Medically Reviewed By: Tom Iarocci, MD

Diabetic nerve pain may be the result of permanent damage to certain nerves. This damage is known as diabetic neuropathy, and it can take on many different forms. Not all diabetic neuropathies are painful, but some are, and chronic nerve pain in some people with diabetes may be difficult to manage.

Neuropathies develop in all kinds of people, not just those with diabetes, but people who have diabetes tend to be particularly affected by several patterns of neuropathy. Nerve damage and resulting symptoms can begin to develop shortly after a diagnosis in some individuals, while for others this may emerge only after years after having diabetes. Some have neuropathy but experience no symptoms, whereas others will see certain warning signs, such as numbness, tingling, and pain. In addition to neuropathies that affect the limbs and extremities, it is possible to have damage in nerves that go to a number of different organs and systems, including the sexual organs, heart, and digestive tract.

It is estimated that as many as 60 to 70 percent of people who suffer from diabetes will experience some manner of neuropathy. But, again, not all of them will have prominent symptoms. The risk of diabetic neuropathy increases with age and also with cumulative exposure to abnormally high blood sugar levels. So, in a person who has had diabetes for, say, 25 years, diabetic neuropathy is quite common.

Diabetic Nerve Pain Signs and Symptoms:

How do you know if it is diabetic nerve pain or some other pain, such as arthritis or a pinched nerve? Well, you should leave that part up to your doctor, but there are certain warning signs that you may experience with diabetic neuropathy, and it is important that you bring these to your doctor’s attention. Symptoms of diabetic neuropathy depend on which nerves become damaged.

Often, when you first start to suffer nerve damage, you may not experience any symptoms whatsoever. In other cases, a typical pattern is numbness, pain or tingling around the feet. Symptoms may start as very minor sensations, and these very mild cases can be ignored for quite a long time, with additional damage occurring all the while. Signs and symptoms may also differ based on which portions of the nervous system are involved. Some diabetic neuropathies come on relatively suddenly and involve the muscles of the hip and thigh area. Signs of nerve damage might include wasting or shrinking of the involved muscles in addition to hip and thigh pain. Some cases of neuropathy tend to get better over months and years, while other cases tend to become progressively worse as the years go on.

Symptoms:

Symptoms involving the hands and feet with tingling, pain, or loss of feeling are common in diabetic peripheral neuropathy. In a different sort of diabetic neuropathy, when the autonomic nervous system is involved, there can be digestive symptoms, nausea, diarrhea, constipation, dizziness, problems urinating, weakness and erectile dysfunction, just to name a few. When chronic nerve pain is one of the symptoms, accompanying depression and weight loss may be seen.

The Types of Neuropathy:

Neuropathy is one of those disorders that have many different classifications and categories—and sometimes more than one term is appropriately used to describe a person’s condition.

Diabetic neuropathy can be classified as peripheral neuropathy, proximal neuropathy or amyotrophy, autonomic neuropathy, or focal neuropathy. Nerve damage that involves more than one nerve may be described as a polyneuropathy, while involvement of just one nerve is a mononeuropathy. Depending on the type of neuropathy and the site of damage, symptoms can be quite different.

Peripheral neuropathy is the most common diabetic neuropathy and it typically results in numbness, tingling or pain that begins in the feet and legs. This type of neuropathy preferentially affects the longest nerve cells of the body, thus it often starts in the feet, since those nerve fibers run from the spinal cord all the way down the legs to the feet. But peripheral neuropathy can also affect the hands and arms, in addition to the feet and legs, in a “stocking and glove” type pattern.

Autonomic neuropathy, on the other hand, may cause changes in bladder and bowel function, digestion, perspiration and sexual function. It can also have an impact on the nerves that control blood pressure, as well as the eyes and lungs. Autonomic neuropathy can also create a condition in which people are no longer aware of the warning symptoms that precede low blood glucose or blood sugar levels, called hypoglycemia unawareness. There are other important causes of hypoglycemia unawareness in diabetics, as well, though.

Proximal neuropathy leads to pain within the hips, thighs or buttocks, and can cause weakness throughout the legs. Focal neuropathy usually presents with sudden weakness within a specific nerve or group of nerves, causing pain or weakness.

If you have been diagnosed with diabetes, it is essential that you understand your risk for diabetic neuropathy and bring any warning signs and symptoms to your doctor’s attention as soon as you experience them. With tight glucose control going forward, you may be able to nip things in the bud. When the damage is already done, your doctor can help you manage your symptoms and prevent further damage from occurring.