How diabetes affects your nerves, the hidden role of vitamin B-12 and what you can do early

Over my years of experience as a diabetologist, I have several patients with diabetes who walk into my clinic, often complaining of a strange tingling or burning sensation in their feet, or a persistent numbness in their hands and feet that simply does not go away. Many of them assume it is tiredness or age. In reality, their nerves are sending out a warning signal, a rather serious one that should never be ignored.

What diabetes does to your nerves

When blood sugar stays high for too long, it slowly begins to damage the tiny blood vessels that feed nerves. Without proper nourishment, these nerves begin to malfunction. This condition is called diabetic peripheral neuropathy. While being one of the most common, it is still a highly underreported complication of diabetes.




The early signs include tingling, numbness, and burning sensation in hands and feet. In few, it can also feel like walking on cotton, or sudden sharp pain at night. If left unaddressed, nerve damage can progress and lead to significant body weakness, loss of balance, and even foot ulcers.

The hidden role of Vitamin B12 deficiency

Patients with diabetes, who are on long-term Metformin therapy are at a significantly higher risk of developing Vitamin B12 deficiency. While it is excellent for blood sugar control, it can reduce the absorption of B12 over time.


Tingling in the limbs, numbness, body weakness, and fatigue are also Vitamin B12 deficiency symptoms; that sometimes overlap almost exactly with diabetic neuropathy symptoms. This makes it very difficult to tell the two apart without a blood test. When both conditions coexist, which they often do; the nerve damage is compounded, and recovery takes longer.

The importance of early action

The most important thing that I ensure to tell my patients is not to wait for the pain to become unbearable before seeking help. Early intervention makes a real difference.

The first step is always tight glucose control — keeping your HbA1c within the target range. Cyanocobalamin is a synthetic form of Vitamin B12 commonly used in supplements and medicines to help treat or prevent B12 deficiency. Once in the body, it is converted into active forms of Vitamin B12 that support nerve health, red blood cell production, and overall energy levels. In my clinical practice, I often also include Vitamin B tablets for diabetics as part of the management plan, especially those that are clinically proven to support nerve health and provide relief from the common symptoms of B-Vitamin deficiency. Supplements that contain a combination of B vitamins especially B12 can be helpful, as they support nerve function and may help relieve symptoms such as tingling, numbness, and weakness.

For patients already experiencing discomfort, a nerve pain relief cream for diabetic neuropathy can also provide localised comfort, especially for those who feel a burning sensation in their feet at night or after long periods of activity.

Using a cream specially formulated to relieve nerve pain, tingling, and burning in the hands and feet can be a practical option. Topical creams that are powered by 0.075% Capsaicin, along with naturally derived ingredients like Menthol, Camphor, and Eucalyptus, which help provide soothing and symptomatic relief.

My advice to every diabetic patient is not dismiss tingling, numbness, or burning in your feet as a minor inconvenience. It is best to get it evaluated early. Also to keep a check on Vitamin B12 levels, and tightening glucose control. If required, consult with a doctor on whether you need the best nerve pain tablets suited to your condition, and whether a cream for peripheral neuropathy symptoms can support day-to-day comfort.

Nerve damage, once severe, is very difficult to reverse. But caught early and managed well, the progression can be slowed.

Medical experts consulted This article includes expert inputs shared with TOI Health by:

Dr. V Mohan, M.D., FRCP, Ph.D., D.Sc.FNASc, FASc, FAMS, FNA, FACE, FTWAS, MACP, FRS (Edinburgh) Chairman, Dr. Mohan’s Diabetes Specialties Centre & Madras Diabetes Research Foundation, Chennai

Inputs were used to explain the link between vitamin B12 and diabetes and why symptoms like tingling of hands should not be ignored.