Diabetic Neuropathy

Medically Reviewed By William C. Lloyd III, MD, FACS

What is diabetic neuropathy?

Neuropathy is a condition in which the peripheral nerves function poorly. These are the nerves found outside the spinal cord and brain. Nerve damage can cause tingling, weakness, numbness, and pain in the affected area. Neuropathy can have several causes, including trauma, but the most common cause is diabetes. This is called diabetic neuropathy.

People with diabetes must keep their blood glucose (sugar) levels as close to normal as possible. Consistently high levels of blood glucose or frequent spikes can cause several complications, including nerve damage. About half of people with diabetes develop diabetic neuropathy, and the likelihood increases the longer the disease is present.

Diabetic neuropathy can be mild or severe, and it can affect different parts of the body. For example, peripheral neuropathy can cause tingling or burning sensations on the skin, most often on the feet and legs. The symptoms usually appear gradually, not always noticeable at first. As the nerve damage progresses, so do the symptoms.

Diabetic neuropathy symptoms should never be ignored because left untreated, neuropathy can lead to vision loss, infections, even amputations. There is no cure for diabetic neuropathy, but treatment can slow down the progression and help relieve pain and other symptoms.

What are the different types of diabetic neuropathy?

Peripheral neuropathy is the most common type of diabetic neuropathy. There are also other types of neuropathies and it is possible to have more than one type:

  • Autonomic neuropathy affects the nerves that control the organs, such as the bladder, heart, intestines, and eyes.

  • Focal neuropathy (also called mononeuropathy) usually affects nerves in the head, often the eyes, although it can affect other parts of the body as well. Focal neuropathy causes weakness, as well as pain, and could cause a facial paralysis called Bell’s palsy.

  • Proximal neuropathy (also called diabetic polyradiculopathy or amyotrophy) is rare. People with proximal neuropathy experience disabling pain on one side of the body, rarely on both sides. Most often, nerve damage occurs on the hip, buttock or thigh.

What are the symptoms of diabetic neuropathy?

The symptoms for diabetic neuropathy depend on which type is present:

Common symptoms of peripheral diabetic neuropathy

The most common symptoms of peripheral diabetic neuropathy are felt on the skin and in the affected area:

  • Pins and needles, tingling sensation on the skin

  • Numbness

  • Sharp pain 

  • Cramping

  • Frequent wounds and infections, particularly on the feet and legs

  • Loss of muscle tone in the hands and feet

  • Swelling in the feet

Common symptoms of autonomic diabetic neuropathy

The most common symptoms of autonomic diabetic neuropathy are:

  • Bowel incontinence, diarrhea or constipation

  • Urinary incontinence or urine retention (unable to empty the bladder)

  • Abdominal bloating

  • Difficulty swallowing

  • Vomiting

  • Visual disturbances, particularly related to adjusting the eyes between light and dark

  • Decreased libido, sexual response

  • Difficulty detecting symptoms of low blood glucose (hypoglycemia)

Common symptoms of proximal diabetic neuropathy

The most common symptoms of proximal diabetic neuropathy are:

  • Sudden, severe pain in a hip, buttock or thigh, usually on one side only

  • Weakness, difficulty standing from a sitting position

  • Decreased reflexes in the lower body

  • Muscle tissue loss

  • Weight loss

Common symptoms of focal diabetic neuropathy

The most common symptoms of focal diabetic neuropathy are:

  • Visual difficulties, including double vision or trouble focusing

  • Pain or ache behind one eye

  • Bell’s palsy

  • Pins and needles in the fingers, but not the little finger (pinky)

  • Hand weakness

  • Carpal tunnel syndrome

Serious symptoms that might indicate a life-threatening condition

In some cases, diabetic neuropathy can be life-threatening. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Signs of an infection, such as a fever higher than 101°F or pus coming from a wound

  • Dizziness and fainting

Most signs and symptoms of diabetic neuropathy do not indicate an emergency. However, any signs of diabetic neuropathy should be evaluated by a healthcare professional as soon as possible to slow down the progression and to reduce the risk of complications.

What are the stages of diabetic neuropathy?

There are three stages of diabetic neuropathy:

  • Early: Intermittent pain and tingling, most often in the feet

  • Moderate: Pain is more frequent or constant, and more intense.

  • Severe: No pain is felt because all sensation is gone. Injuries may be present but go unnoticed because of lack of pain.

What causes diabetic neuropathy?

High blood glucose levels can damage the body’s cells, including the nerve cells. Chronically elevated blood glucose levels interfere with normal metabolism and lead to the abnormal accumulation of waste products that disrupt how the cells can send and receive signals from the brain.

What are the risk factors for diabetic neuropathy?

Anyone can develop neuropathy, but to have diabetic neuropathy, you must have diabetes. The risk factors for diabetic neuropathy are mostly related to controlling the diabetes. People at highest risk for developing neuropathy are those who:

  • Are overweight or obese

  • Have difficulty controlling their blood glucose levels

  • Have had diabetes for many years

  • Have kidney disease in addition to diabetes

  • Smoke

How do you prevent diabetic neuropathy?

The only way to prevent diabetic neuropathy or to slow its progression is by strictly following your prescribed diabetes treatment plan. This will help keep your blood glucose levels within the target range. Report any signs of diabetic neuropathy to your healthcare provider so your diabetic treatment plan can be adjusted, if needed.

If you have diabetes and do not have any signs of diabetic neuropathy, speak with your diabetes care team to see how you can protect yourself from developing neuropathy.

What are the diet and nutrition tips for diabetic neuropathy?

There is no specific diabetic neuropathy diet, but by following your prescribed diabetic diet, you can help decrease the risk of neuropathy.

If you are not sure what types of food you should eat, consult with your diabetes care team and, if possible, speak with a dietitian. Proper nutrition plays a large role in diabetic health overall. It is important to ask your healthcare provider for guidance before making significant changes to your diet.

How do doctors diagnose diabetic neuropathy?

Most often, doctors can diagnose diabetic neuropathy based on the patient’s medical history and medical examination.

To diagnose your condition, your doctor or licensed healthcare practitioner will ask you several questions related to the possible nerve damage including:

  • What kind of pain do you feel and when did it start?

  • How often do you feel it?

  • Are you experiencing any other symptoms, such as urinary incontinence, difficulty with your vision, or pain elsewhere in the body?

  • When do your symptoms occur?

  • Are your symptoms worsened or relieved by anything in particular?

The medical exam will include checking your reflexes, coordination and balance, and overall muscle strength and tone.

If the doctor wants confirmation of the diagnosis or to rule out other possible causes of symptoms, patients could be sent for testing including:

  • Blood tests, possibly including genetic testing

  • Imaging tests, such as magnetic resonance imaging (MRI)

  • Nerve conduction testing (NCS), during which small electrodes are placed on the skin. Brief bursts of electricity are sent into the muscles and the response tells how well the signals travel through the tissue.

  • Needle electromyography (EMG), which uses a similar approach to measure electrical impulses, but instead of patches, a very fine needle is inserted into the muscle.

  • Biopsy of the skin, nerve or muscle

What are the treatments for diabetic neuropathy?

There is no cure for diabetic neuropathy. Treatment focuses on slowing the condition’s progress and relieving uncomfortable symptoms.

The most important treatment is to get blood glucose levels under control, at an acceptable level. This will reduce further damage to the cells.

Pain caused by diabetic neuropathy can be hard to treat, but some people get relief from drugs traditionally used to treat seizures or depression. Some people also find symptom relief with topical treatments (creams) that contain capsaicin or lidocaine. Always check with your diabetes care team before starting a new cream, even if it is available over the counter, to ensure it may not cause more harm.

Treatments for issues caused by the rarer types of neuropathies focus on the problem the nerve damage caused. For example, people who have difficulty digesting food may need to change their diet or take medications to relieve nausea, constipation or diarrhea.

How does diabetic neuropathy affect quality of life?

The pain and discomfort caused by diabetic neuropathy can have a significant impact on quality of life.

People with painful feet may find it difficult to get out and about, or even to complete household tasks. Sleeping can be difficult due to pain, nausea, and other symptoms. People with incontinence (either of stool or urine) may not want to leave the house, for fear of embarrassment. If you have symptoms that are affecting your life, speak with your diabetes care team about available options to manage symptoms and slow progression.

People living with diabetic neuropathy may also benefit from support groups, either online or in-person, related to diabetes, neuropathy, or even chronic pain issues.

What are the potential complications of diabetic neuropathy?

Complications due to diabetic neuropathy also vary according to the type of neuropathy and the affected body part. The most serious complication is an infected wound that could lead to sepsis, gangrene and possible amputation.

Other potential complications of diabetic neuropathy include:

Seeking treatment at the first signs of diabetic neuropathy can help reduce the chances of complications and slow progression of symptoms.

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  1. Alam U, Fawwad A, Shaheen F, Tahir B, Basit A, Malik RA. Improvement in Neuropathy Specific Quality of Life in Patients with Diabetes after Vitamin D Supplementation. Journal of Diabetes Research, vol. 2017, Article ID 7928083, 7 pages, 2017. https://doi.org/10.1155/2017/7928083
  2. Diabetic Neuropathy. Cedars Sinai. https://www.cedars-sinai.org/health-library/diseases-and-conditions/d/diabetic-neuropathy.html
  3. Neuropathy. American Diabetes Association. https://www.diabetes.org/diabetes/complications/neuropathy
  4. Diabetic Neuropathy. National Institute of Diabetes and Digestive Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies
  5. Diabetic Neuropathy. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580
  6. Diabetic Neuropathy. American Association of Neuromuscular & Electrodiagnostic Medicine. https://www.aanem.org/Patients/Muscle-and-Nerve-Disorders/Diabetic-Neuropathy
Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Aug 20
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