Patients’ Guide to Diabetic Neuropathy

Diabetic Neuropathy Symptoms

Pain, Tingling, Numbness, and More

The symptoms of diabetic neuropathy depend on what type of neuropathy  you have. Symptoms are dependent on which nerves have been damaged.

 
In general, diabetic neuropathy symptoms develop gradually; they may seem like minor and infrequent pains at first, but as the nerves become more damaged, symptoms may grow.
 
Because mild symptoms can indicate the beginning of neuropathy, you should pay attention to and take note of any pain, numbness, weakness, or tingling—even if it seems insignificant. Talk to your doctor about your symptoms—your pain may mean the control of your diabetes could be improved, which will help control the progression of your neuropathy.
 
Peripheral Neuropathy Symptoms
Peripheral neuropathy affects nerves leading to your extremities—the feet, legs, hands, and arms. The nerves leading to your feet are the longest in your body, so they are the most often affected nerves (simply because there’s more of them to be affected). Peripheral neuropathy is the most common form of diabetic neuropathy.
 
Peripheral neuropathy symptoms include:
  • Pain
  • Numbness (loss of feeling)
  • Tingling
  • Muscle weakness
  • Muscle cramping and/or twitching
  • Insensitivity to pain and/or temperature
  • Extreme sensitivity to even the lightest touch
  • Symptoms get worse at night
 
Proximal Neuropathy Symptoms
Proximal neuropathy affects the buttocks, hips, thighs, and legs. Its symptoms aren’t usually long-term; they may go away after several weeks or months.
 
Symptoms include:
  • Weakness in the legs
  • Trouble standing up from a seated position without help
 
Autonomic Neuropathy Symptoms
The autonomic nervous system is in charge of the "involuntary" functions of your body. It keeps your heart pumping and makes sure you digest your food right—without you needing to think about it.
 
Autonomic neuropathy symptoms include:
 
Cardiovascular System
  • Dizziness just after standing
  • Fainting just after standing
  • Irregular heart rate

Digestive System

  • Bloating
  • Constipation
  • Diarrhea
  • Nausea
  • Vomiting

Eyes

  • Vision trouble at night or during sudden light changes (e.g., when stepping into a dark building from the sunlight)

Reproductive System

  • Sexual problems—erectile dysfunction in men; vaginal dryness in women

Sweat Glands

  • Profuse sweating, especially at night or when eating particular foods (cheese commonly causes excessive sweating, for example, although that’s not true for every person with diabetic neuropathy)
  • Reduced sweating, especially in the legs and feet

Urinary System

  • Bladder dysfunction
 
People with autonomic neuropathy may also have trouble figuring out when their blood sugar level is too low—which is particularly dangerous for people with diabetes. This is called “hypoglycemia unawareness,” and it occurs when the normal responses to low blood sugar (sweating, shakiness, etc.) don’t kick in because of nerve damage.
 
Again, your symptoms depend on which autonomic nerves are damaged and which part of the body’s autonomic system they control.
 
Focal Neuropathy Symptoms
Unlike the other types of diabetic nerve pain, focal neuropathy comes on suddenly, and it usually affects the head, torso, or legs. Symptoms usually go away after a few weeks; these aren’t long-term symptoms.
 
Possible focal neuropathy symptoms:

Head

  • Vision trouble—double vision, ache behind an eye, difficulty focusing
  • Sudden paralysis of one side of the face (Bell’s palsy)

Torso

  • Pain in the chest
  • Pain in the stomach
  • Pain on the side
  • Pain in the low back

Legs

  • Pain in the front of the thigh
  • Pain on the outside of the shin
  • Pain on the inside of the foot