DIABETIC NEUROPATHY

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Diabetic neuropathy is nerve damage caused by prolonged high blood sugar. It is one of the most common complications of diabetes, and up to 50% of people with diabetes develop some form of diabetic neuropathy during the course of their illness.¹ There is currently no single treatment that reverses the condition. At Singapore Paincare, our diabetic neuropathy treatment applies Painostic® to evaluate the underlying causes and recommend suitable, minimally invasive treatment options.

In Singapore, diabetic neuropathy is a growing concern. A 2021 study of patients with type 2 diabetes at a local tertiary referral centre found that 28% had diabetic peripheral neuropathy, rising to nearly 1 in 2 (49.7%) among patients above 65 years old.² As Singapore’s diabetic population continues to grow, more patients are likely to be affected by this condition.

Diabetic Neuropathy

What Causes Diabetic Neuropathy?

Diabetic neuropathy is caused by high blood sugar (glucose), which damages the nerves over time. There are four main types of diabetic neuropathy.

Type of Diabetic Neuropathy Key Features & Symptoms
Peripheral Symmetric Neuropathy The most common type. It affects the outer parts of the body, especially the feet and hands. Symptoms include numbness, burning or pain in the feet, increased sensitivity to touch, joint pain, and foot infections.
Autonomic Neuropathy Affects the autonomic nervous system, which controls involuntary body functions such as bowel movements, sexual function, blood sugar awareness, sweating, and pupil response. Symptoms vary depending on the organs involved.
Thoracic and Lumbar Root (Proximal) Neuropathy Affects nerves in the thoracic or lumbar spine. Symptoms include weakness in the legs and pain affecting the thighs, hips, or buttocks.
Mononeuropathy (Focal Neuropathy) Damage to a single nerve. Cranial mononeuropathy may cause double vision or one-sided facial numbness or weakness. Peripheral mononeuropathy can cause tingling in the fingers or weakness in the hands.

What Are the Symptoms of Diabetic Neuropathy?

Numbness

These forms of neuropathy are not mutually exclusive and can occur together. Numbness in the feet is usually caused by mononeuropathy or peripheral neuropathy. It can be particularly dangerous, as small cuts or injuries may go unnoticed. If you have diabetic neuropathy, check your feet regularly for any signs of injury or infection.

Pain

Pain from diabetic neuropathy can occur in different parts of the body, depending on the type. Thoracic radiculopathy, for example, causes pain in the ribs and abdomen, while peripheral neuropathy causes pain in the feet and other extremities.

Leg Weakness

Leg weakness is common, especially after exercise or when climbing stairs.

How Is Diabetic Neuropathy Diagnosed?

Identifying the source of the pain is essential for recommending the right treatment and rehabilitation plan. At Singapore Paincare, our team of primary care and specialist pain doctors conducts a thorough diagnosis. This includes a physical examination, a review of your symptoms and an evaluation of your medical history. An X-ray, MRI scan or nerve conduction test may be used to evaluate or confirm the degree of diabetic neuropathy.

What Treatments Are Available for Diabetic Neuropathy?

Treatment for diabetic neuropathy focuses on two things: lowering blood sugar levels and managing pain. At Singapore Paincare, we aim to treat pain using the least invasive approach possible, after first identifying the underlying cause. Treatment may combine pharmacological options with cognitive and physical rehabilitation, to help patients improve function and reduce the chance of pain recurring.

Non-surgical Treatments

Pharmacotherapy

Pain relief medication is generally not effective for nerve-related pain. This type of neuropathy is generally managed with nerve stabilisers, such as anti-convulsants, to reduce sensitivity in the feet, and long-term management may be needed to adjust the dosage over time. Apart from NSAIDs, our physicians and specialists may also prescribe serotonin-norepinephrine inhibitors, where suitable, to reduce painful symptoms. Other medications include tricyclic antidepressants, or in severe cases, opioid pain relief. Once neuropathy has developed, controlling blood sugar levels alone will not reverse numbness in the feet, so monitoring your glucose levels alongside additional treatment is usually needed to manage this type of nerve pain.

Physiotherapy

Our specialists may recommend a range of exercises to improve the strength, elasticity and support of the feet and ankles. Muscle-strengthening exercises can also help reduce pain and prevent further damage.

Electrotherapy Treatments (TENS)

Our doctors may offer heat and cold therapy, as well as transcutaneous electrical nerve stimulation (TENS), which manages pain by blocking nerve transmission.

Surgical Treatment

Diabetic neuropathy has limited surgical options. If weakness develops and other treatments are not effective, surgery may be considered. As with any surgery, there are risks, complications and downtime involved, so it may not be suitable for everyone.

Nerve decompression surgery

Nerve decompression surgery may be used to treat other forms of radiculopathy or nerve compression syndromes, but not peripheral neuropathy.

Spine surgery

Spine surgery may be used to relieve spinal stenosis caused by nerve impingement.

How Can I Prevent Diabetic Neuropathy?

You can lower your risk of diabetes complications, including diabetic nerve pain, by:

  • Limiting alcohol intake
  •  Eating a healthy, balanced diet
  • Exercising regularly
  • Quitting smoking
  • Going for regular health check-ups with your doctor

If you already have diabetes, it’s important to manage your:

  • Blood pressure
  • Blood sugar
  • Cholesterol

Diabetes affects an estimated 8.5% of Singapore residents aged 18 to 74, based on the National Population Health Survey 2022, and nerve damage remains one of its most common complications.³ Because diabetic neuropathy is closely linked to how well diabetes is managed, prevention and regular check-ups remain important for anyone living with or at risk of diabetes in Singapore.

Why See Pain Specialist for Diabetic Neuropathy?

Diabetic neuropathy can be difficult to manage on your own, as there are several types and no single treatment that works for everyone. A pain specialist can help identify the specific type of neuropathy affecting you, and recommend a suitable, minimally invasive treatment plan to help manage your pain.

Numbness in the feet can also make small injuries or infections harder to notice, which may lead to further complications if left unchecked. Seeing a pain specialist allows for closer monitoring of your condition, alongside your diabetes care team. At Singapore Paincare, no referral is needed to consult our pain specialists.

A Message About Diabetic Neuropathy From Our Pain Specialist

Numbness from diabetic neuropathy can extend from the toes up to the ankles and across the entire foot. It tends to be constant regardless of movement or activity, and can affect daily activities such as standing and walking. This may cause a sense of poor balance or unsteadiness, and can also disrupt sleep. Many patients describe a persistent coldness in the feet that does not respond to heat or wearing socks. This is nerve-related pain caused by nerve injury from prolonged high blood sugar exposure.

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Frequently Asked Questions 

Diabetic neuropathy is nerve damage caused by prolonged high blood sugar. It is one of the most common complications of diabetes, and up to 50% of people with diabetes develop some form of it during their illness.

There are four main types: peripheral symmetric neuropathy, autonomic neuropathy, thoracic and lumbar root (proximal) neuropathy, and mononeuropathy (focal neuropathy).

Common symptoms include numbness in the feet, pain in the extremities or torso, and leg weakness, especially after exercise or climbing stairs.

Once neuropathy has developed, controlling blood sugar levels alone will not reverse numbness in the feet. Additional treatment, such as nerve stabilisers, is usually needed to manage the nerve pain.

No. At Singapore Paincare, no referral is needed to consult our pain specialists about diabetic neuropathy.

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References:

  1. Diabetic Peripheral Neuropathy. StatPearls, National Library of Medicine (NCBI Bookshelf), 2024. Available at: ncbi.nlm.nih.gov/books/NBK442009
  2. Hu AH, Teo M-RL. Prevalence of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus at a tertiary referral centre in Singapore. Proceedings of Singapore Healthcare. 2021;30(4):265–270. Available at: journals.sagepub.com/doi/full/10.1177/2010105820978993
  3. Diabetes in Singapore, National Population Health Survey 2022. Diabetes Singapore. Available at: diabetes.org.sg/diabetes-in-singapore

Updated July 2026