Patients’ Guide to Diabetic Neuropathy

Types of Diabetic Neuropathy

Peripheral, Proximal, Autonomic, and Focal Nerve Damage

Diabetic neuropathy can be broken into several types. This is because we have different kinds of nerves in our bodies that serve different functions. Your symptoms and treatments depend on which type of diabetic neuropathy you have.

There are four types of diabetic neuropathy: 

Peripheral Neuropathy

Peripheral diabetic neuropathy goes by various names: peripheral diabetic nerve pain and distal polyneuropathy. In this Patient Guide, we’ll refer to it as peripheral diabetic neuropathy, or simply peripheral neuropathy.

 Peripheral neuropathy is the most common form of neuropathy caused by diabetes. It affects nerves leading to your extremities—to your feet, legs, hands, and arms. The nerves going to your feet are the longest in your body: after they branch off the spinal cord in the lumbar region (low back), they have to go all the way down your legs and into the feet—quite a distance.

 Because the nerves leading to your feet are so long, it’s most often these nerves that are damaged; there’s more of them to be damaged. This nerve damage can lead to the foot problems often associated with diabetes, including foot deformities, infections, ulcers, and amputations.

 The article on diabetic neuropathy symptoms will help you learn more about the specific symptoms associated with peripheral diabetic neuropathy.

Proximal Neuropathy

Proximal neuropathy can also be called diabetic amyotrophy. That myo in the word means muscle, so this is a form of neuropathy that can cause muscle weakness. It specifically affects the muscles in the upper part of your leg(s), buttocks, and hips. 

Sometimes, proximal neuropathy can also involve nerve pain, especially pain that shoots from the low back and down the leg. The technical medical term for that is radiculopathy, although most people refer to it as sciatica. If there’s also shooting nerve pain involved, this form of neuropathy can also be called polyradiculopathy-diabetic amyotrophy.

Proximal neuropathy is the second most common type of diabetic neuropathy (second only to peripheral diabetic neuropathy). It usually affects elderly people with diabetes; as opposed to peripheral neuropathy, it usually resolves with time or treatment.

Autonomic Neuropathy

Autonomic nerves are supposed to keep your body running as it should. There are many functions that happen in your body without you thinking about them: your heart pumps, you breathe, and your stomach digests food. Those actions are controlled by the autonomic nervous system; it’s also sometimes called the automatic nervous system.

The autonomic nervous system should maintain your body’s homeostasis, which is its normal, balanced state. If the autonomic nerves are damaged by the effects of diabetes—autonomic diabetic neuropathy—then your body may have trouble maintaining homeostasis.

Autonomic neuropathy can seem daunting because it can affect so many of your body’s systems, from your digestive tract to how well you can see. However, remember that your symptoms depend on what specific nerves in the autonomic nervous system are damaged.

Focal Neuropathy

All of the types of diabetic neuropathy above—peripheral, autonomic, and proximal—are examples of polyneuropathy. Poly means that they affect many nerves. Focal neuropathy, by contrast, affects one specific nerve; it’s focused neuropathy. It can also be called mononeuropathy.

Focal neuropathy, which comes on suddenly, most often affects nerves in the head (especially ones that go to the eyes). It can also affect the torso and legs.

When focal neuropathy affects the legs, it has different symptoms than proximal neuropathy, which can also affect the legs. Proximal neuropathy, as you can read above, causes muscle weakness in the legs, and it may also cause shooting pain down the leg. Focal neuropathy, however, causes pain in very specific locations on the legs, which you can read more about in the symptoms article.