Symptoms depend on the type of neuropathy and which nerves are affected and can range from mild to painful and disabling.
As symptoms usually develop gradually, considerable nerve damage may have occurred before diabetic neuropathy is detected.
There are four main types of diabetic neuropathy, and it is possible to have more than one type at the same time.
Depending on the affected nerves, diabetic neuropathy symptoms can range from pain and numbness in your legs and feet to problems with your digestive system, urinary tract, blood vessels and heart.
Peripheral neuropathy is the most common type. It affects the feet and legs first, followed by the hands and arms. Signs and symptoms of peripheral neuropathy are often worse at night, and may include:
- Numbness or reduced ability to feel pain or temperature changes
- Tingling or burning sensation
- Sharp pains or cramps
- Increased sensitivity to touch — for some people, even a bedsheet’s weight can be painful
- Serious foot problems, such as ulcers, infections, and bone and joint pain
Autonomic neuropathy affects the autonomic nervous system which controls your heart, bladder, stomach, intestines, sex organs and eyes. Diabetes can affect nerves in any of these areas, possibly causing:
- A lack of awareness that blood sugar levels are low (hypoglycaemia unawareness)
- Bladder or bowel problems
- Slow stomach emptying (gastroparesis), causing nausea, vomiting and loss of appetite
- Changes in the way your eyes adjust from light to dark
- Decreased sexual response
Proximal neuropathy often affects nerves in the thighs, hips, buttocks or legs. It can also affect the abdominal and chest area. Symptoms, which usually affect one side of the body but may spread to the other side, include:
- Severe pain in a hip and thigh or buttock
- Weakening and shrinking of thigh muscles
- Difficulty rising from a sitting position
- Severe stomach pain
Mononeuropathy (focal neuropathy) refers to damage to a specific nerve. There are two types of mononeuropathy — cranial and peripheral. Depending on the nerve affected, symptoms may include:
- Double vision or difficulty focusing
- Aching behind one eye
- Paralysis on one side of your face (Bell’s palsy)
- Numbness or tingling in your hand or fingers, except the smallest finger
- Weakness in your hand that may cause you to drop things
See a doctor if you have:
- A cut or sore on your foot that is infected or will not heal
- Burning, tingling, weakness or pain in your hands or feet that interferes with daily activities or sleep
- Changes in digestion, urination or sexual function
- Dizziness and fainting.