Learn How to Recognize Painful Diabetic Neuropathy


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Living with diabetes isn’t easy, and the complications that can come with it can be overwhelming, scary and painful.

Even though diabetic peripheral neuropathy is considered the most common complication of diabetes—affecting approximately 30 percent of people with type 1 diabetes and 42 percent of people with type 2 diabetes—it can go easily unnoticed for years until it becomes painful diabetic neuropathy. And did you know there are actually several variations of diabetic neuropathy and non-diabetes types of neuropathy?

Here, we’ll take a look at the causes, symptoms and different types of neuropathy that exist.

What is Diabetic Neuropathy?

Quite simply, diabetic neuropathy (DN) is nerve damage caused by diabetes—but it’s a bit more complex than that. The most commonly diagnosed type of neuropathy a person with diabetes can develop is diabetic peripheral neuropathy (DPN), characterized by numbness and/or loss of sensation in the legs, feet and sometimes hands.

Unfortunately, left untreated DPN can lead to other serious conditions, like foot ulcers that struggle to heal, become infected and threaten the well-being of your foot and leg. This is why it’s incredibly important to recognize the symptoms of DPN and work with your healthcare team to manage it carefully.

In general, DN is caused by the combination of several factors:

  • Long-term high blood sugar levels
  • Long-term high triglycerides

Over time, any one of these factors can gradually damage nerves and blood vessels throughout your body—including your eyes, kidneys, heart, digestive system, hands, feet and legs.

Research has found that the following factors increase your risk of developing DN:

  • Being overweight or obese
  • High blood pressure
  • High cholesterol
  • Advanced kidney disease
  • High consumption of alcoholic drinks
  • Smoking
  • Number of years with diabetes
  • Certain genes

Working closely with your healthcare team to manage the most common causes of DN is important to prevent it and to stop or slow the progression if you’ve already developed it.

What are the symptoms of Diabetic Neuropathy?

Let’s take a look at the most common symptoms of the most common type of neuropathy people with diabetes can develop. Keep in mind that these symptoms generally begin after years of damage to the nerves and blood vessels in your toes, feet and legs. Neuropathy can develop many years before you notice some of these symptoms; keeping blood sugar levels in a consistently healthy range is the most effective way to avoid them.

Some or all of the following symptoms can develop in the toes, feet and legs:

  • Numbness, tingling
  • Loss of sensation
  • Increased sensitivity to certain things
  • Muscle weakness
  • Difficulty balancing and walking
  • Not able to feel hot or cold temperatures
  • Not able to feel pressure
  • Decreased mobility and flexibility in your joints
  • Decreased muscle and fat in your feet
  • Visible redness

For some, DN can progress to painful diabetic neuropathy (PDN) which means you may develop some of these symptoms, too:

  • Burning sensation
  • Sharp, shooting, stabbing pain
  • Electric-like shocks of pain
  • Pain when walking (like walking on eggshells)
  • Pain even with light touch (even the sheets on your bed)
  • Symptoms are often worst at the end of the day
  • Pain that keeps you awake at night

PDN affects nearly half of those with DN—but you do not have to suffer with the pain.

Left untreated, the pain of PDN can limit your ability to do basic tasks like run errands, exercise, or play with your children or grandchildren. Today, there are several new and better treatments to help you manage and reduce the daily pain of PDN.

Different types of neuropathy

There are several types of neuropathy that can affect a person with diabetes.

Diabetic peripheral neuropathy: As described earlier, DPN is the most common type of neuropathy. Within DPN is the subtype called “distal symmetric polyneuropathy” or DSP or DSPN. The “poly” in this condition implies that it affects many nerves versus just a single nerve. DSP is actually the most common type of DPN, and the one most people develop, but in conversation, it’s referred to under the umbrella of general DPN.

Autonomic neuropathy: This is the type of neuropathy that has affected your internal organs—including your heart, kidneys, digestive system, bladder, sex organs, eyes, sweat glands and your ability to feel the symptoms of low blood sugar. Subtypes of autonomic neuropathy include retinopathy (eyes), cardiovascular autonomic neuropathy (heart), nephropathy (kidneys), hypoglycemia unawareness and more. Caused by all of the same factors that can lead to DPN, you can significantly reduce your risk of developing this type of neuropathy by working with your healthcare team to improve your blood sugar levels and lifestyle habits and quit smoking.

Focal neuropathy: This type of neuropathy affects just a single nerve, usually in your hand, head, torso, or your leg. Carpal tunnel syndrome is the most well-known type of focal neuropathy. Numbness, tingling and decreased mobility are the most common symptoms. In your legs, it can also involve shooting pain and muscle weakness. It can also come on very suddenly, unlike other types of neuropathy that develop slowly over the course of years.

Proximal neuropathy: This is the second most common type of neuropathy and it affects muscles rather than nerves. It can severely affect your physical function and abilities, specifically in your hip and thigh area. Proximal neuropathy can also include nerve pain, including what’s commonly referred to as “sciatica”—shooting pains down your leg. It can lead to severe pain and usually only develops in one side of the body. Weight loss on that side of the body is also very common. It’s more common in older people with diabetes and the symptoms can lessen overtime and with treatment.

The bottom line

No one should have to suffer through complications from diabetes alone, and better treatments are becoming available every day. Talk to your healthcare team immediately if you believe you may be developing any type of neuropathy and discuss your treatment options.

WRITTEN BY Ginger Vieira, POSTED 11/05/21, UPDATED 10/12/22

Ginger Vieira is an author and writer living with type 1 diabetes, celiac disease, fibromyalgia and hypothyroidism. She’s authored a variety of books, including “When I Go Low” (for kids), “Pregnancy with Type 1 Diabetes,” and “Dealing with Diabetes Burnout.” Before joining Beyond Type 1 as digital content manager, Ginger wrote for Diabetes Mine, Healthline, T1D Exchange, Diabetes Strong and more! In her free time, she is jumping rope, scootering with her daughters, or walking with her handsome fella and their dog.