Numbness and tingling: causes and warning signs

According to MedlinePlus, go to the ER or call 911 if numbness or tingling comes with:

• Weakness, or being unable to move a part of your body
• A recent head, neck or back injury
• Being unable to control an arm or a leg, or loss of bladder or bowel control (for example with back pain)
• Confusion or loss of consciousness, even briefly
• Slurred speech, a change in vision or trouble walking

Most of the time the cause is not an emergency. According to MedlinePlus and the NIH, the most common are:

• A position that presses on a nerve: sitting with your legs crossed or sleeping on your arm ("my hand fell asleep")
• Carpal tunnel syndrome: numbness or tingling in the thumb and the next two or three fingers, and in the palm. See carpal tunnel syndrome
• Diabetes (diabetic neuropathy): burning or tingling in the feet, often worse at night. See type 2 diabetes
• Low vitamin B12 or other B vitamins; long-term metformin use can lower B12. See vitamin B12 deficiency
• A pinched nerve in the neck or back, for example from a herniated disk: tingling that runs down the arm or leg. See neck pain and low back pain
• Underactive thyroid: see hypothyroidism
• Abnormal calcium, potassium or sodium levels; alcohol; some medicines; shingles; and migraine

Puerto Rico has the highest rate of diagnosed adult diabetes of any U.S. state or territory: 14.4% in 2021, according to the CDC. According to the NIH, up to half of people with diabetes have peripheral neuropathy: nerve damage, mostly in the feet and legs, from years of high blood sugar.

Neuropathy can keep you from feeling a cut or blister on your foot, and those sores can become infected. If you have diabetes and a cut or sore on your foot that isn’t healing, or your foot looks red or swollen, have it seen in person soon. Keeping your blood sugar, blood pressure and cholesterol at goal helps keep the damage from getting worse.

You see Dr. Diana Nieves Castro, a Puerto Rico-licensed general practice physician with several years of emergency-department experience, in English or Spanish. She asks where you feel the tingling, since when, what makes it better or worse, whether you have diabetes or thyroid problems, which medicines you take (such as metformin) and whether you drink alcohol.

We evaluate, diagnose and treat. If needed, we give you a lab order for a lab near you: for example glucose and hemoglobin A1c, vitamin B12, thyroid, electrolytes, kidney function and a blood count. If appropriate, the doctor prescribes and we send your prescription to your pharmacy. If you need a nerve study, imaging or a specialist, we refer you.

An online doctor visit costs US$79, the same price for every age. If the patient is under 21, a parent or legal guardian stays on camera for the whole visit and shows ID.