Condition guide
Diabetic neuropathy is damage to the nerves caused by blood glucose that stays high for a long time; it most often causes burning, tingling and numbness in the feet. It affects up to half of people with diabetes. Although the damage cannot be reversed, its progress can be slowed. A daily foot check helps to catch wounds early, and balance and strength exercises help you walk more safely.
Blood glucose and blood fats that stay high for a long time damage the nerves and the small blood vessels that feed them. The damage usually starts at the ends of the longest nerves, that is, in the feet; over time it moves up the legs, and sometimes into the hands and arms.
The real danger is not the pain itself but the loss of feeling: someone who cannot feel a wound, a blister or a stone in their shoe will not notice it. In diabetes, wounds heal slowly and become infected easily.
Stopping it getting worse. Keeping blood glucose, blood pressure and cholesterol close to their target levels helps to stop nerve damage from getting worse. This is the foundation of treatment.
Easing the pain. Ordinary painkillers often do not work well enough for nerve pain. Instead, doctors may prescribe certain antidepressants (such as duloxetine or amitriptyline), certain anti-seizure medicines (pregabalin, gabapentin) or lidocaine applied to the skin. These medicines ease the pain but do not reverse the nerve damage; if one does not help, another may be tried.
Protecting the feet and balance. Daily foot care, together with physiotherapy for strength and balance, is part of treatment. At least once a year your doctor should examine the vibration and touch sensation in your feet, your walking and your balance; take off your shoes and socks for the examination.
Put your feet up when sitting, move your toes and ankles often during the day, and do not wear tight socks. Smoking reduces the blood flow to the feet; stopping matters for your feet too.
When feeling in the soles of the feet is reduced, balance suffers too; the risk of falls and fractures rises. In a 2021 review combining eight randomised controlled trials (457 people), walking, balance and strength exercises slightly improved the time people could stand on one leg and their fear of falling. The only trial that looked at the number of falls found no difference; the authors put this down to the small size and short duration of the trials, and rate the certainty of the evidence as low.
A 2025 review of 21 trials in older adults points the same way: the greatest benefit came from balance exercises and from programmes combining balance with strength. Low-impact activities such as walking, swimming, cycling, dancing and yoga also support the blood flow to the feet.
Do balance exercises next to something solid you can hold on to, such as a worktop. If you have an open wound, a blister or a red, warm and swollen area on your foot, do not exercise on it; show it to your doctor first.
Exercises at home
Exercise in well-fitting shoes, next to something you can hold on to. They are ordered from easier to harder; move on to the next one once you can do a movement safely.
Holding onto a worktop, stand with your feet hip-width apart. Slowly shift your weight onto one foot, then the other; notice how the pressure under your soles changes. If the feeling in your feet is reduced, check with your eyes as well.
10 times to each sideStand upright in front of a worktop, holding on lightly with one or both hands. Lift one foot off the floor and keep your balance. As it gets easier, hold on with one hand, then with a fingertip.
10–15 seconds, 3–5 times on each footWalk alongside a worktop or a wall, keeping one hand ready for support. With each step, place the heel of your front foot just in front of the toes of your back foot.
10 steps, 3 roundsStand upright holding onto a worktop. Lift both heels together and rise onto your toes, pause for 2 seconds and lower slowly. The calf muscles are important for recovering your balance when walking.
10–15 repsSit towards the front of a sturdy chair with your feet flat on the floor. Lean forwards and stand up using your hands as little as possible, then sit down slowly. Leg strength is the foundation of balance.
8–10 reps, 2 setsWalk in well-fitting shoes with a smooth lining and seamless socks. Start with a short distance and build up little by little. After walking, check your feet for redness, blisters or sores.
Most days of the week, building up little by littleVideo
From the YouTube channels of Diabetes UK, the UK diabetes charity, and Mayo Clinic in the USA.
A video showing how to check your feet every day.
A one-minute video summarising foot care in diabetes.
Damage to the nerve cannot be reversed; medicines ease the pain but do not repair the nerve. However, keeping blood glucose, blood pressure and cholesterol close to their targets helps to stop the damage from progressing. That is why noticing it early and protecting the feet matter.
Yes, with a few precautions. In the review of eight trials (457 people), balance and strength exercises slightly improved balance and fear of falling. Wear well-fitting shoes, check your feet after exercise and exercise next to something you can hold on to. If you have an open wound on your foot, ask your doctor first.
No. Because your ability to feel heat and pain is reduced, your skin can burn without you noticing. Keep your feet away from hot water bottles, heaters and open fires; test bath water with your elbow or a thermometer. If your feet are cold, wear socks in bed.
It could; that is why, when investigating neuropathy, doctors check the B12 level along with thyroid and kidney problems. Metformin is among the causes of low B12; in that case the medicine can be continued with a B12 supplement. Your doctor decides; do not stop your medicine yourself.
See a doctor without delay if you have any of the following:
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