How Diabetic Neuropathy Progresses

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The nerve damage that can result from diabetes—diabetic neuropathy—can get worse over time. It's fairly common in people who've had diabetes for many years. The damage starts slowly. In fact, you could have diabetic neuropathy but not notice any symptoms. As it progresses, diabetic neuropathy symptoms begin to appear and affect your life.

As many as 7 out of 10 people with diabetes will get diabetic neuropathy. Progression to severe diabetic neuropathy is more common if you:

  • Are overweight

  • Have had diabetes for more than 25 years

  • Have trouble controlling your blood sugar

  • Have high blood pressure

  • Have high levels of certain lipids in your blood

  • Smoke

Just what causes diabetic neuropathy progression is not known. There's probably more than one cause, and the causes may vary from person to person. However, long-term high blood sugar seems to be a main cause. High blood sugar can damage nerve cells directly. It also can cause damage through chemical changes or inflammation. Diabetes also damages blood vessels. When blood vessels that supply nerves are damaged, this also contributes to progression.
Early on, nerve damage may affect only the outer lining of nerves. With time, the damage may occur in actual nerve fibers. As nerve damage progresses, loss of nerve fibers can occur.

How you will be affected by the progression of nerve damage depends on which nerves are affected. Diabetic neuropathy can start and progress almost anywhere in your body. Here are some common examples.

Peripheral Diabetic Neuropathy Progression

Peripheral nerve damage occurs in the nerves that go to your feet and hands. Early symptoms usually begin in the feet and legs. This may include numbness, loss of pain sensation, tingling, and pain. This diabetic nerve pain may feel burning or sharp. As this neuropathy progresses, you may experience the following:

  • Changes in structure of your feet

  • Frequent infections in your feet that may spread to bones and require amputation of a foot or leg

  • Increasing weakness

  • Shrinking muscles

  • Trouble walking and keeping your balance

Autonomic Diabetic Neuropathy Progression

Autonomic neuropathy is nerve damage to nerves that control your body's automatic functions. This includes nerves that control your heart, digestion, bladder and sexual functions. You might not notice any changes with this type of neuropathy until nerve damage progresses. With time, you may notice symptoms including:

  • Changes in the way you sweat such as at night or when you eat. With time, this can lead to very dry skin.

  • Dizziness when you stand up

  • Nausea and fullness after eating or loss of appetite. This can lead to vomiting, weight loss, and trouble swallowing.

  • Sexual problems. For men, this may mean trouble getting an erection. Women may have loss of vaginal lubrication and trouble having an orgasm.

  • Trouble emptying your bladder, which can lead to frequent urinary tract infections and loss of bladder control

  • Trouble seeing at night

Neuropathic Arthropathy Progression

Neuropathic arthropathy is joint damage caused by diabetic nerve damage. This is most common in the foot and ankle. Another name for this is Charcot joint. Early symptoms are numbness and loss of feeling in your foot. As the neuropathy progresses, other changes may occur, including:

  • You may not be aware of stress on your foot and ankle.

  • You may lose muscle strength you need to support your foot and ankle joints.

  • You could twist or damage your foot or ankle and not know it.

  • The bones in your foot and ankle joints may start to grate on each other.

  • Your joints may collapse and become deformed.

The best way to prevent diabetic neuropathy from progressing is to work with your doctor to get control your blood sugar. You should also reduce your risk factors by not smoking and maintaining a healthy weight.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2021 Jun 12
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Additional Types of Neuropathy. American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/neuropathy/additional-types-of-neuropathy.html
  2. Autonomic Neuropathy. American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/neuropathy/autonomic-neuropathy.html
  3. Boucek P. Advanced diabetic neuropathy: a point of no return? Rev Diabet Stud. 2006 Fall; 3(3): 143–150.
  4. Nerve Damage (Diabetic Neuropathies). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies
  5. Peripheral Neuropathy. American Diabetes Association. http://www.diabetes.org/living-with-diabetes/complications/neuropathy/peripheral-neuropathy.html