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Neuropathy and Diabetes

Updated on August 18, 2022
Medically reviewed by
Robert Hurd, M.D.
Article written by
Jane Chung, PharmD, RPh

Neuropathy occurs when nerves are damaged or not working properly, leading to symptoms including numbness, pain, and muscle weakness. Although many different conditions can cause neuropathy to develop, it is a common complication of diabetes.

Around 60 percent to 70 percent of people with diabetes have neuropathy, also called diabetic neuropathy. The condition mainly affects the peripheral nervous system, which includes the nerves outside of the brain and spinal cord.

Members of DiabetesTeam, the online social support group for people with diabetes, report experiencing neuropathy. One member said, “I have terrible neuropathy in my feet, usually at night in bed. Sometimes, my feet hurt so much I can hardly walk. Other times, they feel numb like they’re asleep. This sometimes results in me falling down, especially stairs.”

If you have diabetes and neuropathy, you are not alone. This article discusses diabetic neuropathy, what causes it, and how to treat it.

Types and Symptoms of Diabetic Neuropathy

The symptoms of neuropathy depend on which nerves are damaged and the type of neuropathy you have. There are four main types of diabetic neuropathy:

  • Peripheral neuropathy
  • Autonomic neuropathy
  • Proximal neuropathy
  • Mononeuropathy

Peripheral Neuropathy

Peripheral neuropathy is the most common type of diabetic neuropathy. It affects the feet and legs first, then the hands and arms.

Symptoms include numbness and a reduced ability to feel pain or temperature changes, especially in the feet and toes. Tingling or burning sensations can occur. Another symptom is extreme sensitivity to touch. In some cases, even the weight of a sheet can cause pain.

Autonomic Neuropathy

Autonomic neuropathy affects bodily functions of the autonomic nervous system — like blood pressure and heart rate, digestion, breathing, and sexual function. This type of neuropathy causes symptoms like bladder problems, increased heart rate, constipation or diarrhea, difficulty swallowing, and excessive sweating.

Autonomic neuropathy can cause a condition called hypoglycemia (low blood sugar) unawareness, or an inability to notice when you have low blood sugar. If you cannot tell when your blood glucose (sugar) is low, you may not treat it, and untreated hypoglycemia can lead to dangerous complications including seizures.

Another symptom of autonomic neuropathy is orthostatic hypotension, which occurs when there is a sudden drop in blood pressure after getting up from sitting or lying down. This can lead to lightheadedness or fainting.

A DiabetesTeam member described their experience: “I’ve been feeling lightheaded and almost falling, even with a walker. The reason is my blood pressure drops way down when I stand.”

Proximal Neuropathy

Proximal neuropathy, also called diabetic polyradiculopathy, causes severe nerve pain in the thighs, hips, buttocks, and legs. Symptoms usually affect only one side of the body, although they may spread to the other side. Most people see at least partial improvements in their symptoms within six to 12 months.

A DiabetesTeam member shared, “I’ve been having so much muscle pain in the front of my thigh since about five or six months ago. I can hardly get my socks on.”

Weak, shrinking thigh muscles, difficulty getting up from sitting, and chest or stomach pain can also occur with proximal neuropathy.

Mononeuropathy

Also known as focal neuropathy, this condition involves damage to a single, specific nerve located in the face, torso, arm, or leg. This type of neuropathy often comes on suddenly and is associated with severe pain. Fortunately, the pain usually lessens and goes away on its own over a few weeks to months.

The symptoms depend on which nerve is involved. For example, double vision and difficulty focusing the eyes may be an issue. Paralysis on one side of the face may occur. People may also experience pain in the shin, foot, and front of the thigh.

Sometimes, mononeuropathy results from a compressed nerve. A common example of this is carpal tunnel syndrome. “I have carpal tunnel in both hands and am wearing a brace on both hands at night now,” said one DiabetesTeam member.

Symptoms of carpal tunnel syndrome include numbness or tingling in the fingers or hands — especially the thumb, index, middle, and ring fingers — as well as muscle weakness in the hands, causing people to drop things.

Causes of Diabetic Neuropathy

The exact causes of diabetic neuropathy are unknown. Health experts believe several factors contribute to diabetic neuropathy.

Elevated levels of blood sugar for long periods of time can damage the blood vessels that carry oxygen and nutrients to the nerves, which could damage the nerves themselves. In addition to sugar, high triglyceride and cholesterol levels can increase the risk of neuropathy. Other risk factors include being overweight or obese.

Complications of Diabetic Neuropathy

Diabetic neuropathy can lead to many complications. It can cause serious foot problems, including ulcers, infections, deformities, and damage to bones and joints. If left untreated, amputation of the affected toe, foot, or leg may be necessary.

Other complications of diabetic neuropathy include hypoglycemia unawareness, sexual dysfunction, urinary tract infections, urinary incontinence, and digestive issues.

Diagnosing Diabetic Neuropathy

Doctors will diagnose neuropathy based on a physical exam as well as a review of your symptoms and medical history.

Doctors may also perform specific tests to aid with diagnosis. These include:

  • Filament test — Tests the skin’s sensitivity to touch with a soft nylon fiber brush
  • Sensory test — Examines how the nerves respond to vibration and temperature changes
  • Nerve conduction test — Measures how quickly the nerves in the arms and legs can conduct electrical signals
  • Electromyography — Also called needle testing, and often done along with a nerve conduction test — Measures electrical discharges produced in muscles
  • Autonomic test — Measures blood pressure changes when someone changes positions, like sitting to standing, and how much they sweat

Managing Diabetic Neuropathy

There is no cure for diabetic neuropathy. It can be prevented by managing your blood sugar levels. For people living with diabetic neuropathy, there are different ways to slow its progression and manage symptoms.

Slowing Disease Progression

The best way to prevent further nerve damage from diabetic neuropathy is to try to manage your diabetes. Work with your doctor to find a diabetes care and treatment plan that helps keep your blood glucose levels in check. This may include a combination of lifestyle changes and medications.

The following tips from the Centers for Disease Control (CDC) can help prevent or delay nerve damage caused by diabetic neuropathy:

  • Keep your blood pressure under control.
  • Stay physically active. Take breaks from sitting by walking around the room every 30 minutes. Take the stairs instead of the elevator if you can.
  • Lose weight if you are overweight, and eat a balanced and healthy diet.
  • Limit alcohol consumption.
  • Quit smoking.
  • Take all of your medications as prescribed by your doctor.

Relieving Pain

Pain relief is an important part of managing neuropathy. Dealing with chronic pain can negatively affect a person’s mental health and quality of life.

Commonly prescribed medications for pain include tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, and gamma-aminobutyric acid analogs. If needed, doctors may choose to add opioids and topical creams to a treatment regimen.

Treating Complications

Complications of diabetic neuropathy will be treated in different ways. For example, gastroparesis — which causes nausea and vomiting — may be managed by eating smaller, more frequent meals throughout the day. Complications like bladder problems or sexual dysfunction may be treated with medications.

Because foot problems are a common complication of diabetic neuropathy, at-home foot care and yearly foot exams are essential for maintaining the health of your feet. The Mayo Clinic has some useful tips for preventing foot complications when you have diabetic neuropathy.

Talk to your doctor about any symptoms or complications you experience with diabetic neuropathy. They will work with you to determine the best treatment for your symptoms.

Communicate With Your Health Care Provider

Talk to your doctor if you experience any symptoms of neuropathy. Proper diabetes management can help prevent further complications. Discuss treatment options and ways to keep your blood sugar levels within the target range.

Find Your Team

DiabetesTeam is the social network for people with diabetes and their loved ones. On DiabetesTeam, more than 123,000 members come together to ask questions, give advice, and share their stories with others who understand life with diabetes.

Are you living with diabetes and neuropathy? Do you have any tips for managing symptoms? Share your experience in the comments below or start a conversation by posting on your Activities page.

All updates must be accompanied by text or a picture.
Robert Hurd, M.D. is a professor of endocrinology and health care ethics at Xavier University. Review provided by VeriMed Healthcare Network. Learn more about him here.
Jane Chung, PharmD, RPh earned a Bachelor of Science in Pharmacy Studies and a Doctor of Pharmacy from Northeastern University in Boston, MA. Learn more about her here.

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