What is happening inside the nerves

Diabetic neuropathy is the most common long-term complication of diabetes. Over time, at least half of people living with diabetes develop it, most often as a gradual loss of sensation that starts in the toes and feet and can later reach the hands [1]. The longest nerve fibers are affected first, which is why symptoms tend to begin at the far ends of the limbs.

Several processes work together. Persistently high blood glucose disturbs the chemistry inside nerve cells and their protective coating. The tiny blood vessels that feed the nerves also suffer, so nerve fibers receive less oxygen and fewer nutrients. Blood fats, blood pressure, and smoking add to the strain. Damaged fibers then misfire: they can go quiet, causing numbness, or become overactive, sending pain signals without a real threat.

Recognizing the signs

Neuropathy can feel different from one person to the next, and some people notice very little at first. Common experiences include:

  • Tingling, prickling, or a "pins and needles" feeling in the feet or hands
  • Burning, stabbing, or electric-shock pains
  • Numbness, or a sense of wearing invisible socks or gloves
  • Reduced ability to feel heat, cold, or minor injuries
  • Unsteadiness, because the brain receives less information about foot and joint position

Why it often feels worse at night

Many people say their symptoms flare in the evening. There is no single explanation, but fewer distractions, cooler temperatures, the pressure of bedsheets on sensitive skin, and the fatigue of the day may all make nerve signals harder to ignore. Poor sleep, in turn, tends to lower pain tolerance the next day.

Why your feet deserve daily attention

Pain is the symptom people notice, but numbness is often the bigger risk. When you cannot feel a pebble in a shoe or a rubbing seam, a small blister can turn into an open sore before you are aware of it. Foot ulcers are a leading reason people with diabetes are admitted to hospital, and in some cases nerve damage contributes to Charcot foot, where the bones and joints of the foot weaken and change shape.

A simple routine lowers these risks:

  • Check both feet every day, using a mirror or a family member's help if needed
  • Wash and dry feet carefully, especially between the toes, and moisturize dry skin (not between the toes)
  • Wear well-fitting shoes and seamless socks, and avoid walking barefoot
  • Have your feet examined at every diabetes check-up

Everyday habits that help protect nerves

Keeping blood glucose in range. Steady glucose control is the foundation. Research shows it can halt progression in type 1 diabetes, with more modest effects in type 2, which is why blood pressure, cholesterol, and weight also matter [1]. A diet rich in fiber, vegetables, whole grains, legumes, and lean protein supports all of these.

Watching vitamin B12. B12 is essential for healthy nerves. Metformin, one of the most widely used diabetes medicines, is linked to lower B12 levels and roughly double the risk of deficiency, which is why regular B12 checks are recommended for people who take it [2]. More is not always better with B vitamins, though: very high intakes of vitamin B6 over time can themselves irritate nerves, so check doses with a pharmacist.

Limiting alcohol. Heavy drinking interferes with nutrient absorption and is directly toxic to nerves. Cutting back helps protect nerve health.

Staying active and not smoking. Regular walking and balance exercises support circulation and stability, while smoking narrows the small blood vessels that nerves depend on.

What research says about topical capsaicin

Capsaicin is the compound that gives chili peppers their heat. Applied to the skin, it acts on the TRPV1 receptor found on pain-sensing nerve endings. The first applications often cause a warm or burning feeling, and with regular use those nerve endings tend to become less responsive, which may reduce the pain signals they send.

The evidence is mixed but encouraging for some people. A 2023 systematic review found that a 0.075% capsaicin preparation reduced pain compared with placebo in one study, while a lower 0.025% strength did not, and that application-site burning and redness were the most common side effects [3]. Not every trial agrees: in a small randomized crossover study, a 0.075% lotion was well tolerated but performed similarly to placebo [4]. Results depend on the formulation, how consistently it is used, and the individual, so a fair trial of several weeks is usually needed to judge whether it helps.

Where Dendrirx fits

Dendrirx is a Health Canada licensed natural health product (NPN 80123181): a targeted cream formulated to help with the discomfort of post-herpetic neuralgia and diabetic neuropathy. Its medicinal ingredient is capsaicin from cayenne pepper (Capsicum annuum) at 0.075%. The label directs adults to apply a thin, even layer up to three or four times a day and to use it for at least one to four weeks to see a beneficial effect. Do not apply it to broken skin or with a heating pad, and ask your doctor before starting.

When to talk to a health professional

Contact your doctor or diabetes team if you notice new numbness, tingling, or burning, if pain interferes with sleep or daily activity, or if symptoms change quickly. Seek care the same day for any foot wound that is not healing, or for redness, swelling, warmth, or a change in foot shape. Tell your care team about every product you use, including creams and supplements, so your neuropathy plan fits your overall diabetes care.