Diabetic neuropathy types: Symptoms tell the story
Medically reviewed on May 17, 2017
There are four main types of diabetic neuropathy — nerve damage that can occur as a result of high blood sugar when you have diabetes. You may have just one type or symptoms of several types. Most types of diabetic neuropathy develop gradually, and you may not notice problems until considerable damage has occurred.
Talk to your doctor about any of the following symptoms. The sooner they can be diagnosed and treated, the better the chance of preventing further complications.
Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms. Possible signs and symptoms of peripheral neuropathy include:
- Numbness or reduced ability to feel pain or changes in temperature, especially in your feet and toes
- A tingling or burning feeling
- Sharp, jabbing pain that may be worse at night
- Extreme sensitivity to the lightest touch — for some people even the weight of a sheet can be agonizing
- Muscle weakness
- Loss of reflex response
- Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain
The autonomic nervous system controls your heart, bladder, lungs, stomach, intestines, sex organs and eyes. Diabetes can affect the nerves in any of these areas, possibly causing:
- A lack of awareness that blood sugar levels are low (hypoglycemia unawareness)
- Bladder problems, including frequent urinary tract infections or urinary incontinence or urinary retention
- Constipation, uncontrolled diarrhea or a combination of the two
- Slow stomach emptying (gastroparesis) leading to nausea, vomiting, sensation of fullness and loss of appetite
- Difficulty swallowing
- Erectile dysfunction in men
- Vaginal dryness and other sexual difficulties in women
- Increased or decreased sweating
- Sharp drops in blood pressure when you rise from sitting or lying down, that may cause you to feel lightheaded or faint (orthostatic hypotension)
- Problems regulating your body temperature
- Changes in the way your eyes adjust from light to dark
- Increased heart rate when you're at rest
Proximal neuropathy (diabetic amyotrophy)
Instead of affecting the ends of nerves in the feet, legs, hands and arms, like peripheral neuropathy, proximal neuropathy affects nerves in the thighs, hips, buttocks or legs. Also called diabetic amyotrophy or radiculoplexus neuropathy, this condition is more common in people with type 2 diabetes and older adults.
Symptoms are usually on one side of the body, though in some cases symptoms may spread to the other side, too. Most people improve at least partially over 6 to 12 months. This condition is often marked by:
- Sudden, severe pain in your hip and thigh or buttock
- Weakness and atrophy of the thigh muscles
- Difficulty rising from a sitting position
Mononeuropathy involves damage to a specific nerve. The nerve may be in the face, torso or leg. Mononeuropathy, which may also be called focal neuropathy, often comes on suddenly. It's most common in older adults.
Although mononeuropathy can cause severe pain, it usually doesn't cause any long-term problems. Symptoms usually diminish and disappear on their own over a few weeks or months. Signs and symptoms depend on which nerve is involved, and may include:
- Difficulty 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 the front of your thigh
- Chest or abdominal pain
Sometimes mononeuropathy occurs when a nerve is compressed. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes.
Signs and symptoms of carpal tunnel syndrome include:
- Numbness or tingling in your fingers or hand, especially in your thumb, index finger, middle finger and ring finger
- A sense of weakness in your hand and a tendency to drop things
Be sure to discuss any neuropathy symptoms with your doctor. Early diagnosis and treatment offer the best chance for controlling symptoms and preventing more-severe problems.