Diabetic neuropathy overview

Nerve damage associated with diabetes

The word ‘neuropathy’ is the medical term for damage to nerves, and diabetic neuropathy describes nerve damage caused by diabetes, where the body is unable to maintain the correct levels of glucose in the blood.

Around 50% of people with diabetes will develop diabetic neuropathy at some point. Although there is no specific cure for the condition, it can be managed so that symptoms and potential complications are minimised.

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Types of diabetic neuropathy

The four main forms of diabetic neuropathy

Diabetic neuropathy is categorised into four broad types:

Peripheral neuropathy

Affects the extremities, most commonly the legs and feet, but sometimes the hands and arms.

Autonomic neuropathy

Affects nerves involved in controlling organs and other automatic bodily functions.

Focal neuropathy

Affects specific individual nerves, commonly in the head, torso, legs or hands.

Proximal neuropathy

Affects nerves in the hips, buttocks or thighs, usually on one side of the body.

Causes and risk factors of diabetic neuropathy

How diabetes can affect the nerves

High blood glucose levels and high levels of fats (triglycerides) in the blood, which are a feature of diabetes, damage nerves and the walls of small blood vessels that supply nutrients and oxygen to these nerves. This in turn impairs the ability of the nerves to communicate properly between their specific parts of the body and the brain.

People who are aware they are diabetic will ordinarily have been advised by their doctors of the risk of diabetic neuropathy, however a large number of people are either diabetic or pre-diabetic and are unaware of this.

Known risk factors for developing diabetic neuropathy include:

  • Being overweight or obese.
  • Smoking
  • Kidney disease
  • Uncontrolled blood sugar levels
  • How long someone has been diabetic

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Diabetic peripheral neuropathy symptoms

Signs of peripheral nerve damage

In its early stages, diabetic neuropathy may not cause any noticeable symptoms at all. Symptoms when they do appear are different depending on the type of neuropathy. Peripheral diabetic neuropathy is the most common type. These symptoms tend to get worse during the night and also tend to affect the legs and feet before spreading to the arms and hands.

Pins and needles

Tingling or burning sensations in the affected area.

Cramping

Painful tightening or spasms affecting the muscles.

Pain

Pain that is often described as sharp.

Heightened sensitivity

Increased sensitivity or discomfort from touch.

Weakness

Reduced strength in the affected legs, feet, arms or hands.

Balance issues

Difficulty maintaining balance or stability.

Loss of feeling

Reduced or absent sensation, particularly in the feet.

Foot complications

May include ulceration, infection or pain affecting joints and bones.

Diabetic autonomic neuropathy symptoms

When nerve damage affects body functions

Symptoms of autonomic diabetic neuropathy are related to dysfunction of one or more organs or bodily functions due to internal nerve communication being compromised.

Bladder or bowel issues

Changes affecting normal bladder or bowel function.

Gastrointestinal issues

May include gastroparesis, nausea, vomiting or appetite loss.

Eye issues

Difficulty adjusting vision between different levels of light.

Sexual response issues

Changes affecting normal sexual function or response.

Diabetic focal neuropathy symptoms

Symptoms linked to individual nerve damage

Focal diabetic neuropathy is further subdivided into cranial and peripheral types.

Eye problems

May include pain behind the eye, difficulty focusing or double vision.

Bell's Palsy

Paralysis affecting one side of the face.

Pins and needles

Tingling affecting the hands and fingers, excluding the little fingers.

Hand weakness

Reduced strength and loss of fine motor control.

Carpal tunnel syndrome

Compression of the nerve at the wrist causing symptoms in the hand.

Diabetic proximal neuropathy symptoms

Pain and weakness around the hips and thighs

Symptoms of proximal diabetic neuropathy generally affect the thighs, hips, buttocks and legs, but can also affect the chest and abdomen. These symptoms are generally confined to one side of the body, but can spread to the other.

Stomach pain

Pain in the abdomen that may be severe.

Difficulty standing

Difficulty getting up from a seated position.

Hip, thigh or buttock pain

Severe pain generally affecting one side of the body.

Thigh weakness

Weakness caused by shrinkage of the thigh muscles.

Diabetic neuropathy tests and diagnosis

How diabetic neuropathy is diagnosed

Diagnosis of diabetic neuropathy generally involves a review of medical history and thorough medical examination. Other tests may be required to eliminate other causes of symptoms, for example low levels of thiamine and/or vitamin B1.

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