What underlying factors could cause a "pins and needles" sensation in the hands at night?

Peripheral neuropathy is frequently associated with blood sugar dysregulation, including prediabetes and insulin resistance. To manage this condition, it is advisable to modify your diet by eliminating sugar and refined carbohydrates, adopting a ketogenic approach, and implementing intermittent fasting. Additionally, supplementation with Benfotiamine, a B vitamin, and alpha-lipoic acid may be beneficial in alleviating symptoms.

If you are already adhering to a ketogenic diet yet continue to experience sensations such as "pins and needles," it may be prudent to assess your calcium levels. Hypercalcemia, or elevated calcium levels, can also contribute to similar neuropathic symptoms, although this is a less common cause.