Diabetic Neuropathy: Symptoms, Causes, Risk Factors

Diabetic neuropathy is a kind of nerve damage that can take place if you have diabetes. High blood sugar (glucose) can hurt nerve fibers throughout your body, however diabetic neuropathy frequently damages nerves in your legs and feet.

Depending on the afflicted nerves, symptoms of diabetic neuropathy can range from pain and numbness in your extremities to issues with your gastrointestinal system, urinary tract, capillary and heart. For some individuals, these symptoms are mild; for others, diabetic neuropathy can be painful, disabling and even deadly.

Diabetic neuropathy is a typical serious complication of diabetes. Yet you can typically prevent diabetic neuropathy or slow its progress with tight blood sugar level control and a healthy lifestyle.


There are four primary types of diabetic neuropathy You might have simply one type or symptoms of numerous types. Many develop slowly, and you may not observe problems till significant damage has occurred.

The symptoms and signs of diabetic neuropathy differ, depending upon the type of neuropathy and which nerves are impacted.

Peripheral neuropathy

Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are typically affected first, followed by your hands and arms. Symptoms and signs of peripheral neuropathy are often worse in the evening, and may include:

  • Numbness or minimized ability to feel pain or temperature changes
  • A tingling or burning sensation
  • Acute pains or cramps
  • Increased level of sensitivity to touch — for some individuals, even the weight of a bed sheet can be agonizing
  • Muscle weak point
  • Loss of reflexes, specifically in the ankle
  • Loss of balance and coordination
  • Severe foot issues, such as ulcers, infections, defects, and bone and joint pain

Autonomic neuropathy

The free nervous system controls your heart, bladder, lungs, stomach, intestinal tracts, sex organs and eyes. Diabetes can affect the nerves in any of these areas, perhaps triggering:

  • A lack of awareness that blood glucose levels are low (hypoglycemia unawareness)
  • Bladder problems, consisting of urinary tract infections or urinary retention or incontinence
  • Constipation, unrestrained diarrhea or a combination of the two
  • Sluggish stomach emptying (gastroparesis), causing queasiness, vomiting, bloating and loss of appetite
  • Problem swallowing
  • Erectile dysfunction in men
  • Vaginal dryness and other sexual problems in women
  • Increased or decreased sweating
  • Failure of your body to adjust high blood pressure and heart rate, resulting in sharp drops in high blood pressure after sitting or standing that might cause you to faint or feel lightheaded
  • Problems controling your body temperature
  • Changes in the method your eyes adjust from light to dark
  • Increased heart rate when you’re at rest

Radiculoplexus neuropathy (diabetic amyotrophy)

Radiculoplexus neuropathy affects nerves in the thighs, hips, butts or legs. Also called diabetic amyotrophy, femoral neuropathy or proximal neuropathy, this condition is more typical in individuals with type 2 diabetes and older adults.

Symptoms are generally on one side of the body, though in some cases symptoms may infect the opposite. Many people improve a minimum of partially in time, though symptoms may intensify prior to they improve. This condition is frequently marked by:

  • Abrupt, severe pain in your hip and thigh or buttock
  • Eventual weak and atrophied thigh muscles
  • Problem rising from a sitting position
  • Abdominal swelling, if the abdomen is affected
  • Weight reduction


Mononeuropathy involves damage to a particular nerve. The nerve may be in the face, upper body or leg. Mononeuropathy, likewise called focal neuropathy, frequently begins all of a sudden. It’s most typical in older grownups.

Although mononeuropathy can cause severe pain, it typically does not cause any long-term issues. Symptoms typically lessen and disappear by themselves over a few weeks or months. Symptoms and signs depend on which nerve is included and might consist of:

  • Trouble focusing your eyes, double vision or aching behind one eye
  • Paralysis on one side of your face (Bell’s palsy)
  • Pain in your shin or foot
  • Pain in your lower back or pelvis
  • Pain in the front of your thigh
  • Pain in your chest or abdominal area

Sometimes mononeuropathy happens when a nerve is compressed. Carpal tunnel syndrome is a common type of compression neuropathy in individuals with diabetes.

Signs and symptoms of carpal tunnel syndrome include:

  • Numbness or tingling in your fingers or hand, particularly in your thumb, index finger, middle finger and ring finger
  • A sense of weakness in your hand and a tendency to drop things

When to see a doctor

Look for treatment if you notice:

  • A cut or sore on your foot that doesn’t appear to be healing, is infected or is worsening
  • Burning, tingling, weakness or pain in your hands or feet that interferes with your day-to-day regimen or your sleep
  • Dizziness
  • Modifications in your food digestion, urination or sexual function

These signs and symptoms don’t always show nerve damage, but they may signal other issues that require treatment. Early medical diagnosis and treatment use the best chance for controlling symptoms and avoiding more-severe problems.

Even minor sores on the feet that do not heal can become ulcers. In the most severe cases, unattended foot ulcers might end up being gangrenous — a condition where the tissue passes away — and need surgery or perhaps amputation of your foot. Early treatment can help prevent this from occurring.


Damage to nerves and blood vessels

Extended direct exposure to high blood sugar can harm fragile nerve fibers, causing diabetic neuropathy. Why this takes place isn’t really entirely clear, however a combination of elements most likely plays a role, including the intricate interaction in between nerves and blood vessels.

High blood sugar level interferes with the capability of the nerves to transfer signals. It likewise damages the walls of the small capillary (capillaries) that supply the nerves with oxygen and nutrients.

Other elements

Other aspects that may contribute to diabetic neuropathy include:

  • Swelling in the nerves triggered by an autoimmune response. This occurs when your body immune system wrongly assaults part of your body as if it were a foreign organism.
  • Genetic aspects unrelated to diabetes that make some individuals more susceptible to nerve damage.
  • Cigarette smoking and alcohol abuse, which damage both nerves and capillary and considerably increase the risk of infections.

Risk factors

Anyone who has diabetes can develop neuropathy, however these aspects make you more prone to nerve damage:

  • Poor blood glucose control. This is the best risk aspect for every single problem of diabetes, including nerve damage. Keeping blood sugar level regularly within your target range is the best way to safeguard the health of your nerves and capillary.
  • Length of time you have diabetes. Your risk of diabetic neuropathy increases the longer you have diabetes, especially if your blood glucose isn’t well-controlled.
  • Kidney disease. Diabetes can cause damage to the kidneys, which might increase the toxins in the blood and contribute to nerve damage.
  • Being obese. Having a body mass index greater than 24 may increase your risk of establishing diabetic neuropathy.
  • Smoking. Cigarette smoking narrows and solidifies your arteries, minimizing blood flow to your legs and feet. This makes it harder for wounds to recover and harms the stability of the peripheral nerves.


Diabetic neuropathy can cause a variety of severe complications, consisting of:

  • Loss of a limb. Because nerve damage can cause an absence of feeling in your feet, cuts and sores might go unnoticed and eventually become severely infected or ulcerated — a condition where the skin and soft tissues break down. The risk of infection is high due to the fact that diabetes minimizes blood circulation to your feet. Infections that spread to the bone and cause tissue death (gangrene) may be impossible to treat and need amputation of a toe, foot or even the lower leg.
  • Charcot joint. This occurs when a joint, normally in the foot, degrades because of nerve damage. Charcot joint is marked by loss of feeling, along with swelling, instability and often defect in the joint itself. Early treatment can promote recovery and avoid additional damage.
  • Urinary tract infections and urinary incontinence. Damage to the nerves that manage your bladder can prevent it from emptying entirely. This allows bacteria to increase in your bladder and kidneys, causing urinary tract infections. Nerve damage can likewise impact your ability to feel when you have to urinate or to control the muscles that release urine.
  • Hypoglycemia unawareness. Typically, when your blood sugar drops too low — below 70 milligrams per deciliter (mg/dL), or 3.9 millimoles per liter (mmol/L) — you develop symptoms such as shakiness, sweating and a quick heart beat. Free neuropathy can disrupt your capability to observe these symptoms.
  • Low blood pressure. Damage to the nerves that control flow can impact your body’s ability to adjust high blood pressure. This can cause a sharp drop in pressure when you stand after sitting (orthostatic hypotension), which might result in lightheadedness and fainting.
  • Digestion issues. Nerve damage in the gastrointestinal system can cause constipation or diarrhea — or alternating bouts of constipation and diarrhea — in addition to nausea, vomiting, bloating and anorexia nervosa. It can also cause gastroparesis, a condition where the stomach clears too slowly or not at all. This can hinder food digestion and cause queasiness, vomiting and bloating, and seriously impact blood glucose levels and nutrition.
  • Sexual dysfunction. Free neuropathy frequently damages the nerves that impact the sex organs, resulting in erectile dysfunction in men and problems with lubrication and arousal in women.
  • Increased or reduced sweating. When the sweat glands don’t work generally, your body isn’t really able to regulate its temperature appropriately. A decreased or total lack of sweating (anhidrosis) can be deadly. Autonomic neuropathy might also cause extreme sweating, especially during the night or while eating.

Also read: Diabetic Neuropathy: Diagnosis, Treatment, Prevention

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