What Is Diabetic Neuropathy?

Diabetic neuropathy, a common complication of diabetes, is damage to the nerves that allow you to feel things such as pain. There are several ways that diabetes damages the nerves, but they all seem related to blood sugar being too high for a long period of time.

Diabetes-related nerve damage can be painful, but it isn’t severe pain in most cases.

There are four types of diabetic neuropathy: peripheral, autonomic, proximal, and focal.


  1. What is the difference between peripheral Neuropathy and Autonomic Neuropathy?

Neuropathy is a disorder of the human nervous system. The Central nervous system consists of the sensory nervous system and the autonomic nervous system. The sensory nervous system is responsible for sensing and managing the external environment of the body like the feet, the hands. The autonomic nervous system (a part of the body that is little understood, even by medical practitioners) is responsible for functioning of the internal environment of the body like the heart, the kidneys, the lungs. The autonomic nervous system functions voluntarily. It cannot be controlled by us it does its work silently and in the background.

Complications of diabetes lead to disorders of these systems. A disorder of the sensory nervous system leads to issues with limbs like the feet, the hands. This is called peripheral neuropathy.

Disorders of the autonomic nervous system lead to issues with internal organs like the heart, the kidneys, the lungs. This is called autonomic neuropathy .Many Diabetes suffer from silent heart attacks when they sleep at night. Dysfunction of the autonomic nervous system is at bottom of this.

Autonomic neuropathy is by far, the most serious of the complications. Some Doctors say “With peripheral neuropathy, you can lose a limb, with autonomic neuropathy u can lose a LIFE”.

Clinical Signs Of Autonomic Dysfunction.


e.g. Decreased diameter of dark adapted pupil.


e.g.  unawareness and unresponsiveness  of low blood sugars


e.g.  Exercise intolerance, orthostatic hypotension.

(e.g. giddiness on getting up from supine to standing position )


e.g. Increased sweating


e.g. Constipation, Diarrhea.


e.g. Cystopathy, Erectile dysfunction.


The ANSiscope is currently the only device that makes it possible to screen and measure for autonomic neuropathy.

The results of autonomic function testing can contribute to good patient management in the following ways.

  • § To confirm diagnosis of diabetic autonomic neuropathy.

e.g. in case of patient presenting clinical signs which may be attributed to autonomic dysfunction.

  • § To assist in the establishment of tight Glycemic control Diabetes control and complications trail (DCCT) documented that intensive therapy can slow the progression and the development of abnormal autonomic function.
  • §  To facilitate the decision to start the treatment for cardiovascular autonomic dysfunction

e.g. use of beta blockers may modulate the effects of autonomic dysfunction.

  • § To accentuate the importance of adherence to diet, this helps to maintain tight Glycemic control and physical training which improves autonomic function.
  • § To observe deterioration extent of patient’s health.
  • § To adapt treatment according to the evolution of the measurements

e.g. studies using antioxidants have shown promising results

  • § To provide diabetic patients with a concrete measure of the effects of their efforts on their health.

Diabetic Proximal Neuropathy

Diabetic proximal neuropathy causes pain (usually on one side) in the thighs, hips, or buttocks. It can also lead to weakness in the legs. Treatment for weakness or pain is usually needed and may include medication and physical therapy. The recovery varies, depending on the type of nerve damage. Prevention consists of keeping blood sugar under tight control.

Diabetic Focal Neuropathy

Diabetic focal neuropathy can also appear suddenly and affect specific nerves, most often in the head, torso, or leg, causing muscle weakness or pain. Symptoms of diabetic focal neuropathy may include:

  • Double vision
  • Eye pain
  • Paralysis on one side of the face (Bell’s palsy)
  • Severe pain in a certain area, such as the lower back or leg(s)
  • Chest or abdominal pain that is sometimes mistaken for another condition such as heart attack or appendicitis

Diabetic focal neuropathy is painful and unpredictable; however, it tends to improve by itself over weeks or months and does not tend to cause long-term damage.

Other Nerve Damage Seen With Diabetes

People with diabetes can also develop other nerve-related conditions, such as nerve compressions (entrapment syndromes).

Carpal tunnel syndrome is a very common type of entrapment syndrome and causes numbness and tingling of the hand and sometimes muscle weakness or pain.

Prevention of Diabetic Neuropathy

Keeping tight control of your blood sugar levels will help prevent many of these diabetes-related nerve conditions. Talk to your doctor about optimizing your individual diabetes treatment plan.