Nerves

Peripheral nerves, the common causes of neuropathy and how to protect your nerves.

Peripheral nerves carry signals between the brain and every part of the body. They are long, energy hungry cells, which makes them sensitive to high blood sugar, poor circulation and shortages of B vitamins. When nerves are strained, the first signs are often tingling, numbness or burning in the feet and hands.

Each nerve fibre is wrapped in a fatty sheath called myelin that speeds signals along. Nerves depend on a constant supply of glucose and oxygen from tiny blood vessels, and on vitamins B1, B6 and B12 to make energy and maintain myelin.

What strains it

Raised blood sugar over many years
Low vitamin B12, common with vegetarian diets and some diabetes medicines
Alcohol
Reduced blood flow to the hands and feet
Smoking

Habits that protect it

Know your blood sugar and keep it in the range your doctor advises
Check your feet every day if you have diabetes
Include B12 sources or ask your doctor about testing your level
Walk daily to keep circulation strong
Stop smoking

See a doctor if you notice

Numbness, tingling or burning that is spreading
A foot wound that is slow to heal
Weakness or falls
Sudden loss of sensation or movement, which is an emergency

The health journey

Your health journey

Six stages, and where to find help at each one. Scroll sideways on smaller screens.

01 Lifestyle

Raised blood sugar over many years
Low vitamin B12, common with vegetarian diets and some diabetes medicines
Alcohol

02 Early signals

Numbness, tingling or burning that is spreading
A foot wound that is slow to heal
Weakness or falls

03 Understanding

04 Testing

Monofilament and vibration testing of the feet
HbA1c and blood glucose
Vitamin B12 level
Nerve conduction studies where needed

05 Management

Know your blood sugar and keep it in the range your doctor advises
Check your feet every day if you have diabetes
Include B12 sources or ask your doctor about testing your level

06 Long-term wellbeing

Regular check-ups, as your doctor advises
Revisit the health checks
Formulations for the nerves

Could my symptoms be caused by diabetes or low vitamin B12?
Should my B12 level be checked?
How should I check and care for my feet?
What can help with nerve pain at night?

Evidence library

Research

Appraised studies relevant to the nerves, including results that did not support a treatment.

Randomised controlled trial No clear effect

Long-term benfotiamine in type 1 diabetes

A useful null result. Benfotiamine is well absorbed, but whether it changes nerve outcomes depends on who is treated, and that question is still open.

Diabetes Care, 2012 · 67 participants · Vitamin B1

Randomised controlled trial Supportive

Oral alpha lipoic acid for symptomatic diabetic neuropathy (SYDNEY 2)

Supports short-term symptom relief at 600 mg a day, the dose with the best balance of benefit and tolerability.

Diabetes Care, 2006 · 181 participants · Alpha lipoic acid

Randomised controlled trial Mixed or partial

Four years of alpha lipoic acid in diabetic neuropathy (NATHAN 1)

Long-term use appears safe, with signals of benefit on clinical signs, but it did not meet its main goal. Evidence for slowing progression is not settled.

Diabetes Care, 2011 · 460 participants · Alpha lipoic acid

Randomised controlled trial Context