitamin deficiencies can cause peripheral neuropathy, which can lead to numbness and tingling sensations 2, 3.
- Vitamin B12 deficiency can cause significant neurological pathology, including peripheral neuropathy 2.
- Vitamin D deficiency is independently associated with a higher risk of diabetic peripheral neuropathy, and may promote the development of the condition by affecting large nerve fibers 5.
Therapeutic Strategies
- Vitamin supplementation may serve as an effective therapeutic strategy for neuropathy, particularly for diabetic neuropathy 3.
- Vitamin D supplementation may help reduce the severity of symptoms in patients with diabetic peripheral neuropathy 5.
- More research is needed to fully understand the effects of vitamin supplementation on neuropathy and to establish optimal treatment strategies 3, 4.