Smoking, caffeine, and stress usually increase the severity of these symptoms. An examination by a podiatric physician will reveal any circulatory deficiencies. Diabetic neuropathy can cause insensitivity or a loss in the ability to feel pain, heat, and cold. If precautions are not taken, a hot bath can be a potential for a burn. Position sense is also often lost with neuropathy, so the feet strike objects in their path.
Diabetic neuropathy can also affect the muscles of the feet, causing deformities such as hammertoes.
When insensitivity is present, serious problems, such as ulcers and gangrene, can occur without pain. The infection may go unnoticed and appropriate care delayed until too late. By the time the trouble is discovered, amputation may be necessary to save the person's life. Daily observation of the feet is necessary by the diabetic or a responsible family member or other party. If the circulatory response is adequate, most diabetic ulcers can be healed if diagnosed and treated early.