There are four main types of diabetic neuropathy, of which you can have one or more types. The type(s) of neuropathy and the nerves affected will determine your symptoms. Typically initial symptoms are mild and slowly worsen over time, so you may not notice anything is wrong until significant nerve damage has occurred.

Peripheral Neuropathy

This is the most common type of diabetic neuropathy. The feet and legs are affected first, followed by the hands and arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include:

• Numbness or reduced ability to feel pain or temperature changes

• Tingling or burning sensation

• Sharp pains or cramps

• Increased sensitivity to touch

• Muscle weakness

• Loss of reflexes, balance and coordination

• Serious foot problems (ulcers), infections, and bone and joint pain

Autonomic Neuropathy

Your heart, bladder, stomach, intestines, sex organs and eyes are controlled by the autonomic nervous system. Diabetes can affect nerves in any of these areas, possibly causing:

• A lack of awareness that blood sugar levels are low

• Bladder problems

• Constipation, uncontrolled diarrhea or both

• Slow stomach emptying (gastroparesis), causing nausea, vomiting, bloating and loss of appetite

• Difficulty swallowing

• Increased or decreased sweating

• Problems controlling body temperature

• Changes in the way your eyes adjust from light to dark

• Increased heart rate at rest

• Sharp drops in blood pressure after sitting or standing that may cause you to faint or feel lightheaded

• Decreased sexual response, erectile dysfunction, and vaginal dryness

Radiculoplexus Neuropathy (Diabetic Amyotrophy)

Radiculoplexus neuropathy affects nerves in the thighs, hips, buttocks or legs, and is more common in people with type 2 diabetes and older adults. This type is also known as diabetic amyotrophy, femoral neuropathy or proximal neuropathy. Symptoms are usually on one side of the body, but sometimes may spread to the other side. You may have:

• Severe pain in a hip and thigh or buttock that occurs in a day or more

• Weak and shrinking thigh muscles

• Difficulty rising from a sitting position

• Abdominal swelling

• Weight loss

Most people improve at least partially over time, though symptoms may worsen before they get better.

Mononeuropathy

Mononeuropathy, or focal neuropathy, is damage to a specific nerve in the face, middle of the body (torso) or leg. It’s most common in older adults. Mononeuropathy often strikes suddenly and can cause severe pain. Symptoms usually go away without treatment over a few weeks or months. Your specific signs and symptoms depend on which nerve is involved. You may have pain in the:

• Shin or foot

• Lower back or pelvis

• Front of thigh

• Chest or abdomen

Nerve problems in the eyes and face may lead to difficulty focusing, double vision, aching behind one eye, and paralysis on one side of your face (Bell’s palsy)

Mononeuropathy can also occur when a nerve is being compressed. Carpal tunnel syndrome is a common type of compression neuropathy in people with diabetes. This can cause numbness or tingling in your hand or fingers, except your pinkie (little finger). Your hand may feel weak, and you may drop things.

What Diabetic Neuropathy?