In some cases, nerve damage is caused by the inability to properly use energy in the body. In other cases, dangerous substances (toxins) build up in the body and damage nerves.

Diabetes is one of the most common causes of metabolic neuropathies. People who are at the highest risk of nerve damage from diabetes include:

• Those with damage to the kidneys or eyes
• Those with poorly controlled blood sugar

Other common metabolic causes of neuropathies include:

• Alcoholism
• Low blood sugar (hypoglycemia )
• Kidney failure
• Porphyria
• Severe infection throughout the body (sepsis )
• Thyroid disease
• Vitamin deficiencies (including vitamins B12 , B6 , E , and B1 )

Some metabolic disorders are passed down through families (inherited), while others develop due to various diseases.

These symptoms occur because nerves cannot send proper signals to and from your brain:

• Clumsy walk (gait)
• Inability to feel things properly (numbness)
• Loss of coordination
• Pain -- burning, pins and needles, or shooting pains
• Weakness

Usually, these symptoms start in the toes and feet and move up the legs, eventually affecting the hands and arms.

Your doctor will test your:

• Coordination
• Feeling (sensation)
• Reflexes
• Strength

Abnormal findings on any of these tests can indicate that you have a neuropathy.

Tests used to detect most metabolic neuropathies:

• Blood tests
• Electrical test of the nerves (EMG )

For most metabolic neuropathies, the best treatment is to correct the metabolic problem.

Vitamin deficiencies are treated with diet. Abnormal blood sugar or thyroid function may need medication to correct the problem.

In some cases, pain is treated with medications that reduce abnormal pain signals from the nerves. Lotions, creams, or medicated patches can provide relief in some cases.

Weakness is often treated with physical therapy. You may need to learn how to use a cane or walker if your balance is affected. You may need special braces on the ankles to walk better.

For additional information and support, see www.neuropathy.org .

The outlook mainly depends on the cause of the disorder. In some cases, the problem can easily be treated. In other cases, the metabolic problem cannot be controlled and nerves may continue to become damaged.

• Injury to feet
• Numbness
• Pain
• Trouble walking
• Weakness

Maintaining a healthy lifestyle can reduce the risk of neuropathy.

• Avoid excess alcohol use.
• Eat a balanced diet.
• Visit the doctor regularly to find metabolic disorders before neuropathy develops.

If you already have a metabolic problem, regular doctor visits can help control the problem and reduce the chance of further nerve damage.

Patients who already have metabolic neuropathy can reduce the risk of some complications. A foot doctor (podiatrist) can teach you how to inspect your feet for signs of injury and infection. Proper fitting shoes can lessen the chance of skin breakdown in sensitive areas of the feet.