Diabetic neuropathy is a serious and common complication of type 1 and type 2 diabetes. It’s a type of nerve damage caused by long-term high blood sugar levels. 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, you should see your doctor. 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, poor wound healing or infection can lead to amputation.

There are different types of diabetic neuropathy that affect different areas of your body, causing a variety of symptoms. If you have diabetes, it’s important to regularly check your blood glucose levels and contact your doctor if 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
  • 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
  • inability to sense low blood glucose
  • 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
  • extreme sensitivity to touch
  • insensitivity to hot and cold temperatures
  • sharp pain or cramping
  • muscle weakness
  • loss of balance or coordination

Some people experience symptoms more often at night.

If you have peripheral neuropathy, you may not feel an injury or sore on your foot. People with diabetes often have poor circulation, which makes it more difficult for wounds to heal. This combination increases the risk for 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. Many organs and muscles are controlled by it, including your:

Digestion problems

Nerve damage to the digestive system may cause:

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

Gastroparesis causes a delay in digestion, which can worsen over time, leading to frequent nausea and vomiting. You’ll typically feel full too quickly and be 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 for a hypoglycemic emergency.

Sexual and bladder problems

Autonomic neuropathy may also cause 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 lightheaded 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 warning signs for heart attack, including:

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

3. Proximal neuropathy

A rare form of neuropathy is proximal neuropathy, also known as diabetic amyotrophy. This form of neuropathy is more commonly seen in adults over 50 years old with fairly well controlled type 2 diabetes, and 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. Fortunately, 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 percent 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 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 B-12 can also lead to neuropathy. Metformin, a common medication used to manage diabetes, can decrease levels of vitamin B-12. You can ask your 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, your heart rate, blood pressure, and muscle tone.

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

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 and exercising regularly are also parts of a comprehensive treatment plan. Always talk to your doctor or healthcare team before beginning a new fitness routine. You may also ask your doctor about complementary treatments or supplements for neuropathy.

Pain management

Medications may be used to treat pain caused by diabetic neuropathy. Talk to your 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. Some research has found capsaicin to be helpful. Alternative therapies may provide additional relief when used in conjunction with medication.

Managing complications

Depending on your type of neuropathy, your doctor can suggest medications, therapies, or lifestyle changes that may help deal with symptoms and ward off complications.

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

If you have vaginal dryness, your 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 quickly get help if you have an injury or sore.

Diabetic neuropathy can often be avoided if you manage your blood glucose vigilantly. To do this, 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 your doctor and follow their recommendations for slowing its progression. With proper care, you can reduce the damage to your nerves and avoid complications.

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