Diabetes and Nerve Damage: Types, Symptoms and Prevention

Over time, high blood sugar can damage nerves, a condition called diabetic neuropathy. It can affect the hands, feet, arms and legs, and some types reach the internal organs. Keeping blood sugar under close control can prevent it or delay it.

Who is at risk

Anyone with diabetes can develop nerve damage. The risk is higher for people who:

• have high blood sugar levels
• have had diabetes for many years
• have overweight or obesity
• are older than 40
• have high blood pressure or high cholesterol

The four main types

Diabetic nerve damage comes in four main types: peripheral, autonomic, proximal and focal. A person can have more than one, and the symptoms depend on the type and on which nerves are affected.

Peripheral

This is the most common type in people with diabetes. It can affect the feet, legs, hands and arms, but it usually begins in the feet. Symptoms can include:

• tingling, or a "pins and needles" feeling
• pain or heightened sensitivity, especially at night
• numbness or weakness
• serious foot problems such as ulcers, infections, and bone and joint pain

Numbness is dangerous because cuts, blisters and sores can go unnoticed and become infected, leading to serious foot problems. Sometimes amputation (surgical removal) becomes necessary, but checking and caring for the feet can prevent it in some cases.

Autonomic

Autonomic nerve damage affects the heart, bladder, stomach, intestines, sex organs or eyes. Signs can include:

• bladder or bowel problems, with urine leakage, constipation or diarrhea
• nausea, vomiting and loss of appetite
• changes in how the eyes adjust between light and dark
• sexual dysfunction, including trouble getting an erection or vaginal dryness

Proximal

Proximal nerve damage affects the nerves of the thighs, hips, buttocks or legs, and can also reach the stomach and chest. It can cause:

• severe pain in a hip, thigh or buttock
• difficulty standing up from a seated position
• severe stomach pain

Focal

Focal nerve damage involves a single nerve, most often in the head, the torso, or a hand or leg. It can cause:

• trouble focusing the eyes, double vision, or aching behind one eye
• inability to move one side of the face (Bell's palsy)
• numbness or tingling in the hands or fingers
• weakness in a hand that makes it hard to hold on to things

When to call a doctor

Get in touch with a doctor about:

• a cut or sore on the foot that is infected or will not heal
• burning, tingling, weakness or pain in the hands or feet that gets in the way of daily life or sleep
• changes in digestion, urination or sexual function
• dizziness or fainting

Preventing complications

Most people with diabetes can prevent or delay serious complications of nerve damage by managing their blood sugar closely and by:

• caring for their feet at home
• keeping their medical appointments
• having regular foot and eye exams

Sources

• Centers for Disease Control and Prevention, "Nerve Damage" (Diabetes and Nerve Damage). https://www.cdc.gov/diabetes/diabetes-complications/diabetes-and-nerve-damage.html
• CDC, "Preventing Diabetes-Related Amputations": https://www.cdc.gov/diabetes/diabetes-complications/preventing-diabetes-related-amputations.html