What is Diabetic Neuropathy?

Nearly half of patients who have diabetes suffer from some kind of neuropathy. Diabetic neuropathy is nerve damage caused by high glucose levels. It is common and serious for patients who have diabetes. While diabetic neuropathy can cause issues with the digestive system, blood vessels, and heart, it most often damages nerves in the legs and feet. 

This condition sometimes causes painful and disabling symptoms. However, it can often be prevented by managing blood sugar levels and with a healthy lifestyle. 

Different Types of Diabetic Neuropathy

There are four main types of diabetic neuropathy. The symptoms may develop gradually and you may not even notice that anything is wrong or painful until significant nerve damage has occurred. 

Peripheral Neuropathy

This type of nerve damage usually affects the legs and feet. It can also affect the hands and arms. It is the most common type of diabetic neuropathy. Symptoms are typically worse at night, and include: 

• Numbness and loss of sensitivity to pain & temperature
• Sharp pain or cramps
• Muscle weakness
• Decreased balance and coordination
• Serious foot problems – ulcers, infections, joint and bone pain

Focal Neuropathy

Focal neuropathies, or mononeuropathies, are conditions in which there is damage to a single nerve. It is most common in the face, torso, or leg. This type of diabetic neuropathy can cause severe pain and symptoms can appear suddenly. However, there is rarely long-term damage and the symptoms usually go away on their own. 

Pain usually occurs in the foot, lower back, pelvis, or chest and abdomen. Focal neuropathy causes nerve problems in the face and eyes which can lead to double vision, paralysis to the face (Bell’s palsy), and trouble focusing. 

Autonomic neuropathy

Autonomic neuropathy is damage to the nerves that control your internal organs. It leads to problems with blood pressure and your heart rate, bladder, sweat glands, digestive system, and sex organs. 

Common symptoms include:

• Bladder paralysis
• Erectile dysfunction
• Diarrhea
• Constipation
• Stomach conditions, such as gastroparesis 

Proximal neuropathy

Proximal neuropathy, also known as radicuoplexus neuropathy, is nerve damage that affects the hip, buttocks, and thighs. This is more common in patients who have type 2 diabetes and elderly patients. 

Symptoms typically appear on one side of the body, but can spread to the other side. Symptoms include severe pain in the hip, weak or atrophying thigh muscles, or weight loss.

Diagnosing Diabetic Neuropathy

Your doctor will perform a physical exam as the first step of diagnosing this type of neuropathy. They will review your medical history and look at your symptoms. At each visit, your physician will check your overall muscle strength, tendon reflexes, and sensitivity to touch and sensation. 

The American Diabetes Association recommends that all people with diabetes have a comprehensive foot exam once a year, so your physician will check for sores, cracked skin, blisters, and joint and/or bone problems. 

Your doctor may order other tests to be performed to help diagnose this neuropathy, such as: 

• Filament Test: A soft, nylon fiber will be brushed over specific areas of skin to test sensitivity to touch.

• Autonomic testing: This includes tests that measure how your blood pressure changes when you change positions and whether your sweat normally. 

• Quantitative Sensory Testing: This is a noninvasive test used to show how your nerves respond to changes in temperature and vibrations. 

Sources:

Mayo Clinic: Diabetic Neuropathy. Symptoms and Causes

National Institute of Diabetes and Digestive and Kidney Diseases: Diabetic Neuropathy

Diabetes: Complications & Neuropathy

JAMA: Diabetic Neuropathy