The Four Types of Diabetic Neuropathy


Beth W. Orenstein

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One of the most serious complications of diabetes is nerve damage, known as diabetic neuropathy. Diabetes can damage a single nerve or an entire network of nerves, which will affect you in different ways. For example, you might lose feeling in one foot or you could have trouble digesting food.

More than 60% of people with diabetes will develop diabetic neuropathy at some point. The longer you have diabetes, the more likely you are to develop nerve damage. The key to preventing diabetic nerve damage is blood sugar control. The better you control blood sugar levels and maintain your health in general, the better you can protect yourself.

Nerve damage from diabetes can occur just about anywhere in your body. There are four different types of neuropathy, named for where and how they occur. Being aware of the symptoms of each type can help you know when it’s time to see your doctor.

Peripheral Neuropathy

Peripheral neuropathy is the most common type of diabetic neuropathy. It affects your peripheral — or outer — body parts, including your feet, legs, hands, and arms. The most common symptoms are numbness, pain or tingling in your lower extremities. But peripheral neuropathy can also occur in your upper extremities.

When peripheral neuropathy affects your legs and feet, you might feel less coordinated, be unable to balance yourself, or have a hard time walking. This can lead to foot, ankle, or other injuries. Neuropathy in your feet is especially dangerous if you don't notice a blister or other injury to your foot because you have lost feeling.

That's why it's important to check your feet daily for cuts or sores when you have peripheral neuropathy. Nerve damage and poor circulation to your feet can delay healing and lead to dangerous infection. Left untreated, an infection can spread and cause you to lose a foot or part of your leg.

Autonomic Neuropathy

Autonomic neuropathy is nerve damage that affects some of your body's organ systems. These include your heart and blood vessels, digestive system, urinary tract, sexual organs, sweat gland, and eyes. Here are some symptoms of nerve damage to key parts of your nervous system: 

  • Cardiovascular system: feeling dizzy, lightheaded or faint when you stand up or sit down

  • Digestive system: difficulty swallowing, nausea, vomiting, bloating, constipation, and episodes of severe diarrhea

  • Sexual organs: low sex drive, trouble getting aroused if you’re a woman, or trouble getting erections if you’re a man

  • Sweat glands and nerves that regulate body temperature: sweating more than normal, especially when sleeping or eating

  • Urinary tract: difficulty controlling urination or feeling the urge to go

  • Eyes and the nerves of your pupils: difficulty reading, trouble seeing in the dark, and difficulty with night driving

What’s more, autonomic neuropathy may affect your ability to notice the warning signs of low blood sugar (hypoglycemia). If this happens to you, testing becomes even more vital to keep your blood sugar levels in check. 

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Proximal Neuropathy

Think of proximal neuropathy as one step closer to your trunk than peripheral — you'll feel its painful effects in your thighs, hips and butt. As a result, you will feel a loss of strength in your legs. This makes it hard for you to get up without support when you've been sitting. With proximal neuropathy, you may feel it on only one side at first, and you may need medication to help you manage it.

Focal Neuropathy

As its name suggests, focal neuropathy focuses on one area. Focal neuropathy commonly affects the stomach, eyes, facial muscles, ears, pelvis and lower back, chest, thighs, legs, or feet. It typically comes on suddenly and unpredictably and may go away on its own without causing any lasting effects.

In particular, focal neuropathy can cause vision problems, double vision, pain behind your eyes, and a type of facial paralysis called Bell’s palsy. You also might feel pain when nerves on the outside of your shin, the inside of your foot, or in your hands or wrist get compressed, a condition called entrapment. This commonly affects the hands as carpal tunnel syndrome.

Key Takeaways

  • Diabetic neuropathy is damage to nerves in your body caused by diabetes.

  • Diabetic neuropathy is highly preventable, by controlling your blood sugar levels.

  • There are four types of neuropathies, defined by where and how they occur: peripheral, autonomic, proximal, and focal.

  • You can work with your doctor to manage this diabetes complication and prevent more serious health issues.
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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Aug 14, 2017

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Medical References

  1. Diabetic Neuropathies: The Nerve Damage of Diabetes. National Institutes of Health. National Institute of Diabetes and Digestive and Kidney Diseases.
  2. Neuropathy (Nerve Damage). American Diabetes Association.
  3. Nerves (Neuropathy). Diabetes UK.
  4. Neuropathy (Nerve Damage). American Diabetes Association.
  5. Berger, S, et al. Diabetic and Drug/Cancer-Induced Neuropthy. Diabetic Neuropathy.

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