Neuropathy

Neuropathy refers to damage or dysfunction of the peripheral nerves that carry signals for sensation, movement, and autonomic functions. Symptoms often begin gradually with numbness, tingling, burning pain, or weakness—frequently in the feet and hands. Because many conditions can cause or worsen neuropathy (diabetes, thyroid disease, vitamin deficiencies, autoimmune disorders, toxins, infections, and medications), targeted blood tests are a practical first step.

A proactive lab approach starts with general health and metabolic screens (CBC, CMP, A1c/glucose, TSH) and vitamin B12 with methylmalonic acid (MMA), then expands to protein studies (SPEP/IFE)autoimmune panelsheavy metals, and infection tests when history points that way. Blood tests support screeningdiagnostic triage, and monitoring trends, but they do not replace a neurologic exam, nerve conduction studies/EMGskin biopsy for small-fiber neuropathy, or imaging when indicated.

Signs, Symptoms & Related Situations

  • Sensory: numbness, tingling (“pins and needles”), burning pain, allodynia (pain from light touch), reduced vibration/position sense

  • Motor: weakness, foot drop, hand clumsiness, muscle cramps, frequent tripping, decreased reflexes

  • Autonomic: dizziness on standing, sweating changes, heat/cold intolerance, bowel or bladder changes, erectile dysfunction

  • Pattern clues: stocking-glove distribution (length-dependent), asymmetry, sudden onset, or rapidly progressive symptoms

  • Risk & exposure: diabetes/prediabetes, thyroid disease, heavy alcohol use, chemotherapy or other neurotoxic meds, nutritional issues, bariatric surgery, celiac disease, autoimmune disease, tick exposure (Lyme), HIV/hepatitis risk, occupational metals/solvents

  • Seek urgent care now: sudden severe weakness, rapidly ascending paralysis, breathing trouble, stroke-like symptoms, high fever with stiff neck, or new seizures

All symptoms and risks should be reviewed by a qualified clinician.

Why These Tests Matter

What testing can do

  • Identify reversible contributors (high A1c, low B12/folate, abnormal thyroid, toxin exposure)

  • Differentiate patterns suggesting immunemetabolictoxic, or monoclonal causes (via autoantibodies, metals, SPEP/IFE)

  • Guide next steps by prioritizing EMG/NCS, imaging, or specialist referral; track trends over time

What testing cannot do

  • Diagnose neuropathy on blood tests alone—electrodiagnostics and clinical evaluation are often required

  • Replace a full medication/supplement review (e.g., excess vitamin B6 can cause neuropathy)

  • Provide treatment or dosing advice—interpret results with your clinician

What These Tests Measure (at a glance)

  • Metabolic & general health: A1c/fasting glucose (diabetes/prediabetes), CMP (kidney/liver, electrolytes), CBC(anemia/infection), lipid panel (vascular risk).

  • Thyroid: TSH ± Free T4—hypo/hyperthyroidism can contribute to neuropathy and fatigue.

  • Vitamin & nutrition: Vitamin B12 with MMA (functional B12 deficiency), folatevitamin Dthiamine (B1)vitamin B6 (both deficiency and excess can cause neuropathy)vitamin?E (select cases).

  • Protein disorders: SPEP/IFE to detect monoclonal proteins (MGUS/MM) linked to neuropathy.

  • Autoimmune & inflammation: ESR/CRPANA (± ENA/dsDNA), SSA/SSB (Sjögren), RF/anti-CCP (RA context), ANCAcomplements (C3/C4)anti-ganglioside (GM1, GD1a, GQ1b) and anti-MAG for specific neuropathies.

  • Infections (when indicated): HIV 4th-generationsyphilis (RPR/treponemal), Lyme two-tier testing, hepatitis B/C.

  • Toxins & metals: lead, mercury, arseniccopper/ceruloplasminammonia (encephalopathy).

  • Neuromuscular injury context: CK and aldolase to screen for myopathy if weakness predominates.

  • Celiac-neurology link: tTG-IgA with total IgA (or DGP) for gluten-related neuropathy/ataxia.

Quick Build Guide

Clinical goal Start with Add if needed
New distal numbness/tingling A1c • TSH • B12 + MMA • CMP • CBC Folate • Vitamin D • B1/B6
Painful small-fiber symptoms A1c • B12 + MMA • TSH SSA/SSB • tTG-IgA • Lipids • B1/B6
Weakness or motor-predominant signs CK • CMP • TSH Anti-ganglioside • Anti-MAG • ESR/CRP • EMG/NCS (clinical)
Suspected immune neuropathy ESR/CRP • ANA SSA/SSB • ANCA • Anti-ganglioside • Complements C3/C4
Monoclonal protein concern (age >50 or red flags) SPEP/IFE Serum free light chains (clinician-directed)
Exposure risk (work/hobby, new meds) CMP • CBC Lead • Mercury • Arsenic • Copper/Ceruloplasmin
Infection risk HIV 4th-gen • Syphilis tests Lyme two-tier • Hep B/C

How the Testing Process Works

  1. Pick a starting set using the Quick Build Guide and your symptoms.

  2. Provide samples: standard blood draw; fasting only if fasting glucose/lipids are included.

  3. List supplements/meds: especially vitamin B6, alcohol use, chemotherapy, or other neurotoxic agents.

  4. Review results with your clinician: abnormal screens trigger targeted add-ons and often EMG/NCS or other studies.

  5. Trend key markers: repeat labs to confirm abnormalities, watch metabolic control (A1c), and monitor safety.

Interpreting Results (General Guidance)

  • A1c elevated or rising: supports diabetic/prediabetic neuropathy; trends matter.

  • Low B12 with elevated MMA: indicates functional B12 deficiency; correlate with symptoms.

  • TSH abnormal: thyroid disease can mimic or worsen neuropathy symptoms.

  • SPEP/IFE monoclonal band: consider MGUS-related neuropathy; needs clinician follow-up.

  • High vitamin B6: may cause sensory neuropathy—review supplement doses.

  • Positive autoimmune antibodies (anti-ganglioside/anti-MAG, SSA/SSB): suggest immune-mediatedmechanisms; coordinate specialist care.

  • Heavy metals elevated: indicate toxic exposure—address promptly with your clinician.
    Blood tests are context tools; diagnosis and care plans rely on clinical evaluation and, often, EMG/NCS or skin biopsy.

Choosing Panels vs. Individual Tests

  • Foundational neuropathy panel: A1c • TSH • B12 + MMA • CMP • CBC

  • Immune neuropathy add-ons: ESR/CRP • ANA • SSA/SSB • ANCA • Anti-ganglioside • Anti-MAG • Complements

  • Monoclonal screen: SPEP/IFE (± free light chains per clinician)

  • Toxin panel: Lead • Mercury • Arsenic (± copper/ceruloplasmin)

  • Infection panel (risk-based): HIV • Syphilis • Lyme • Hep B/C

  • Vitamin/nutrition set: Folate • Vitamin D • B1 • B6 • Vitamin E

FAQs

Can blood tests diagnose neuropathy by themselves?
No. Labs find causes and guide next steps. Diagnosis often needs EMG/NCS or skin biopsy.

Which labs are best to start with?
Most begin with A1c, TSH, B12 + MMA, CMP, and CBC. Add tests based on symptoms and risks.

Do I need to fast?
Only if your order includes fasting glucose or fasting lipids.

Can too much vitamin B6 cause neuropathy?
Yes. High B6 can cause sensory neuropathy. Tell your clinician about all supplements.

What if my B12 is “normal” but I still have symptoms?
MMA helps detect functional B12 deficiency even when serum B12 looks normal.

I’ve had chemo—should I test?
Chemotherapy can cause neuropathy. Labs help rule out additional causes; discuss with your clinician.

When should I see a neurologist?
If symptoms are progressive, asymmetric, motor-predominant, or disabling, or labs are clearly abnormal.

Related Categories & Key Tests

  • Neurological Disorders Tests Hub

  • Blood Tests for Neurological Disorders • Diabetes Health • Thyroid Tests • Vitamin & Nutrient Tests • Heavy Metal Tests • Infectious Disease (HIV, Syphilis, Lyme) • Autoimmune Panels

  • Key Tests: A1c • Fasting Glucose • CMP • CBC • TSH/Free T4 • Vitamin B12 + MMA • Folate • Vitamin D • Thiamine (B1) • Vitamin B6 • SPEP/IFE • ESR/CRP • ANA/ENA • SSA/SSB • ANCA • Complements (C3/C4) • Anti-ganglioside (GM1, GD1a, GQ1b) • Anti-MAG • HIV 4th-gen • Syphilis (RPR/treponemal) • Lyme two-tier • Hepatitis B/C • Lead • Mercury • Arsenic • Copper/Ceruloplasmin • CK • Aldolase • tTG-IgA + total IgA

References

  • American Academy of Neurology — Practice guideline update: Distal symmetric polyneuropathy evaluation.
  • American Association of Neuromuscular & Electrodiagnostic Medicine — Guidelines on the evaluation of neuropathy.
  • American Diabetes Association — Standards of Care: Neuropathy screening and glycemic targets.
  • Infectious Diseases Society of America — Lyme disease testing recommendations.
  • NIH Office of Dietary Supplements — Vitamin B12 and Vitamin B6 fact sheets.
  • Centers for Disease Control and Prevention — HIV and Syphilis testing guidance.
  • Clinical reviews on monoclonal gammopathy–associated neuropathy and immune-mediated neuropathies.

Available Tests & Panels

Your Neuropathy Tests menu is pre-populated in the Ulta Lab Tests system. Start with a foundational screen (A1c, TSH, B12 + MMA, CMP, CBC). Use filters to add autoimmune panelsSPEP/IFEheavy metalsvitamin sets, and infection screens based on your history. Follow any prep instructions (fasting when included) and review results with your clinician to plan electrodiagnostic testing and next steps.

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The Tetanus and Diphtheria Titer Test measures antibody levels to determine immunity from prior vaccination or exposure. Adequate titers indicate protective immunity, while low levels may suggest the need for a booster. Doctors order this test for healthcare workers, students, travelers, or those with uncertain vaccination history. It provides essential information for maintaining protection against these serious bacterial infections.


The Thyroid Peroxidase and Thyroglobulin Antibodies Test measures TPO and TgAb antibodies that target thyroid enzymes and proteins essential for hormone production. High levels are linked to autoimmune thyroid disorders such as Hashimoto’s thyroiditis and Graves’ disease. Doctors order this test to evaluate fatigue, weight changes, neck swelling, or irregular heartbeat and to confirm thyroid autoimmunity. It provides vital insight into thyroid function and endocrine health.

Also Known As: Thyroid Antibodies Test, TPO and TgAb Test

Most Popular

The Thyroid Stimulating Hormone (TSH) Test measures TSH levels in blood to assess thyroid function and diagnose hypothyroidism or hyperthyroidism. It evaluates how the thyroid controls metabolism, energy, weight, and heart rate. Doctors use the TSH test to investigate symptoms such as fatigue, hair loss, or mood changes. Frequently included in routine health exams, it is also key for monitoring thyroid disease treatment and overall endocrine balance.

Blood
Blood Draw
Also Known As: Thyroid Stimulating Hormone Test, Thyrotropin Test

Most Popular

The Thyroid Stimulating Immunoglobulin (TSI) Test detects antibodies that stimulate the thyroid gland, often causing hyperthyroidism and Graves’ disease. High TSI levels may lead to symptoms such as weight loss, rapid heartbeat, or eye problems. Doctors order this test to confirm Graves’ disease, monitor treatment, or assess relapse risk. Results provide essential insight into autoimmune thyroid disorders and guide personalized management strategies.

Blood
Blood Draw
Also Known As: Thyroid Stimulating Immunoglobulin Test

The Varicella Titer Test is a blood test that measures antibodies to the varicella-zoster virus (VZV), which causes chickenpox and shingles. A positive result indicates past infection, while a negative suggests no exposure. This test is not considered reliable for confirming immunity from vaccination. Doctors use it to evaluate history of natural infection, meet school or work requirements, and provide documentation of varicella exposure status.

Blood
Blood Draw
Also Known As: Varicella Zoster Virus IgG Antibody Test, Chicken Pox Titer Test, Shingles Titer Test

The Vitamin B1 Blood Test measures thiamine levels to assess nutritional status and detect deficiency. Vitamin B1 is essential for energy metabolism, nerve function, and muscle health. Low levels may cause weakness, fatigue, irritability, or serious conditions such as beriberi or Wernicke-Korsakoff syndrome. Doctors order this test for patients with poor diet, alcoholism, or unexplained neurological symptoms. Results provide key insight into vitamin balance and metabolic health.

Blood
Blood Draw
Also Known As: Thiamine Blood Test

The Vitamin B1 Blood Micronutrient Test measures thiamine levels in the blood to assess nutritional status and detect deficiencies. Thiamine is essential for energy production, nerve function, and carbohydrate metabolism. This test helps identify malnutrition, absorption disorders, or risk from poor diet or alcohol use, supporting diagnosis and management of overall health.

Patient must be 18 years of age or older.
Blood
Blood Draw
Also Known As: Thiamine Blood Test

The Vitamin B1 Plasma/Serum Test measures thiamine levels in blood to evaluate nutritional status and detect deficiencies. Thiamine is essential for energy metabolism, nerve function, and muscle health. Low levels may result from poor diet, alcoholism, malabsorption, or chronic illness and can lead to conditions like beriberi or Wernicke-Korsakoff syndrome. Doctors use this test to confirm deficiency and monitor supplementation or therapy effectiveness.

Blood
Blood Draw
Also Known As: Thiamine Serum/Plasma Test

The Vitamin B12 Micronutrient Test measures blood levels of vitamin B12, essential for red blood cell production, nerve health, and DNA synthesis. Deficiency can cause anemia, fatigue, neurological issues, and cognitive changes. This test helps identify dietary deficiencies, absorption problems, or related health conditions, supporting diagnosis and ongoing management of overall wellness.

Patient must be 18 years of age or older.
Blood
Blood Draw
Also Known As: B12 Test, Cobalamin Test

Most Popular

The Vitamin B12 Test measures cobalamin levels in blood to evaluate nutritional health, red blood cell production, and nervous system function. Low B12 can cause anemia, fatigue, weakness, memory problems, and nerve damage, while high levels may indicate liver or kidney disease. Doctors use this test to detect B12 deficiency, monitor treatment, and assess malabsorption conditions like pernicious anemia, Crohn’s disease, or celiac disease.

Blood
Blood Draw
Also Known As: B12 Test, Cobalamin Test

The Vitamin B12 and Folate Panel Test measures blood levels of vitamin B12 and folate to evaluate nutritional status, red blood cell production, and nervous system health. Deficiencies may cause anemia, fatigue, weakness, neuropathy, or cognitive decline, while elevated levels can indicate liver or kidney disease. Doctors use this panel to diagnose deficiency, monitor therapy, and assess absorption disorders such as pernicious anemia, Crohn’s disease, or celiac disease.

Blood
Blood Draw
Also Known As: Cobalamin and Folic Acid Test, Vitamin B12 and Vitamin B9 Test

The Vitamin B3 Micronutrient Test measures niacin levels in the blood to assess nutritional status and detect deficiencies or excess. Niacin is essential for energy production, nervous system function, and healthy skin and digestion. This test helps identify malnutrition, absorption problems, or toxicity from supplements, supporting diagnosis and monitoring of overall health and metabolic balance.

Patient must be 18 years of age or older.
Blood
Blood Draw
Also Known As: Nicotinic Acid Test

Most Popular

The Vitamin B3 Test measures niacin levels in the blood to evaluate nutritional status and detect deficiencies. Niacin is essential for energy metabolism, DNA repair, and nervous system function. Low levels may lead to pellagra, with symptoms such as diarrhea, dermatitis, dementia, and fatigue. Doctors use this test to assess dietary intake, investigate unexplained symptoms, and monitor patients on supplementation or therapy for metabolic health.

Blood
Blood Draw
Also Known As: Nicotinic Acid Test, Niacin Test

The Vitamin B6 Micronutrient Test measures pyridoxine levels in the blood to assess nutritional status and detect deficiencies or excess. Vitamin B6 is essential for protein metabolism, neurotransmitter production, hemoglobin synthesis, and immune function. This test helps identify dietary insufficiency, absorption issues, or toxicity, supporting diagnosis and management of overall health and metabolic balance.

Patient must be 18 years of age or older.
Blood
Blood Draw
Also Known As: Pyridoxal Phosphate Test

Most Popular

The Vitamin B6 Test measures pyridoxal phosphate levels in blood to evaluate vitamin B6 status. Deficiency may cause anemia, confusion, irritability, depression, or weakened immunity, while high levels from supplementation may lead to nerve damage. Doctors use this test to investigate neurological symptoms, nutritional health, or metabolic disorders. Results provide essential insight into vitamin balance, nerve health, red blood cell production, and overall wellness.

Blood
Blood Draw
Also Known As:  Pyridoxal Phosphate Test

The Vitamin E Micronutrient Test measures blood levels of vitamin E to assess antioxidant status and detect deficiencies or excess. Vitamin E protects cells from oxidative damage, supports immune function, and promotes cardiovascular and neurological health. This test helps identify poor dietary intake, absorption issues, or toxicity from supplements, aiding in diagnosis and management of overall wellness.

Patient must be 18 years of age or older.
Blood
Blood Draw
Also Known As: Tocopherol Test

Most Popular

The Vitamin E Test measures blood levels of vitamin E, a fat-soluble antioxidant essential for protecting cells, supporting immunity, and maintaining nerve and muscle health. Low levels may result from poor diet, malabsorption, or liver disease, leading to weakness or vision problems. High levels can occur with excessive supplementation. Doctors order this test to assess nutritional status, monitor chronic illness, or guide therapy for deficiency or toxicity.

Blood
Blood Draw
Also Known As: Tocopherol Test

Blood
Blood Draw

More than 20 million people in the United States struggle with neuropathy. These individuals experience pain and weakness that come from a defect in the nervous system.

Unfortunately, there's no cure for neuropathy. However, some available treatments work better for patients who identify their condition early on.

Neuropathy lab tests are the best way to determine whether or not you have neuropathy or are currently developing it.

Keep reading to learn more about neuropathy and the neuropathy tests you need for a diagnosis.

What Is Neuropathy?

Neuropathy is a condition of the nervous system that's associated with nerve damage. The condition can stand alone or develop as a result of another condition.

A couple of the common conditions that may cause neuropathy are diabetes and Guillain-Barre syndrome. Some patients may even develop neuropathy as a side effect of treatments like chemotherapy.

Neuropathy is also called peripheral neuropathy. Although peripheral neuropathy is localized to the legs and arms, neuropathy can occur anywhere in the body.

Neuropathy does not have a singular cause or symptom. It's a set of symptoms that occurs because of a few different processes happening in the body. 

Unfortunately, neuropathy is not curable. However, there are steps that you can take to prevent the condition before you develop it, as well as steps that you can take to prevent the condition from worsening after you develop it.

Risk Factors for Neuropathy

The risk factors for neuropathy are linked to previous medical history and current lifestyle choices. Here are the common risk factors associated with neuropathy:

  • Diabetes
  • Cancer
  • HIV/AIDS
  • Vitamin B deficiency
  • Copper deficiency
  • Nutrient excess
  • Exposure to toxins

If you have any of these risk factors, it's important to let your health provider know so that they can better care for you. While having these conditions isn't guaranteed to lead to neuropathy, they are strongly correlated with them. 

Causes of Neuropathy

The most common cause of neuropathy is diabetes. Because of the changes in the blood that happen with the condition, it can lead to numbness and tingling in the legs and arms.

Cancer patients can experience chemotherapy-induced neuropathy. The chemo treatment kills fast-growing cells in the body. Unfortunately, it can go after some of your healthy cells as well.

Getting these treatments over time can cause damage to the nervous system as nerve cells die.

Autoimmune diseases can also cause neuropathy. People with these conditions have an immune system that is attacking healthy cells. Sometimes, this includes healthy nerve cells.

Infectious diseases can lead to neuropathy as well. Like with the HIV/AIDS virus, these infectious agents can cause damage to the nervous system over time.

Those people with HIV or AIDS can develop the condition from the virus, while others develop it from the medications that providers use to contain the virus.

Nutrition problems, including deficiencies, malnutrition, excess, and alcoholism, can cause neuropathy as well. The imbalance within the body causes problems with the nerve cells, eventually leading to neuropathy.

Repetitive stress, inflammation, and irritation can also cause nerve problems. If you've had an injury in the past, you could be at risk of developing neuropathy.

Lastly, we should point out idiopathic neuropathy and genetic neuropathy. Idiopathic neuropathy has no known cause, while genetic neuropathy is passed down through families.

What Are the Signs and Symptoms of Neuropathy?

The signs and symptoms that a patient gets from neuropathy will depend on how advanced it is and what kind of neuropathy they have. Here are some of the most common signs and symptoms for patients with neuropathy:

  • Numbness
  • Tingling
  • Burning
  • Sensitivity to touch
  • Pain
  • Muscle weakness

Usually, these signs and symptoms occur in the arms and/or legs. However, the location of these signs and symptoms depends on the location of your neuropathy.

If the condition has a chance to develop too far, you could develop paralysis. It's important to catch the condition early.

How Is Neuropathy Diagnosed?

There are several ways that a healthcare provider can diagnose neuropathy. 

First, they could use electrodiagnostic testing. This includes a series of tests that look at the nerve function and nerve sensitivity in different areas of your body.

They can also use a needle examination, which requires using a needle to get audio and visual information about your muscle functioning.

Your healthcare provider may choose to get a skin biopsy. By looking at the sample under a microscope, they can determine whether your neuropathy is associated with your nerve fibers.

Quantitive sensory testing is also an option. This can help healthcare providers determine how much damage there is to your existing nerves.

Lastly, your healthcare provider may want to run a couple of neuropathy blood tests to see if you have signs of inflammation and damage in your blood.

The Lab Tests to Screen, Diagnose, and Monitor Neuropathy

Since neuropathy is a nerve condition, there aren't many regular neuropathy lab tests. However, there are a few tests that can help your provider determine the kind of neuropathy that you have. These include the following:

By getting these kinds of tests, you can take the next steps when it comes to controlling your neuropathy. By knowing how it developed, you and your healthcare provider can make better decisions about your future health. This means that you may be able to slow down the development of the condition or even help with symptoms.

Get Your Neuropathy Lab Tests at Ulta Lab Tests

If you think that you may have neuropathy, you should get neuropathy lab tests sooner rather than later. If you get a diagnosis now, you can take the necessary steps to get it under control before you experience signs like paralysis.

Luckily, you can get neuropathy lab tests at Ulta Lab Tests. We can help you figure out whether or not you're at risk for the condition. If you are, you should have a conversation with your healthcare provider about controlling the disease.

Ulta Lab Tests offers highly accurate and reliable tests so that you can make informed decisions about your health. Benefits of using Ulta Lab Tests include:

  • 2100 patient service centers across the nation
  • Secure and confidential results delivered to you in 24 to 48 hours for most tests
  • No insurance required
  • No doctor’s referral is required
  • A 100% satisfaction guarantee

Take control of your health today with neuropathy lab tests from Ulta Lab Tests.