Diabetes Self-Management Blog

Neuropathy, or nerve damage, is one of the most common diabetic complications, affecting up to 70% of people who have diabetes. Now, new research from the University of Michigan shows that many people with the condition are receiving a less effective — and more expensive — test to diagnose the condition, instead of a more accurate diagnostic test.

In people who have diabetes, neuropathy is believed to be caused in large part by excess glucose in the blood infiltrating the nerves and interfering with their electrical signals. Sensory neuropathy impacts the nerves responsible for sensation, and typically affects the feet, legs, hands, and arms. Symptoms include pain, numbness, loss of sensation, tingling, coldness, and sensitivity to touch. (Another type of neuropathy, autonomic neuropathy, impacts nerves that control the functions of internal organs, and may cause complications ranging from gastroparesis to sexual dysfunction.)

Along with diabetes, other causes of neuropathy include shingles, vitamin deficiency (particularly of vitamin B12), autoimmune diseases such as lupus and rheumatoid arthritis, exposure to toxins, use of certain cancer medicines, and more. Diabetes is the most common cause of peripheral neuropathy, or neuropathy that affects the arms, legs, hands, and feet.

In an effort to make diagnosis of peripheral neuropathy more efficient, researchers used the 1996–2007 Health and Retirement Study to determine how this condition is typically diagnosed. They identified 1,031 people who had been diagnosed with neuropathy and met the study’s criteria. The researchers then focused on 15 diagnostic tests for the condition, studying the pattern of testing six months before and after the participants’ diagnoses.

The researchers found that the low-cost glucose tolerance test — the test measures a person’s blood glucose response to the consumption of a glucose-rich drink after at least eight hours without food or drink — which could detect undiagnosed diabetes in people experiencing neuropathy symptoms, was ordered in only 1.0% of people. Expensive magnetic resonance imaging, or MRI, tests of the spine or brain (which cannot identify diabetes), on the other hand, were ordered in 23.2% of people.

“Our findings, that MRIs were frequently ordered by physicians, but a lower-cost glucose tolerance test was rarely ordered, show that there is substantial opportunity to improve efficiency in the evaluation of peripheral neuropathy,” noted lead researcher Brian Callaghan, MD. “Currently no standard approach to the evaluation of peripheral neuropathy exists. We need more research to determine an optimal approach. We do a lot of tests that cost a lot of money, and there’s no agreement on what we’re doing.”

For more information, read the article “Neuropathy Patients More Likely to Receive High-Cost, Low-Yield Screening Instead of More Effective Tests” or see the study’s abstract in the Archives of Internal Medicine. And to learn more about controlling pain from neuropathy, see the articles “Coping With Painful Neuropathy” and “Controlling Neuropathic Pain.”


  1. Makes sense to do the obvious first. Actually the Doctors should do a finger prick. If the sugar is high enough for nerve damage it should show up on even the inaccurate 5 second meters that we all now enjoy.

    Posted by calgarydiabetic |
  2. I thought the best part of the article was the quota:

    “We do a lot of tests that cost a lot of money, and there’s no agreement on what we’re doing.”

    Keeping blood sugar under best control is obviously the answer — this is not new science. Those who do this have even experienced decreased neuropathy.

    Posted by John_C |
  3. thank you for bringing up autonomic neuropathy for sure as there is little you can really find about it and to most people it’s just another word..their are those of us out there scared to death almost trying to live with the results of this and not knowing what to do except wait for sure and keep the diabetes under control..it’s hard when you lose the ability to ‘feel’ the drops in blood sugars and haver no symptoms at all
    again thanks

    oh and by the way calgarydiabetic my meter is accurate with the doc plus or minus 5 points and it is the same with the blood draw..are you cleaning the fingers with warm soap and water???

    Posted by marylittle |
  4. My overnight fasting test was normal.
    Not until I had a glucose tolerance test and an A1c test did I learn I was diabetic and that high blood sugar had caused my neuropathy.

    Posted by Gardengirl |
  5. Another example of lawyers running the country. Doctors are giving the MRI so that they can’t be sued for missing a brain or spine disease.
    If they find high glucose levels, let the person know they have diabetes, and that with 99% certainty that is the cause of the neuropathy, there is still a 1% chance it’s something else also (or instead), and the doc could get sued for missing a spine or brain problem.
    Have you ever heard a doc be sued for missing a diabetes diagnosis for a few months?

    Posted by Indy Guy |
  6. I’ve found that a heating pad rolled in a towel or small throw to avoid over heating and placed at the foot of the bed under the covers has reduced the numbness in my toes and the ball of my foot. Anecdotal, but cheap to try. It works for me. I’m type II 12 years

    Posted by John A |
  7. I had numbness in my left leg. I underwent several expensive tests, MRI included. There was not a determined cause. A few years later, I was diagnosed with diabetes. If I had had a glucose tolerance test, I would have been diagnosed sooner. However, the numbness went away because I have tightly controlled my blood sugar since diagnosis. I did have 3 toes go numb since then, but that went away when I quit taking statins. I don’t know if that is a coincidence or not.

    Posted by Becky |

Post a Comment

Note: All comments are moderated and there may be a delay in the publication of your comment. Please be on-topic and appropriate. Do not disclose personal information. Be respectful of other posters. Only post information that is correct and true to your knowledge. When referencing information that is not based on personal experience, please provide links to your sources. All commenters are considered to be nonmedical professionals unless explicitly stated otherwise. Promotion of your own or someone else's business or competing site is not allowed: Sharing links to sites that are relevant to the topic at hand is permitted, but advertising is not. Once submitted, comments cannot be modified or deleted by their authors. Comments that don't follow the guidelines above may be deleted without warning. Such actions are at the sole discretion of DiabetesSelfManagement.com. Comments are moderated Monday through Friday by the editors of DiabetesSelfManagement.com. The moderators are employees of Madavor Media, LLC., and do not report any conflicts of interest. A privacy policy setting forth our policies regarding the collection, use, and disclosure of certain information relating to you and your use of this Web site can be found here. For more information, please read our Terms and Conditions.

Diabetic Complications
Statins May Reduce Risk of Nerve Damage, Other Diabetes Complications (09/18/14)
New Approach for Neuropathy Pain? (08/18/14)
Study Evaluating Treatment for Neuropathy Pain (07/08/14)
Good Control Now = Lifetime Benefit (06/25/14)

Diabetes Research
Can Grapefruit Juice Prevent Weight Gain, Increase Insulin Sensitivity? (10/16/14)
Low-Carb Diet Improves Quality of Life in Type 2 Diabetes (10/07/14)
Long Hours at Low-Income Jobs Linked to Increased Diabetes Risk (10/02/14)
Statins May Reduce Risk of Nerve Damage, Other Diabetes Complications (09/18/14)

Diabetes News
FDA Approves Remote Glucose-Monitoring Technology (10/23/14)
Can Grapefruit Juice Prevent Weight Gain, Increase Insulin Sensitivity? (10/16/14)
Low-Carb Diet Improves Quality of Life in Type 2 Diabetes (10/07/14)
Long Hours at Low-Income Jobs Linked to Increased Diabetes Risk (10/02/14)

Diane Fennell
FDA Approves Remote Glucose-Monitoring Technology (10/23/14)
Take Part in the Big Blue Test! (10/15/14)
Can Grapefruit Juice Prevent Weight Gain, Increase Insulin Sensitivity? (10/16/14)
Low-Carb Diet Improves Quality of Life in Type 2 Diabetes (10/07/14)



Disclaimer of Medical Advice: You understand that the blog posts and comments to such blog posts (whether posted by us, our agents or bloggers, or by users) do not constitute medical advice or recommendation of any kind, and you should not rely on any information contained in such posts or comments to replace consultations with your qualified health care professionals to meet your individual needs. The opinions and other information contained in the blog posts and comments do not reflect the opinions or positions of the Site Proprietor.