What is the Most Common Cause of Peripheral Neuropathy?

When patients ask why they are experiencing tingling, burning or numbness in their hands and feet, the answer most often points to one underlying culprit: type 2 diabetes. Across epidemiological studies and clinical practice, diabetes accounts for roughly half of all diagnosed peripheral neuropathy cases, making it the single most prevalent cause worldwide.

The link between high blood sugar and nerve damage is multifactorial. Chronically elevated glucose leads to the formation of advanced glycation end‑products (AGEs) that stiffen blood‑vessel walls, reducing the microcirculation that supplies peripheral nerves.

Simultaneously, excess glucose overloads the polyol pathway, converting glucose into sorbitol. Sorbitol accumulates inside Schwann cells (the myelin‑producing glia) and pericytes that line tiny capillaries, drawing water into the cells, swelling them, and eventually causing rupture. The resulting loss of myelin insulation and capillary leakage creates an “energy crisis” inside the nerve: DNA repair enzymes (PARPs) consume intracellular NAD⁺, leaving insufficient co‑enzyme for glycolysis and the Krebs cycle. Without ATP, the nerve cannot maintain its membrane potential, leading to the characteristic pain, tingling,, and loss of sensation.

Other contributors—such as vitamin B12 deficiency, chronic kidney disease, hypothyroidism, certain medications (especially chemotherapy and some antibiotics), and autoimmune disorders—are certainly important, but they each represent a smaller slice of the overall neuropathy pie. In a typical primary‑care population, diabetes is the dominant factor, followed by B12 deficiency (particularly in older adults or strict vegans) and alcohol‑related toxicity.

Because diabetes is the most common cause, controlling blood glucose is the single most effective preventive strategy. Maintaining an HbA1c below 7 % dramatically reduces the incidence and progression of neuropathy. Lifestyle measures—low‑glycemic, nutrient‑dense diets, regular aerobic exercise, weight management, and stress reduction—are the foundation. When lifestyle alone is insufficient, pharmacologic agents (metformin, GLP‑1 agonists, SGLT2 inhibitors) and targeted supplements (Bio Glycozyme Forte, vitamin B12, NMN to replenish NAD⁺) can further protect nerves.

If you have diabetes or suspect a metabolic problem, early screening is essential. Simple bedside tests—monofilament, vibration, and temperature assessments—combined with laboratory panels (fasting glucose, HbA1c, vitamin B12, renal function) can catch neuropathy before it becomes disabling. Once identified, a comprehensive protocol that addresses the six essential needs (nutrition, oxygen, stimulation, neurotrophic factors, healthy tissue, and mitochondrial health) can halt or even reverse the damage.

In summary, while many conditions can injure peripheral nerves, type 2 diabetes remains the most common cause of peripheral neuropathy. Managing blood sugar, supporting mitochondrial function, and using advanced regenerative therapies give patients the best chance of preserving nerve health and avoiding the painful sequelae of uncontrolled diabetes.

If you are living with diabetes or have unexplained nerve symptoms, schedule a free neuropathy screening at our clinic. We’ll evaluate your blood‑sugar control, run NAD⁺ testing and design a personalized treatment plan that tackles the root cause of your neuropathy.

Call 507-524-4000 or 507-387-1222 or book online today and start your journey toward a neuropathy‑free future.

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This article should be used as an educational resource to help you explore lifestyle habits, self‐management techniques, and wellness ideas that may complement your neuropathy health journey.