Diabetic Neuropathy: Types, Symptoms, Causes & Treatment

Updated in April 2023

Diabetic neuropathy is a complication of diabetes which is characterized by progressive nerve degeneration. It can lead to decreased sensitivity or pain in many areas of the body, particularly the hands and feet.

Diabetic neuropathy typically develops at a slow rate, but can cause symptoms like pain, tingling, burning or loss of sensitivity. It is not curable, however worsening can be prevented if diabetes is well-managed. Medications like analgesics and antidepressants can help with more specific symptoms. 

If you suspect you may have diabetic neuropathy, you should consult and endocrinologist or neurologist for a more thorough assessment and treatment as necessary. 

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Types of diabetic neuropathy 

Diabetic neuropathy is classified based on the presenting symptoms and the areas of the body affected. The main types of neuropathy are: 

  • Focal or multifocal neuropathy: Symptoms with this condition indicate that a specific nerve in the hands, feet, legs, trunk or head has been compromised 
  • Diabetic polyneuropathy: This is characterized by symptoms that mainly affect the hands and feet, and tend to progress toward the trunk. 
  • Proximal neuropathy: This is characterized by symptoms that affect the hips, glutes, abdomen and thorax. It generally affects one side of the body, but it can spread to the other side.
  • Autonomic neuropathy: This affects organ control, like the heart, bladder, stomach, intestines and genitals. 

Generally, the doctor will determine the type of neuropathy by evaluating the presenting symptoms and physical assessment. Some people may need further testing, however, with electroneuromyography and nerve conduction tests. 

Common symptoms

The most common symptoms of diabetic neuropathy include: 

  • Tingling, burning, electric shocks, sharp pain, numbness or heaviness in some parts of the body (particularly the hands and feet) 
  • Pain with palpation or loss of sensation
  • Weakness with activity 
  • Easily fatigued 
  • Imbalance when walking 
  • Difficulty getting up from a seated position
  • Muscle tremors
  • Lack of hypoglycemia symptoms, like confusion, dizziness, hunger, tremors or decreased motor coordination 
  • Constipation
  • Difficulty digesting or swallowing 
  • Vaginal dryness 
  • Erectile dysfunction
  • Increased or decreased sweat production 
  • Drops in blood pressure
  • Bladder issues, like urinary frequency or urgency

These symptoms can affect different parts of the body depending on the type of neuropathy occurring. They can often go unnoticed for a long time. Patients with pain typically experience more pain at night or when resting, and it can improve with walking. Loss of sensation increases the risk for foot ulcers.

If you suspect you may have diabetic neuropathy, you should consult an endocrinologist or neurologist for a thorough assessment. 

What causes diabetic neuropathy?

Diabetic neuropathy is a complication of diabetes and mainly affects people who do not adhere to treatment. These patients tend to have high blood sugars on a frequent basis, which causes progressive nerve damage. 

Confirming a diagnosis

A diabetic neuropathy diagnosis is confirmed by an endocrinologist or neurologist based on the signs and symptoms and diabetes history. The doctor will complete a physical assessment to determine muscular strength and tonus, as well as perform tendon reflex testing and assess sensitivity to touch and temperature changes. 

The doctor may also order more specific testing, like nerve conduction tests. This tests measure the speed at which nerves in the arms or legs conduct electrical pulses. Another test the doctor may order is an electroneurogram, which measures the electrical discharges produced by muscles..

Treatment options

Treatment for diabetic neuropathy should be oriented by an endocrinologist or neurologist and is normally aimed at relieving symptoms and preventing worsening and other complications. 

Treatment for diabetic neuropathy can include medications like: 

  • Antidiabetics, like insulin injections or oral pills to control blood sugar levels 
  • Anticonvulsants, like pregabalin and gabapentin to relieve pain 
  • Antidepressants, like amitriptyline, imipramine, duloxetine or venlafaxine, which help to relieve light to moderate pain
  • Opioids, which can be taken orally (e.g. tramadol, morphine, oxycodone or methadone) or applied transdermally (e.g. fentanyl or buprenorphine) 

Treatment for the complications associated with diabetic neuropathy can be oriented by more specific specialists (like a urologist for bladder issues or erectile dysfunction, or a cardiologist for blood pressure control).

Is diabetic neuropathy curable? 

There is no cure for diabetic neuropathy, however it is possible to reduce progression by adequately treating diabetes. Related symptoms can be managed with medications like antidepressants and analgesics. 

A healthy diet and regular exercise also provide benefits and can help to recover lost sensation.

Prevention measures

Diabetic neuropathy can be prevented by controlling blood sugar levels rigorously. To achieve this, you should consider measures like: 

  • Regularly following-up with your doctor
  • Monitoring sugar levels with a glucometer at home, as instructed by your doctor
  • Taking diabetes medication and insulin as prescribed
  • Exercising regularly, like going on light walks, swimming and water aerobics. 

You should maintain a balanced diet that is rich in fiber, protein and healthy fats. Foods that are high in sugar, like cookies, soda or cake, should be avoided.