Diabetic neuropathy types: Symptoms tell the story

When you have diabetes, nerve damage can occur as a result of high blood sugar. This is known as diabetic neuropathy. There are four main types of this condition. You may have just one type or you may have symptoms of several types. Most types of diabetic neuropathy develop gradually, and you may not notice problems until considerable damage has occurred.

Talk with your health care provider if you have any of the following symptoms. The sooner they can be diagnosed and treated, the better the chance of preventing further complications.

Peripheral neuropathy

Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms. Possible signs and symptoms of peripheral neuropathy include:

• Numbness or reduced ability to feel pain or temperature changes, especially in your feet and toes
• A tingling or burning feeling
• Sharp, jabbing pain that may be worse at night
• Extreme sensitivity to touch — for some people even the weight of a sheet can be painful
• Muscle weakness
• Loss of reflex response
• Serious foot problems, such as ulcers, infections, deformities, and bone and joint damage

Autonomic neuropathy

The autonomic nervous system controls your blood pressure, heart rate, sweat glands, eyes, bladder, digestive system and sex organs. Diabetes can affect the nerves in any of these areas, possibly causing symptoms including:

• A lack of awareness that blood sugar levels are low (hypoglycemia unawareness)
• Bladder problems, including frequent urinary tract infections, loss of bladder control (urinary incontinence) or trouble emptying the bladder (urinary retention)
• Constipation, uncontrolled diarrhea or a combination of the two
• Slow stomach emptying (gastroparesis) leading to nausea, vomiting, sensation of fullness and loss of appetite
• Difficulty swallowing
• Erectile dysfunction in men
• Vaginal dryness and other sexual difficulties in women
• Increased or decreased sweating
• Drops in blood pressure when rising from sitting or lying down, that may cause feelings of lightheaded or fainting (orthostatic hypotension)
• Problems regulating your body temperature
• Changes in the way your eyes adjust from light to dark or distance to nearness
• Increased heart rate even when you're at rest

Proximal neuropathy (diabetic polyradiculopathy)

Unlike peripheral neuropathy, which affects the ends of nerves in the feet, legs, hands and arms, proximal neuropathy affects nerves in the thighs, hips, buttocks or legs. This condition is more common in people who have type 2 diabetes and in older adults.

Symptoms are usually on one side of the body, though in some cases symptoms may spread to the other side, too. Most people improve at least partially over 6 to 12 months. This condition is often marked by symptoms including:

• Severe pain in the buttock, hip or thigh
• Weak and shrinking thigh muscles
• Difficulty rising from a sitting position
• Chest or stomach (abdominal) pain

Mononeuropathy (focal neuropathy)

Mononeuropathy involves damage to a single, specific nerve. The nerve may be in the face, torso, arm or leg. Mononeuropathy, which may also be called focal neuropathy, often comes on suddenly. It's most common in older adults.

Although mononeuropathy can cause severe pain, it usually doesn't cause any long-term problems. Symptoms usually lessen and disappear on their own over a few weeks or months. Symptoms depend on which nerve is involved, and may include:

• Double vision or difficulty focusing your eyes
• Paralysis on one side of your face
• Pain in your shin or foot
• Pain in the front of your thigh

Sometimes mononeuropathy occurs when a nerve is compressed. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes.

Symptoms of carpal tunnel syndrome include:

• Numbness or tingling in your fingers or hands, especially in your thumb, index finger, middle finger and ring finger
• Loss of strength with a sense of weakness in your hand that may cause you to drop things

Be sure to talk with your health care provider if you notice any of these symptoms. The sooner treatment begins, the better the chance of reducing complications.