Overview

Diabetic neuropathy is a form of nerve damage that can occur as a result of diabetes. Elevated levels of blood sugar (glucose) can lead to injury in nerves throughout the body. The nerves primarily affected by diabetic neuropathy are those in the legs and feet.

Symptoms of diabetic neuropathy vary depending on which nerves are affected and can include pain and numbness in the legs, feet, and hands. It can also give rise to issues in the digestive system, urinary tract, blood vessels, and heart. While some individuals may experience mild symptoms, others may find diabetic neuropathy to be highly distressing and disabling.

Diabetic neuropathy is a significant complication of diabetes, affecting potentially up to 50% of individuals with the condition. However, consistent management of blood sugar levels and adopting a healthy lifestyle can often help prevent diabetic neuropathy or slow down its progression.

Symptoms

There are four primary types of diabetic neuropathy, and it is possible to experience one or multiple types of neuropathy.

The symptoms you experience depend on the specific type of neuropathy and the nerves affected. Generally, symptoms develop gradually, and you may not notice any issues until significant nerve damage has occurred.

Peripheral Neuropathy

Also known as distal symmetric peripheral neuropathy, this is the most common form of diabetic neuropathy. It typically begins in the feet and legs before progressing to the hands and arms. Symptoms of peripheral neuropathy are often more pronounced at night and may include:

• Numbness or reduced sensation of pain or temperature changes
• Tingling or burning sensations
• Sharp pains or cramps
• Muscle weakness
• Heightened sensitivity to touch, sometimes even slight pressure can cause pain
• Serious foot problems such as ulcers, infections, and damage to bones and joints

Autonomic Neuropathy

The autonomic nervous system controls various functions, including blood pressure, heart rate, sweating, eye function, bladder control, digestion, and sexual organs. Diabetes can affect nerves in any of these areas, leading to signs and symptoms such as:

• Lack of awareness of low blood sugar levels (hypoglycemia unawareness)
• Dizziness or fainting upon standing due to drops in blood pressure (orthostatic hypotension)
• Bladder or bowel problems
• Delayed stomach emptying (gastroparesis), resulting in nausea, vomiting, feeling full quickly, and loss of appetite
• Swallowing difficulties
• Changes in vision when transitioning between light and dark or near and far
• Excessive or reduced sweating
• Sexual response problems, such as vaginal dryness in women and erectile dysfunction in men

Proximal Neuropathy (Diabetic Polyradiculopathy)

This type of neuropathy typically affects nerves in the thighs, hips, buttocks, legs, abdomen, and chest. Symptoms usually manifest on one side of the body but may spread to the other side. Proximal neuropathy may include:

• Severe pain in the buttocks, hips, or thighs
• Weakness and shrinking of thigh muscles
• Difficulty rising from a seated position
• Chest or abdominal wall pain

Mononeuropathy (Focal Neuropathy)

Mononeuropathy refers to damage to a specific nerve, which can occur in various areas of the body, such as the face, torso, arms, or legs. Mononeuropathy may lead to:

• Difficulty focusing or double vision
• Paralysis on one side of the face
• Numbness or tingling in the hands or fingers
• Weakness in the hand, resulting in dropping objects
• Shin or foot pain
• Weakness causing difficulty lifting the front part of the foot (foot drop)
• Pain in the front of the thigh