Diabetic Neuropathy: Causes, Types, Symptoms, Diagnosis, Treatment and Complications

It refers to the damage that affects the body’s nerves in people who have diabetes.

It is a progressive disease, and symptoms get worse over several years.

People who do not control their blood sugar levels and those with high blood pressure, high cholesterol, or overweight are more susceptible.

Neuropathy can affect any nerve in the body, especially the nerves located in the ganglia, the outside of the skull, and the spinal cord.

This disease also affects the functioning of the main organs, such as the heart, bladder, intestines, and stomach.

Problems can occur in the nerves that control the periphery or outside the body, such as the feet and hands, control the body’s automatic functions, such as heart rate and digestion, or just one or a small group of nerves.

It is important to note that different nerves are affected in different ways.


About 60 to 70 percent of people with diabetes develop diabetic neuropathy, but symptoms can take 10 to 20 years. The highest rates of neuropathy are found in patients who have been diagnosed with diabetes for 25 years or more.

What Causes Diabetic Neuropathy?

Sustained high blood sugar levels cause diabetic neuropathy over a long period. Other factors can cause nerve damage, such as:

  • Damage to blood vessels as a result of high cholesterol levels.
  • Mechanical injuries, such as those that are caused by carpal tunnel syndrome.
  • Lifestyle factors, such as smoking or consuming alcohol.

Low levels of vitamin B-12 can also lead to neuropathy. Thus, metformin (Glucophage), a common drug used to control the symptoms of diabetes, can cause lower levels of vitamin B-12.

Talk to your doctor if you are concerned about vitamin deficiencies. A simple blood test can identify any vitamin deficiencies that are present.


There are four main types of neuropathy, and they are:

  • Peripheral neuropathy, which affects the feet and hands, is the most common form of diabetic neuropathy.
  • Autonomic neuropathy affects the nerves that control involuntary body functions, such as digestion
  • Proximal neuropathy, which affects the legs
  • Focal neuropathy, in which damage can occur to any nerve or group of nerves.

The symptoms of neuropathy depend on the affected nerves. A variety of problems are associated with diabetic neuropathy.

These include cardiovascular problems, intestinal problems like constant diarrhea, nausea and vomiting, weakness, muscle pain, and paralysis.

Symptoms of diabetic neuropathy

The signs and symptoms of diabetic neuropathy depend, as already mentioned above, on which nerves are affected and generally take several years to appear.

Signs and symptoms of peripheral neuropathy include:

  • Numbness, pain, tingling, and (or) burning sensations that begin in the extremities and continue up the legs or arms.
  • Not being able to feel hot, cold, or any injury.
  • Loss of balance
  • Charcot’s joint, in which joint breaks due to a problem with the nerves. This often affects the feet.

Signs and symptoms of autonomic neuropathy include:

  • Heartburn and bloating.
  • Nausea, constipation, diarrhea.
  • Not feeling low blood sugar levels (ignorance of hypoglycemia).
  • Significant difficulty speaking or swallowing.
  • Feeling full when eating small amounts of food.
  • Vomiting frequently a few hours after eating.
  • Orthostatic hypotension, or feeling dizzy and dizzy when standing up.
  • Faster than average heart rate.
  • Excessive sweating, even when the temperature is appropriate, or the individual is at rest.
  • Bladder problems include difficulty emptying the bladder when urinating, leading to incontinence.
  • Sexual dysfunction in men.
  • Sexual issues in women with vaginal dryness and inability to experience orgasm.
  • Dysesthesia is when the patient’s sense of touch is distorted.
  • Significant drooping of the face and eyelids.
  • Muscle contractions and weakness.

Proximal neuropathy can cause pain in the lower body, often on one side, and weakness in the legs.

Symptoms of focal neuropathy vary widely, depending on the nerve affected.

It is fully expected that people with diabetic neuropathy usually do not realize that they are affected until the symptoms are more advanced and then consult a specialist.


A doctor will perform a physical exam and complete a foot exam to check:

  • Ankle reflexes.
  • Loss of sensation.
  • Changes in the texture of the skin.
  • Changes in skin color

Other tests may include an ultrasound of the affected organs or monitoring of blood pressure or heart rate variability.

If the doctor suspects diabetic neuropathy, the patient may undergo some diagnostic tests, such as an electromyogram (EMG), which records electrical activity in the muscles.

Another option is a nerve conduction velocity (NCV) test, which records the speed at which induced signals pass through the nerves.

Treatment of diabetic neuropathy

Diabetic neuropathy always gets worse over time. The first step in treating neuropathy is controlling blood sugar levels and maintaining high blood pressure and cholesterol levels.

If diabetes is well controlled and glucose levels stay within a healthy range throughout the day, the risks of diabetic neuropathy can be minimized.

An essential part of treatment focuses on reducing pain and controlling some symptoms.

Some medications, physical therapy, and other treatments can help control pain caused by diabetic neuropathy.


Classes of medications that can help control pain usually include opioids and opioid-like drugs; anticonvulsants and tricyclic antidepressants are also widely used.

Other types of antidepressants, such as serotonin-norepinephrine inhibitors, are commonly used to attack the painful symptoms of diabetic neuropathy and can help patients with depression.

physical therapy

Physical therapy, used in combination with medications, can help relieve pain and reduce the risk of drug dependence.

Some physical therapies can commonly soothe pain, burning, and tingling in the legs and feet.

Physical therapy can help patients with muscle cramps, muscle weakness, and sexual dysfunction.

Electrical nerve stimulation is painless and can help relieve the feeling of stiffness and improve the healing of foot ulcers.

When it comes to gait training, it means relearning how to walk. Helps prevent and stabilize foot complications such as ulcers.

This type of training is crucial for prosthesis people because they have lost limbs due to diabetic neuropathy.

A good physical therapist will make sure that exercises for diabetic neuropathy patients do not harm their feet, which are usually sensitive.

Other therapies include devices that can keep painful limbs from touching the bed or chair. Topical lotions and some supplements can also provide relief.

A chiropractor, massage therapist, or osteopath can perform regular massages or manual therapy to stretch the muscles. Massage can inhibit muscle contractures, spasms, and atrophy due to poor blood supply.

Specific exercises such as swimming or aerobics can build and maintain muscle strength and reduce muscle wasting.

Therapeutic ultrasound uses high-frequency sound waves to stimulate the tissue below the skin’s surface. This can help some patients regain feeling in their feet.


There are several complications related to diabetic neuropathy, and patients should be aware of the risks of developing them.

Possible complications include:

  • A lack of sensation in the feet and the consequent risk of not feeling cuts or sores can become infected, leading to amputation.
  • Bladder and kidney infections.
  • Muscle damage or loss of muscle mass.
  • Frequent nausea and vomiting will reduce blood sugar control.

Good foot care is needed to prevent complications from diabetic peripheral neuropathy. People with this condition should inspect their feet every day for injuries or sores.

Smoking increases the risk of foot problems. A pediatrician can help with foot care, and a healthcare provider can advise you to quit smoking.