Medically Reviewed By: Tom Iarocci, MD
Diabetes is a very common disease nowadays, and that means that a related condition that produces symptoms such as numbness, tingling or burning pain is also quite common—diabetic neuropathy. Whether you or a loved one has had diabetes for two years or two decades, the risk for diabetic nerve damage is there. Here is a run-down of some of the different types of neuropathy that may emerge in people with diabetes, along with a few characteristic symptoms or patterns. One thing to know is that the absence of symptoms is not necessarily the absence of neuropathy.
Neuropathy, or nerve damage, is one of those things that can by typed and classified six ways to Sunday. Diabetic neuropathy just refers to any of the types of neuropathy that are particularly associated with or inextricably linked with having diabetes. Different neuropathies affect different nerves and may have different symptoms. Peripheral neuropathy, for example, can cause damage in the feet and legs and symptoms may include numbness or a lack of sensation that can lead to unrecognized injury, sores and infection. Numbness, tingling and sometimes burning pain may be worse at night. Diabetic foot care is a huge deal when you are confronted with this type of neuropathy, because typically there are a bunch of factors that make you more susceptible to serious foot infections that can spread. This type of neuropathy is often symmetrical, meaning both feet (or both hands) are affected.
“Autonomic” sounds like automatic, and that is a good clue to follow. The autonomic nervous system has nerves that take care of a lot of our automatic or non-thinking activities, such as digestion, sweating, urination, heart beat adjustments, and parts of sexual function. It makes sense, then, that when these nerves are impacted (autonomic neuropathy) it can affect your stomach and digestive system and can cause discomfort, urinary trouble, stomach pain, diarrhea or constipation, and many other things, depending on the organs impacted. The best preventive step is to control your blood sugar levels as much as possible—by eating smaller meals, taking your medication on time, and all of those other good steps you know about to keep your diabetes in control. Depending on how autonomic neuropathy emerges in your particular case, there may be different therapies or remedies offered, tailored to what you are experiencing. Some of these treatments involve an entire strategy that your doctor would go over with you, but an example is the use of special compression stockings that help if you are having instability with your blood pressure when you get up. Known officially as “orthostatic intolerance” feeling dizzy when you get up too quickly is quite common, and the stockings help with this.
This kind of neuropathy, also known as diabetic amyotrophy, is linked to diabetes, but it is not as common as peripheral neuropathy, so it is number two here. This causes pain in the legs and hips, and usually only affects one side of the body, though it can spread. It is more common in elderly people with diabetes. And, unlike peripheral neuropathy, it usually goes away with time or treatment.
The focal in focal neuropathy refers to the fact that one nerve, in particular is affected. This type of neuropathy is also called mononeuropathy. This is in contrast to peripheral, autonomic and proximal neuropathies, which affect multiple nerves. Focal neuropathy is known to come on suddenly, and the areas typically affected are in the head, leg or torso.
Symptoms such as severe pain in the leg or lower back are possible. When nerves that serve structures in the head are involved, you might get other symptoms such as pain in the eye, double vision, or one side of face becoming paralyzed. The facial paralysis is known as Bell’s palsy, and it can happen in people who are not diabetic, but diabetes is a big risk factor.
When focal neuropathy affects the chest, stomach, or abdomen with pain, this can be a diagnostic problem for doctors in that symptoms may overlap with potentially life-threatening conditions such as heart attack or appendicitis.
Like other forms of diabetic neuropathy, achieving and maintaining good blood sugar control is the key to prevention and to limiting future nerve damage.