Pain and Diabetes

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Pain and Diabetes

What’s the connection, and how to get relief

Diabetes is a chronic, lifelong condition, so it’s not surprising that it both impacts and is impacted by so many areas of our lives. It can also be associated with its share of stigma, and people living with diabetes may hear things like “Just do what your doctor says and it will get better” or “you can change it if you really want to.” These messages can wear us down and leave us feeling hopeless. Similarly, pain can be a chronic, lifelong condition. For some, pain comes and goes, but for others, it is a part of our every day. As with diabetes, pain conditions can impact many areas of our lives and can also be associated with stigma.

The combination of having to manage pain and having to manage diabetes can feel overwhelming, and some may react by avoiding dealing with either one. You may be surprised to learn, though, that your diabetes and your pain may be linked in a number of ways, and improving your care and management in one area can improve the other. Let’s dive into how diabetes and pain are linked and learn about some ways to get relief.

The link between diabetes and pain

Diabetes can directly affect our experience of pain: Studies have shown that elevated blood glucose levels reduce our body’s pain suppression mechanisms. In other words, the chemical, neurological, and hormonal processes that should reduce our experience of pain are inhibited. There is also evidence that when blood glucose levels are elevated, pain medications may be less effective. People with diabetes may therefore need additional assistance with pain management.

Muscles and joints

Diabetes can also cause changes in our bodies that are painful. The muscles and joints are one of the areas most commonly affected. These issues often start with postural or movement injuries that lead to loss of flexibility. This loss of flexibility leads to tension, stress on joints, and pressure on nerves, which can be very painful. This pain, in turn, then leads to less movement and less flexibility. Eventually muscles can shorten or even atrophy (waste away), and the cycle is very hard to break.

Did you know that elevated blood glucose levels also cause loss of flexibility? When there is excess glucose in our blood, the connective tissues (tendons and ligaments) that hold our muscles and bones together and keep our joints in alignment get glycated (linked with sugar molecules). As a result, they get more rigid and less flexible, which adds pain to everyday tasks and can make being active less enjoyable.


Another pain condition experienced by many people with diabetes is a long-term complication called neuropathy (nerve damage). Damage from high blood glucose levels to the small blood vessels leads to reduced circulation to nerve fibers. Without sufficient oxygen and nutrients, these nerves begin to die. Nerve damage can cause numbness, and it can also be extremely painful. (Anyone who’s had a hand or foot “fall asleep” and felt the pins and needles of nerves briefly deprived of oxygen flow has an inkling of the pain potential of nerve damage.)


People with diabetes are also at higher risk of developing peripheral arterial disease (PAD), a condition in which arteries become blocked and circulation is reduced. When PAD affects the legs, symptoms can include pain in the calves, thighs, and hips, which typically occurs with activity and goes away with rest.

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Blood glucose and pain

The risk of developing these painful complications can be reduced by keeping blood glucose levels in target range and taking steps to avoid erratic blood glucose swings. This can be complicated, however, since not only does diabetes impact pain, but pain can impact blood glucose.

Why is this? For one thing, when we are in pain, it is hard to maintain regular physical activity, which in turn makes it harder to keep blood glucose levels stable and in target range. Experiencing pain can also raise our levels of stress hormones, which increase insulin resistance and elevate blood glucose levels. Inflammation from a chronic injury can also cause persistent low-level elevation in blood glucose. In these cases, diabetes medications may need to be increased to keep blood glucose levels well managed.

Additionally, people who live with chronic pain are also far more likely to self-medicate with food — rates of food addiction and binge eating disorders are much higher in those who report chronic pain — and to deal with depression. People in pain are also more likely to miss or cancel health care appointments, which leads to a general reduction in wellness over all. If we are struggling to get through each day due to the burdens presented by a pain condition, our diabetes may take a back seat. 

So, as we can see, managing pain is not just important for quality of life — it can actually be a critical component of diabetes management, too.

Managing pain: tips and techniques

What can we do to help manage pain? Prescription medication options can be effective, but they also carry risks and the potential for side effects. Before we look to steroids, opiates, nerve blocks, and other medicines and procedures, what can we do to help reduce and manage our pain issues at home? Here are a few suggestions. (Be aware that, because pain can increase blood glucose levels, starting pain management can result in low blood glucose, or hypoglycemia. A reduction in insulin or other blood-glucose-lowering medications may be needed at the start of treatment, so work with your health care team to have a plan in place.)

Avoid injury

  • Maintain a healthy weight, since carrying extra weight increases the risk of joint and back injury and pain.
  • Also adopt a stretching routine. Maintaining flexibility reduces strain on joints and nerve pressure, so stretch daily. Be sure to stretch both before and after exercise to avoid muscle and joint injuries.

Consider hot and cold therapy

  • Talk to your doctor about the use of hot and cold therapy to relieve pain, particularly muscle pain. From heating pads and hot water bottles to cold compresses and cooling sprays, these therapies can reduce inflammation, improve circulation, reduce swelling, and increase comfort.

Try physical therapy/chiropractic care

  • Don’t think of these as another appointment, think of them as a personal trainer your insurance will pay for! Physical therapy can help you increase range of motion and flexibility. Your therapist can give you exercises to strengthen muscles and reduce the burden on painful joints. They can even help you find patterns of misuse that have been leading to your pain in the first place. Physical therapy is available and covered by insurance for nearly any cause of pain, and coverage is often continued until the issue is resolved.
  • These professionals can also guide you in the use of stimulation therapy. This involves using a device that emits a low electrical impulse, which can help block pain receptors if worn long term. Some versions can even be implanted for pain management. In shorter-term use, this treatment creates tiny micromovements in the muscles that can help them release tension and increase circulation to reduce pain and nerve impingement.

Get moving to stay moving

  • It may hurt to get moving at first, but the more we move the less it will hurt. So, while an injury may have us briefly sidelined while healing, it should never stop us from moving entirely. As we move, circulation increases, helping muscles to receive oxygen and nutrients and heal better, reducing fluid in joints that causes painful stiffness, and allowing muscles to strengthen and stabilize injured areas. It may ache to get started, but remember that the more we move, the less we hurt. Work with your doctor on a plan to manage that initial pain and to ensure you can get moving without further injury. Stretching is a fantastic place to start!

Investigate topical options

  • Topical pain relievers can be effective for muscle pain and short-term relief. Options include menthol gels, magnesium oil sprays, lidocaine, and numbing creams. These great options are available over the counter, cheaply, and without sedative or digestive side effects (be aware, though, that too much magnesium can cause loose stools) or the potential for addiction. Topical pain relievers are of minimal assistance for more severe nerve pain or joint pain, but they can provide temporary relief to assist in mobility.

Look into over-the-counter medications

  • Speak with your provider about the use of over-the-counter medications. While these options can be highly effective, using them long-term can pose some potential health risks (such as liver function issues from acetaminophen or blood pressure and digestive impacts from long-term NSAID use). They may also interact with other medications you are taking. However, these medicines can be highly effective for treating pain. A recent study even showed that alternating acetaminophen and ibuprofen every four hours resulted in pain control comparable to opioid pain management. Talk with your prescriber about appropriate use, timing, and dosages to meet your needs.

There is hope

I live with chronic pain, and I live with diabetes. Managing both of these conditions together is key to staying healthy and active and enjoying life. Just as it is for you, it is important that I work with my entire medical team to achieve my goals and to ensure they understand how my pain control and blood glucose management are equally important and depend on one another. With good communication and a collaborative approach, you can feel better.

Want to learn more about diabetes and related pain conditions? Read “Coping With Painful Neuropathy,” “Diabetes and Headaches: What’s the Link?” and “Diabetic Leg Pain and Peripheral Arterial Disease.”

Originally Published February 15, 2022

Alicia Downs, RN, MSN, CDCES

Alicia Downs, RN, MSN, CDCES on social media

Alicia Downs, RN, MSN, CDCES, is the director of patient care and education at Integrated Diabetes Services in Wynnewood, Pennsylvania. After an initial diagnosis of type 2 diabetes, she was diagnosed with LADA (latent autoimmune diabetes in adults) and uses her personal experience and diverse nursing background to coach people with all types of diabetes. Visit for more information.

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