Diabetes Care
Diabetic Neuropathy Treatment in San Diego
Diagnosis, protecting the nerves, and treating neuropathic pain, including in-office Qutenza.
Diabetic neuropathy is nerve damage caused by diabetes. It most often affects the feet and legs, causing numbness, tingling, burning or sharp pain. It is common, it can be painful enough to disrupt sleep and daily life, and it is treatable. Our endocrinologists manage both the diabetes behind it and the symptoms it causes.
Symptoms
- Numbness, tingling or “pins and needles,” usually starting in the toes and feet
- Burning, electric or stabbing pain, often worse at night
- Sensitivity to light touch, such as bed sheets
- Loss of balance or not feeling injuries on the feet
Diabetes can also affect nerves that control the stomach, bladder, blood pressure and heart rate (autonomic neuropathy), causing bloating, early fullness, dizziness on standing or sexual dysfunction. Tell us about these symptoms too.
How it is diagnosed
Diagnosis is based on symptoms and a foot examination, including sensation testing with a monofilament and a tuning fork, and reflexes. We also check for other causes that can mimic or worsen neuropathy, including vitamin B12 deficiency (more common with long-term metformin use), thyroid disease, kidney disease and alcohol. Nerve conduction studies are reserved for unusual presentations.
Treatment
Protecting the nerves
Steady glucose control slows progression, and good control of blood pressure and cholesterol, not smoking, and regular activity help too. Daily foot checks and proper footwear prevent ulcers in people who have lost sensation.
Treating the pain
Several medicines reduce neuropathic pain, including duloxetine, pregabalin, gabapentin and certain older antidepressants. The right choice depends on your other conditions and side effects, and the dose is increased gradually.
Qutenza (capsaicin 8% patch)
Qutenza is a prescription-strength capsaicin patch approved by the FDA for painful diabetic neuropathy of the feet. It is applied in the office for about 30 minutes and can relieve pain for up to three months per treatment, without daily pills. It can be used alone or together with oral medicines. We offer Qutenza at two of our offices.
See a doctor promptly for a foot wound that is not healing, a red, warm or swollen foot, or sudden weakness. These need same-week attention.
Common questions
Can diabetic neuropathy be reversed?
Established nerve damage usually does not fully reverse, but progression can be slowed and pain can often be controlled well.
Does Qutenza hurt?
The skin is cooled or numbed beforehand. Burning or redness during and shortly after application is common and temporary.
Painful neuropathy evaluation
Call (858) 622-7200 or send a request. See also diabetes care.
Sources: Pop-Busui R, et al. Diagnosis and Management of Diabetic Neuropathy. American Diabetes Association; 2022. American Diabetes Association. Standards of Care in Diabetes—2026, Retinopathy, Neuropathy, and Foot Care. Diabetes Care. 2026;49(Suppl 1). QUTENZA (capsaicin) topical system, prescribing information. Written by Darius A. Schneider, MD, PhD. Reviewed October 2026.
