It tends to, particularly while blood glucose stays high. Progression follows nerve length, so symptoms that begin in the toes move up the feet and later reach the hands. Better glucose control slows that progression, with the strongest evidence in type 1 diabetes, but it does not restore nerves already lost.
It tends to, particularly while blood glucose stays high. Progression follows nerve length, so symptoms that begin in the toes move up the feet and later reach the hands. Better glucose control slows that progression, with the strongest evidence in type 1 diabetes, but it does not restore nerves already lost.
The injury is cumulative. Both the duration of diabetes and the degree of glucose exposure over that time predict how much nerve damage develops, which is why neuropathy is more common the longer someone has had the condition. Other factors add to it independently: high triglycerides, hypertension, smoking, alcohol, kidney impairment and vitamin B12 deficiency. Because the longest axons are the most vulnerable, advance follows a predictable geography, moving up the legs before the hands are involved at all.
Glucose control is the main lever, and it is worth being precise about the evidence: it clearly reduces the development and progression of neuropathy in type 1 diabetes, while in type 2 diabetes the effect is more modest and control of blood pressure and lipids carries proportionally more weight. Stopping smoking helps. Reducing alcohol helps, since alcohol damages nerves in its own right and the two causes compound. Weight reduction and regular walking are associated with better outcomes.
Axons that have died do not regrow to their original state, so established sensory loss generally persists. This produces a pattern patients find confusing and clinicians expect: pain often improves with treatment while numbness stays the same or slowly increases. Pain and numbness are carried by different fibre populations and respond differently. Improvement in comfort is therefore a genuine treatment success even when the numbness is unchanged, and it is worth naming that at the outset so the result is not read as failure.
Once protective sensation is reduced, an injury that cannot be felt is an injury that goes unnoticed until it is established. Blisters from new shoes, a small cut, a stone in the shoe, a burn from a hot bath. Daily inspection of the whole foot including between the toes, properly fitted footwear, checking inside shoes before putting them on, and prompt review of any wound are the interventions with the largest effect on outcome. This is the part of management that patients control entirely.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.