Diabetic neuropathy refers to nerve damage that develops gradually and is caused by long-term high blood sugar levels. While there’s no cure, managing blood sugar levels can slow its progression and prevent complications.

Diabetic neuropathy is a serious and common complication of type 1 and type 2 diabetes. The condition usually develops slowly, sometimes over the course of several decades.

If you have diabetes and notice numbness, tingling, pain, or weakness in your hands or feet, see a doctor or healthcare professional, as these are early symptoms of peripheral neuropathy. The danger is usually when you can’t feel pain and an ulcer develops on your foot.

In cases of severe or prolonged peripheral neuropathy, you may be vulnerable to injuries or infections. In serious cases, slow wound healing or infection can lead to amputation.

Different types of diabetic neuropathy affect different areas of the body and cause a variety of symptoms. If you have diabetes, it’s important to regularly check your blood glucose levels and contact a doctor if you have any symptoms of neuropathy.

It’s common for symptoms of neuropathy to appear gradually. In many cases, the first type of nerve damage to occur involves the nerves of the feet. This can lead to the symptom of sometimes painful “pins and needles” in your feet.

Symptoms vary depending on the areas affected.

Common signs and symptoms of the different types of diabetic neuropathy include:

  • sensitivity to touch or loss of sense of touch
  • difficulty with coordination when walking
  • numbness or pain in your hands or feet
  • burning sensation in feet, especially at night
  • muscle weakness or wasting
  • bloating or fullness
  • nausea, indigestion, or vomiting
  • diarrhea or constipation
  • dizziness when you stand up
  • excessive or decreased sweating
  • bladder problems such as incomplete bladder emptying
  • vaginal dryness
  • erectile dysfunction
  • vision trouble such as double vision
  • increased heart rate

The term neuropathy is used to describe several types of nerve damage. In people with diabetes, there are four main types of neuropathy.

1. Peripheral neuropathy

The most common form of neuropathy is peripheral neuropathy. Peripheral neuropathy usually affects the feet and legs, but it can also affect the arms or hands. Symptoms are varied and can be mild to severe. They include numbness, tingling or burning sensations, and muscle weakness.

If you have peripheral neuropathy, you may not feel an injury or sore on your foot. People with diabetes often have compromised blood circulation, which makes it more difficult for wounds to heal. This combination increases the risk of infection. In extreme cases, infection can lead to amputation.

2. Autonomic neuropathy

The second most common type of neuropathy in people with diabetes is autonomic neuropathy.

The autonomic nervous system runs other systems in your body over which you have no conscious control, such as the digestive and cardiovascular systems and organs such as the sex organs and bladder.

Digestion problems

Nerve damage to the digestive system may causeTrusted Source:

  • constipation
  • diarrhea
  • swallowing trouble
  • gastroparesis, which causes the stomach to empty too slowly into the small intestines

Gastroparesis causesTrusted Source a delay in digestion, which can worsen over time, leading to frequent nausea and vomiting. Typically, people with gastroparesis feel full too quickly and are unable to finish a meal.

Delayed digestion often makes it more difficult to control blood glucose levels, too, with frequently alternating high and low readings.

Also, symptoms of hypoglycemia, such as sweating and heart palpitations, can go undetected in people with autonomic neuropathy. This can mean not noticing when you have low blood sugar, increasing the risk of a hypoglycemic emergency.

Sexual and bladder problems

Autonomic neuropathy may also causeTrusted Source sexual problems such as erectile dysfunction, vaginal dryness, or difficulty achieving orgasm. Neuropathy in the bladder can cause incontinence or make it difficult to fully empty your bladder.

Cardiovascular problems

Damage to the nerves that control your heart rate and blood pressure can make them respond more slowly. You may experience a drop in blood pressure and feel light-headed or dizzy when you stand up after sitting or lying down or when you exert yourself. Autonomic neuropathy can also cause an abnormally fast heart rate.

Autonomic neuropathy can make it difficult to identify some of the symptoms of a heart attack. You may not feel any chest pain when your heart isn’t getting enough oxygen. If you have autonomic neuropathy, you should know the other symptoms of a heart attack, includingTrusted Source:

  • profuse sweating
  • pain in the arm, back, neck, jaw, or stomach
  • shortness of breath
  • nausea
  • lightheadedness

3. Proximal neuropathy

Proximal neuropathy, also known as diabetic amyotrophy, is rare. This form of neuropathy is more commonTrusted Source in adults over 50 years old with type 2 diabetes and is diagnosed more often in men.

It often affects the hips, buttocks, or thighs. You may experience sudden and sometimes severe pain. Muscle weakness in your legs may make it difficult to stand up without assistance. Diabetic amyotrophy usually affects only one side of the body.

After the onset of symptoms, they usually get worse and then eventually begin to improve slowly. Most people recover within a few years, even without treatment.

4. Focal neuropathy

Focal neuropathy, or mononeuropathy, occurs when there’s damage to one specific nerve or group of nerves, causing weakness in the affected area. This occurs most often in your hand, head, torso, or leg. It appears suddenly and is usually very painful.

Like proximal neuropathy, most focal neuropathies go away in a few weeks or months and leave no lasting damage. The most common type is carpal tunnel syndrome.

Although most don’t feel the symptoms of carpal tunnel syndrome, about 25%Trusted Source of people with diabetes have some degree of nerve compression at the wrist.

Symptoms of focal neuropathy include:

  • pain, numbness, tingling in fingers
  • an inability to focus
  • double vision
  • aching behind the eyes
  • Bell’s palsy
  • pain in isolated areas such as the front of the thigh, lower back, pelvic region, chest, stomach, inside the foot, outside the lower leg, or weakness in the big toe

Diabetic neuropathy is caused by high blood sugar levels sustained over a long period of time. Other factors can lead to nerve damage, such as:

  • damage to the blood vessels caused by high cholesterol levels
  • mechanical injury, such as injuries caused by carpal tunnel syndrome
  • lifestyle factors such as smoking or alcohol use

Low levels of vitamin B12 can also lead to neuropathy. Metformin, a common medication used to manage diabetes, can decrease levels of vitamin B12. You can ask a doctor for a simple blood test to identify any vitamin deficiencies.

A doctor will determine whether or not you have neuropathy, starting by asking about your symptoms and medical history. You’ll also have a physical examination. They’ll check your level of sensitivity to temperature and touch, heart rate, blood pressure, and muscle tone.

A doctor may do a filament test to test the sensitivity in your feet. For this, they’ll use nylon fiber to check your limbs for any loss of sensation. A tuning fork may be used to test your vibration threshold. A doctor may also test your ankle reflexes.

In some cases, they may also perform a nerve conduction study, which can assess nerve damage by measuring the speed and strength of nerve signals.

There’s no cure for diabetic neuropathy, but you can slow its progression. Keeping your blood sugar levels within a healthy range is the best way to decrease the likelihood of developing diabetic neuropathy or slow its progression. It can also relieve some symptoms.

Quitting smoking, if applicable, and exercising regularly are also parts of a comprehensive treatment plan. Always talk with a doctor or healthcare professional before beginning a new fitness routine. You can also ask a doctor about complementary treatments or supplements for neuropathy.

Pain management

Medications may be used to treat pain caused by diabetic neuropathy. Talk with a doctor about the available medications and their potential side effects. Several medications have been shown to help with symptoms.

You may also want to consider alternative therapies, such as acupuncture. When used in conjunction with medication, alternative therapies may provide additional relief.

Managing complications

Depending on your type of neuropathy, a doctor can suggest medications, therapies, or lifestyle changes that may help you manage symptoms and prevent complications.

For example, if you have problems with digestion as a result of your neuropathy, a doctor may suggestTrusted Source you try eating smaller meals more often and limit the amount of fiber and fat in your diet.

If you have vaginal dryness, a doctor may suggest a lubricant. If you have erectile dysfunction, they may prescribe medication that can help.

Peripheral neuropathy is very common in people with diabetes and can lead to serious foot complications, which in turn can lead to amputation. If you have peripheral neuropathy, it’s important to take special care of your feet and to get prompt medical help if you have an injury or sore.

Diabetic neuropathy can often be avoided if you are careful about managing your blood glucose.

To do this, it can help to be consistent in:

  • monitoring your blood glucose levels
  • taking medications as prescribed
  • managing your diet
  • being active

If you do develop diabetic neuropathy, work closely with a doctor and follow their recommendations for slowing its progression. With proper care, you can reduce the damage to your nerves and avoid complications.