What Do You Know About Diabetic Peripheral Neuropathy?

The symptoms depend on which and how many nerves are affected. Problems with sensation can occur in hands, arms, legs, and feet. Because of damage to nerves that control the automatic functions of organs, a person can have health problems involving the digestive tract, heart and circulatory system, and reproductive system.

About half of the people with diabetes have some form of neuropathy, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) says. People who have had diabetes for at least 25 years have the highest rates of nerve damage. Neuropathies are also more common in people who cannot keep their blood sugar under control, in those with high blood pressure, and in people older than 40.

Researchers aren't sure exactly how the damage occurs, but they think that over time, the combination of high blood sugar and high blood pressure damages the nerves. They also suspect that the nerves may be damaged by an autoimmune response triggered by diabetes, and that smoking or alcohol abuse contributes to the problem.

The symptoms of neuropathy depend on which and how many of the nerves are affected, the NIDDK says. Some people have no symptoms, but others have numbness, tingling, or pain in the feet or hands. Other symptoms include indigestion, diarrhea or constipation, dizziness, urination problems, and erectile dysfunction or vaginal dryness.

Symptoms are often worse at night. Peripheral neuropathy affects the peripheries of the body – the toes, feet, legs, hands, and arms, the NIDDK says. Symptoms include numbness to pain or temperature in those areas; a tingling, burning, or prickling feeling; sharp pain or cramps; extreme sensitivity to touch; and difficulty with balance and coordination.

Autonomic neuropathy affects digestion, the bowel and bladder, sexual response, and perspiration, the NIDDK says. It also can reduce the symptoms of hypoglycemia, such as shakiness or sweating, and can affect the heart, blood pressure, and vision.

Proximal neuropathy, also called femoral neuropathy, causes pain on one or both sides of the body in the thighs, hips, or buttocks and leads to weakness in the legs, according to the NIDDK. Muscles become weaker, and the affected muscles waste away. A person with this type of neuropathy often has difficulty getting up from a chair without help. Proximal neuropathy is more common in older adults with diabetes.

Focal neuropathy affects one nerve or a group of nerves that control a specific area of the body. This neuropathy causes either sudden muscle weakness or pain. According to the NIDDK, these are possible problems caused by focal neuropathy: difficulty focusing the eye; double vision; aching behind the eye; paralysis on one side of the face (called Bell’s palsy); severe pain in the lower back; pain in the front of the thigh; pain in the chest, stomach, or side; pain in the shin or inside the foot; and chest pain.

Treatment focuses on controlling blood sugar because bringing blood sugar under control helps prevent further nerve damage. This may be accomplished by better meal planning, exercise, medication, and monitoring blood sugar. Symptoms may worsen at first, but then ease as normal blood sugar levels are maintained, the NIDDK says. If pain is a problem, your health care provider also may prescribe a pain reliever, or in some cases, an antidepressant, anticonvulsant, or other medications that treat pain. Your health care provider can also help with problems related to digestion, urinary and sexual functions, and dizziness. Nerve damage can be stopped but not reversed, so you may need to pay special attention to areas of the body affected by neuropathy. If your feet and legs are affected, you should check those areas every day for wounds or sores or other problems.