Diabetes is among the most common causes of peripheral neuropathy. It's also the one where the evidence points most clearly at something you can't buy in a bottle — which makes it worth saying plainly on a page like this.
Sustained high blood glucose damages the small blood vessels supplying peripheral nerves, and damages the nerve fibres themselves. Symptoms typically begin in the longest nerves first — hence feet before hands — as tingling, numbness, burning or pain.
Glycaemic control. Keeping blood glucose within target range has the strongest evidence base of any intervention for slowing progression of diabetic nerve damage.
It isn't a cure, and it doesn't reliably reverse established damage. But nothing else in the field has comparable support, and it's the foundation everything else sits on.
Numbness means injuries go unnoticed. Daily foot inspection, well-fitting footwear, and prompt attention to any wound genuinely prevent serious complications — and this is standard clinical advice for good reason.
For neuropathic pain specifically, several prescription options have evidence behind them. Those are conversations with your doctor, not decisions to make from a supplement page.
Here's an underappreciated overlap. Long-term metformin use impairs vitamin B12 absorption — and B12 deficiency itself causes neuropathy.
So someone with diabetes on long-term metformin may have nerve symptoms from the diabetes, from a metformin-induced B12 deficiency, or both. These need different responses, and only a blood test distinguishes them.
If that describes you, ask your doctor specifically about B12 testing. It's a genuinely common and genuinely fixable oversight.
Honestly: around the edges, after the above.
Alpha-lipoic acid has the best supplement evidence in this space, with oral trials typically using around 600 mg daily, mostly showing effects on symptom scores rather than measured nerve function.
Benfotiamine and acetyl-L-carnitine have some supporting research at their own studied doses.
None of these substitutes for glucose control. All of them are reasonable additions to a picture where glucose control is already happening.
Most supplement marketing invites you to start at step five. Starting at step one produces better outcomes.
Read next: how to measure whether anything is working.