What causes numbness and tingling in hands and feet?

Pressure on a nerve from sitting or sleeping on a limb is the commonest cause and passes quickly. Lasting tingling in both hands and feet is most often linked with diabetes, and also with heavy drinking, low vitamin B12, too much vitamin B6, some medicines including cancer treatments, an underactive thyroid and kidney disease. Tingling in the thumb and first fingers points to carpal tunnel syndrome.

Can anxiety cause tingling in hands and feet?

Yes. Breathing too fast during anxiety or panic (hyperventilation) is one of the causes of pins and needles the NHS lists. It usually passes as breathing settles. Tingling with sudden one-sided weakness, trouble speaking or a drooping face is a stroke sign, not anxiety: call 911.

Can metformin or heartburn medicines cause tingling?

They can lower vitamin B12 over time. MedlinePlus lists long-term metformin and long-term acid-reducing heartburn medicines among the causes of B12 deficiency, which can cause tingling. Do not stop either on your own; ask the prescriber whether a B12 test makes sense.

When is tingling an emergency?

Call 911 for sudden numbness or weakness in the face, arm or leg, especially on one side, or with confusion, trouble speaking or seeing. Weakness and tingling that start in the legs and spread up over hours or days, with any trouble breathing, need emergency care. Numbness around the bottom or genitals with loss of bladder or bowel control needs immediate attention.

What blood tests check for the cause of tingling?

Blood and urine tests look for causes of nerve damage. The usual ones read blood sugar (HbA1c or fasting glucose), vitamin B12 with methylmalonic acid, thyroid (TSH), kidney function (eGFR), electrolytes, and in heavy drinkers thiamine, B6 and folate. Nerve conduction tests and electromyography check the nerves themselves.

Numbness and tingling in hands and feet: the common causes

Q: What deficiency causes numbness in hands?

Low vitamin B12 is the best-known one: MedlinePlus lists numbness and tingling of the hands and feet and loss of balance among its nerve symptoms. Low B1 (thiamine), B6 and other vitamins can also damage nerves, and low calcium can cause tingling in the fingers, lips and feet. Too much B6 from supplements causes it too.

Q: Why are my hands numb when I wake up?

Sleeping on an arm or with the wrists bent is the usual reason, and the feeling goes within minutes of moving. If you often wake with numb thumbs and first fingers, carpal tunnel syndrome is the common cause; MedlinePlus suggests a wrist splint at night and not sleeping on your wrists. Diabetic nerve symptoms are also often worse at night.

Quick answer

Tingling or numbness in the hands and feet (pins and needles) usually comes from pressure on a nerve, such as sleeping on an arm, and passes in minutes. ¹ Tingling that lasts or keeps returning is most often linked with carpal tunnel syndrome (a squeezed nerve at the wrist), diabetes, heavy drinking, low vitamin B12, too much vitamin B6 from supplements, some medicines including chemotherapy, an underactive thyroid or kidney disease. ¹²⁸¹⁰ Up to half of people with diabetes have nerve damage in the feet. ³ The blood tests that read these causes are HbA1c or fasting glucose, vitamin B12 with methylmalonic acid, TSH and eGFR. ²⁴⁷ Sudden numbness or weakness on one side of the body or face, weakness climbing up the legs over hours or days, or new loss of bladder or bowel control needs 911. ¹²¹³¹⁴

The distinctions

01
The pattern of the tingling points to the cause
Sudden numbness on one side of the body is a stroke sign. Tingling in the thumb and the next two or three fingers points to the wrist (carpal tunnel). Tingling that starts in both feet and creeps up, with the hands later, points to nerve damage from something in the blood: high blood sugar, low B12, alcohol, too much B6, a medicine. Each pattern has its own test.
02
Low B12 can damage nerves before it shows on a blood count
The NHS notes that nerve problems from low B12 can happen without anemia, so a normal blood count does not rule it out. A B12 level, confirmed with methylmalonic acid when it is borderline, reads it, and nerve damage from low B12 can become permanent if it is not treated promptly.

Tingling, pins and needles, or numbness in the hands and feet usually happens because a nerve has been pressed on, for example sleeping on an arm or sitting with your legs crossed, and it fades within minutes of moving. ¹ Tingling that lasts, keeps coming back or spreads is a sign a nerve is irritated or damaged. The common causes are carpal tunnel syndrome (a nerve squeezed at the wrist), diabetes, heavy drinking, low vitamin B12, too much vitamin B6 from supplements, and some medicines. ¹²⁸¹⁰ Peripheral neuropathy is the word for damage to the nerves outside the brain and spinal cord; MedlinePlus notes that its tingling and burning "often start in your toes and feet." ² Sudden numbness on one side of the body is different: it is a stroke sign. ¹²

When to get help now

Most tingling is not an emergency. These signs can mean a stroke, a fast-moving nerve illness or pressure on the spinal nerves, and they need help now.

Call 911 or your local emergency number

Sudden numbness or weakness in the face, arm or leg, especially on one side ¹²
Numbness with sudden confusion, trouble speaking, trouble seeing or loss of balance ¹²
Weakness or tingling that starts in the legs and spreads upward over hours or days ¹³
Weakness with trouble breathing or swallowing ¹³
New numbness around the bottom or genitals, or loss of bladder or bowel control, especially with back pain or leg weakness ¹⁴

See a doctor soon, the same day if you can

Pins and needles that last a long time or keep coming back ¹
Tingling that is spreading, or with weakness, clumsiness or a weak grip ²⁸
Loss of balance or unsteady walking ⁵
A cut, blister or sore on the foot that you did not feel or that is slow to heal ³
Tingling with diabetes, heavy drinking, a vegan diet, weight-loss surgery, or long-term metformin or heartburn medicines ³⁵
Tingling that started after a new medicine or a supplement containing B6 ²¹⁰

LifeFrom can't examine you or assess a symptom. If something feels seriously wrong, trust that and get care rather than waiting on a test.

What counts as normal pins and needles?

Everyone gets pins and needles. The NHS explains that it happens when the blood supply to the nerves is cut off, usually when you sit or sleep on part of your body, and that it is normal if it fades after you move. ¹ The NHS advises seeing a GP "if you keep getting it or it lasts a long time." ¹ Numbness is a loss of feeling; tingling, burning and prickling are the nerve misfiring. Both can come from the same causes, and nerve damage can also bring shooting pain, weakness and poor balance. ²⁹

One side or both: the pattern that matters most

Where the tingling is, and how fast it came, sorts the causes better than how it feels. Clinicians read the pattern first, then pick the tests.

Pattern	What it can be linked with	What checks it
Sudden numbness or weakness on one side, face, arm or leg	Stroke: call 911 ¹²	Emergency exam and brain scan
Thumb, index and middle fingers	Carpal tunnel syndrome ⁸	Exam, nerve conduction tests, EMG ⁸
Both feet first, slowly creeping up, hands later	Nerve damage from diabetes, alcohol, low B12, too much B6, medicines, thyroid or kidney disease ²	HbA1c, B12, TSH, eGFR; nerve tests ²
Legs then arms, weaker over hours or days	Guillain-Barré syndrome: emergency care ¹³	Emergency exam and nerve tests
Lips, fingers and feet, with muscle spasms	Low calcium ¹¹	Calcium, magnesium ¹¹
Around the mouth and in the hands while breathing fast	Overbreathing during anxiety or panic ¹	Settles as breathing slows

What can cause it, most likely first

Ranked from most to least likely in adults in general. The order shifts with age, sex and history: diabetes tops the list for lasting tingling in the feet, carpal tunnel is more common in women aged 30 to 60, and a vegan diet, weight-loss surgery or long-term metformin moves low B12 up. ²⁵⁸

01
Pressure on a nerve from posture or sleepEverydaycommon
Sitting or sleeping on part of your body cuts off the blood supply to the nerves for a while, and the tingling fades within minutes of moving. ¹ Sleeping with an arm under the pillow or the wrists bent, or sitting cross-legged, are the usual culprits. This needs nothing more unless it keeps happening without an obvious cause. ¹
02
Carpal tunnel syndromeMedicalcommon
The median nerve gets squeezed where it passes through the wrist, causing numbness or tingling in the thumb and the next two or three fingers, sometimes pain up to the elbow and a weak grip. ⁸ It is more common in women and between 30 and 60, and is linked with repeated hand movements, vibrating tools, pregnancy, obesity and arthritis. ⁸ No blood test checks it; an exam and nerve conduction tests or electromyography (EMG) do. ⁸
03
Overbreathing during anxiety or panicMedicalcommon
Breathing too fast (hyperventilation) is one of the causes of pins and needles the NHS lists. ¹ It often comes with a racing heart and lightheadedness, and passes as breathing slows; see dizziness and heart palpitations. No blood test checks it. Tingling with one-sided weakness or slurred speech is a stroke sign, not anxiety. ¹² If anxiety comes with thoughts of harming yourself, call or text 988.
04
Diabetes and high blood sugarMedicalcommon
Diabetes is the most common cause of peripheral neuropathy, and "Up to one-half of people with diabetes have peripheral neuropathy." ²³ It usually starts as burning, tingling or numbness in both feet, and symptoms are often worse at night. ³ Because numb feet can miss a blister or cut, NIDDK advises checking your feet every day and a foot exam at least once a year. ³ See blood sugar explained.
Can be linked with Prediabetes
HbA1c
HbA1c is average blood sugar over 2 to 3 months: below 5.7% is normal, 5.7% to 6.4% prediabetes, and 6.5% or above diabetes. ⁴
Fasting glucose
After an overnight fast, 99 mg/dL or below is normal, 100 to 125 mg/dL fits prediabetes, and 126 mg/dL or above fits diabetes. ⁴
05
Heavy drinkingEverydaycommon
Long-term heavy drinking is a recognized cause of nerve damage, and up to half of long-term heavy drinkers may develop it, from alcohol's direct effect on nerves and the poor nutrition that often comes with it. ²⁹ It causes numbness, pins and needles and pain, more noticeable in the legs, and gets worse gradually. ⁹ Clinicians check vitamins and other causes alongside it. ⁹
Vitamin B1 (thiamine)
A low thiamine fits the poor nutrition that can come with heavy drinking; it is one of the vitamins MedlinePlus lists for testing in alcoholic neuropathy. ⁹
06
Low vitamin B12Medicalless common
Low B12 can cause numbness and tingling of the hands and feet, loss of balance and, when severe, confusion. ⁵ The causes include pernicious anemia (an autoimmune problem that blocks B12 absorption), a strict vegan diet, stomach or bowel surgery, and long-term use of metformin or acid-reducing heartburn medicines. ⁵ The NHS notes that some of these nerve problems can happen with low B12 or folate even without anemia. ⁶ Nerve damage may be permanent if treatment does not start promptly, so a clinician decides on B12 after a test. ⁵
Can be linked with B12 deficiency
Vitamin B12
A B12 below 299 pg/mL (219 pmol/L) is a possible sign of deficiency on MedlinePlus's range; metformin and acid reducers can lower it. ⁷
Methylmalonic acid (MMA)
A high methylmalonic acid confirms a true B12 deficiency when the B12 level is low or borderline. ⁷
07
Too much vitamin B6 from supplementsEverydayless common
Vitamin B6 (pyridoxine) is in many multivitamins and B complexes as well as single supplements, and taking too much over time can damage sensory nerves. ¹⁰ A 2021 review states that "Excessive PN intake induces neuropathy through the preferential injury of sensory neurons," where PN is pyridoxine. ¹⁰ The NHS links 200 mg or more of B6 daily with a loss of feeling in the arms and legs, says the effect of smaller amounts is unclear rather than known to be safe, and warns that after large amounts taken for more than a few months the damage can be permanent. ¹⁵ Low B6 can also cause nerve damage, so the level matters both ways. ² Check every label you take for B6, and bring them to a clinician rather than adjusting on your own.
Vitamin B6
A high B6 level in someone taking supplements points to B6 as a possible cause of the tingling; a low level points to deficiency, another cause of nerve damage. ²¹⁰
08
Medicines, including chemotherapyEverydayless common
Medicines that treat infections, cancer, seizures and high blood pressure can cause nerve damage, and the NHS lists chemotherapy and some other medicines among the causes of pins and needles. ¹² A start date that lines up with the tingling is a clue. Do not stop a prescribed medicine on your own; the prescriber can weigh the options.
09
Underactive thyroid or kidney diseaseMedicalless common
An underactive thyroid gland and chronic kidney disease are both on MedlinePlus's list of causes of nerve damage. ² If tingling comes with feeling tired and cold, see always cold. See kidney function explained.
Can be linked with Hypothyroidism
TSH
A high TSH (thyroid stimulating hormone) points to an underactive thyroid, one of the listed causes of nerve damage. ² See how to read your thyroid panel.
eGFR
A low eGFR (estimated glomerular filtration rate) points to reduced kidney function; chronic kidney disease is one cause of nerve damage. ²
10
Low calcium or magnesiumMedicalrare
Severe low calcium can cause "Tingling in your lips, tongue, fingers and/or feet," with muscle aches and spasms; milder low calcium causes cramps, especially in the back and legs. ¹¹ Causes include underactive parathyroid glands, low vitamin D, kidney failure and low magnesium, which the parathyroid glands need to release their hormone. ¹¹ Seizures, an abnormal heart rhythm or throat spasms with low calcium need urgent care. ¹¹ See muscle cramps.
Calcium
A total calcium below 8.8 mg/dL is low by Cleveland Clinic's definition; tingling and spasms come with more severe lows. ¹¹ See electrolytes explained.
Magnesium
A low magnesium can pull calcium down with it, so the two are read together when calcium is low. ¹¹

These are things a symptom like this can be linked with, not a diagnosis. Several can sit together, and a clinician who knows your history puts them in order for you.

What deficiency causes numbness in hands?

Low vitamin B12 is the deficiency most often behind numb or tingling hands and feet. ⁵ The nerve symptoms appear when the low level lasts a long time. ⁵ The people most at risk are those with pernicious anemia, vegans, people who have had stomach or weight-loss surgery, and people on long-term metformin or acid-reducing heartburn medicines. ⁵ Low B1, low B6 and low calcium can cause tingling too, and so can too much B6. ²¹⁰¹¹

This may be permanent if you do not start treatment promptly after your symptoms begin.MedlinePlus, on nerve damage from vitamin B12 deficiency ⁵

That is why tingling with any of the B12 risk factors is worth a test rather than a wait. A B12 level is the first test, and MedlinePlus says deficiency "should be confirmed" with methylmalonic acid, a substance that builds up when cells are short of B12. ⁷ Because the NHS notes nerve problems can come without anemia, a normal blood count does not settle the question. ⁶ For the full picture, see B12 deficiency.

Why are my hands numb when I wake up?

The commonest reason is posture: sleeping on an arm, or with the wrists curled under the chin or pillow, presses on a nerve, and the numbness clears within minutes of shaking the hands out. ¹ If it happens most nights, or the thumb and first two or three fingers are numb, carpal tunnel syndrome is a common cause. ⁸ MedlinePlus suggests wearing a wrist splint at night for several weeks and avoiding sleeping on your wrists. ⁸ Diabetic nerve symptoms are also often worse at night, but they usually start in the feet. ³ Morning numbness with weakness, or that does not clear, is worth a clinician's look.

Tingling in feet and diabetes

Diabetes is the most common cause of lasting tingling in both feet. ² NIDDK describes "burning or tingling, like 'pins and needles,' in your feet," usually on both sides, often worse at night. ³ The risk is what goes unfelt: blisters and sores can go unnoticed, heal slowly and become infected. ³ An HbA1c of 6.5% or above, or a fasting glucose of 126 mg/dL or above, is in the diabetes range on CDC cutoffs. ⁴ If you already have diabetes, NIDDK advises checking your feet every day and having a foot exam at least once a year. ³

The panel that checks these

The first round usually reads blood sugar (HbA1c or fasting glucose), vitamin B12 with methylmalonic acid, TSH and eGFR, because those cover the commonest treatable causes. ²⁷ B6 is added for anyone taking supplements, thiamine for heavy drinkers, and calcium and magnesium for tingling around the lips or with spasms. Only fasting glucose needs an overnight fast. Carpal tunnel and nerve damage itself are checked with nerve conduction tests, not blood.

HbA1cDiabetes and high blood sugar
Fasting glucoseDiabetes and high blood sugar
Vitamin B1 (thiamine)Heavy drinking
Vitamin B12Low vitamin B12
Methylmalonic acid (MMA)Low vitamin B12
Vitamin B6Too much vitamin B6 from supplements
TSHUnderactive thyroid or kidney disease
eGFRUnderactive thyroid or kidney disease
CalciumLow calcium or magnesium
MagnesiumLow calcium or magnesium

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Getting a useful test

Draw where the tingling is on a simple body outline: one side or both, fingers or whole hand, feet only or hands too.
Note when it started, whether it is getting worse, and whether it is worse at night. ³⁸
List every medicine, with start dates, including metformin, heartburn medicines, chemotherapy and seizure medicines. ²⁵
Bring every supplement label, because B6 is in many multivitamins and B complexes, and too much of it can cause tingling. ¹⁰
Tell the clinician about diet (vegan or not), alcohol, and any stomach or weight-loss surgery. ⁵⁹
One result is a snapshot; see why trends beat single readings.

What may help

What helps depends on the cause, and lasting tingling is worth a clinician's look before anything else. These everyday steps have support for the causes on this page.

Start with the everyday things

Change sleeping position, and avoid sleeping on your arms or with your wrists bent. ¹⁸
For hand numbness at night, a wrist splint and a better desk and keyboard set-up are the first steps MedlinePlus lists for carpal tunnel. ⁸
Cut down on alcohol; heavy drinking damages nerves directly and through poor nutrition. ⁹
With diabetes, check your feet every day for cuts, blisters and sores. ³
Read supplement labels for B6 and add up the total across products, then show the list to a clinician. ¹⁰

Supplements people look at

Vitamin B12What people take it for: keeping B12 in range, for example on a vegan diet. It only helps tingling if you are low, which a blood test shows, and a clinician then finds out why you are low and decides the form and amount.

No B complex or multivitamin is listed, because many contain B6 and too much B6 is itself a cause of tingling. Supplements support general wellness. They don't treat the causes above, and if a test finds one, treating that comes first. If you take medicines, are pregnant or have a health condition, check with your clinician before starting anything.

Questions to ask your clinician

Does the pattern of my tingling point to one nerve, like carpal tunnel, or to many nerves?
Should I have HbA1c, B12 with methylmalonic acid, TSH and eGFR checked?
Could any of my medicines or supplements, including B6, be causing it?
Do I need nerve conduction tests or a referral to a neurologist?
How should I look after my feet if I have lost feeling?
Which signs would mean I should call 911?

This page is general education, not medical advice or a diagnosis. Tingling has many causes that can overlap, and the clinician who knows your history and examines you is the one to read your results and put them in order.

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Citations

Educational context only, not medical advice or a diagnosis. Always discuss your results with a clinician.

Numbness and tingling in hands and feet: the common causes, and the tests that check them