What is diabetic nerve pain?

Diabetic nerve pain, also called diabetic neuropathy^[1], is a type of nerve damage that occurs in people with diabetes. This damage makes it hard for nerves to carry messages to the brain and other parts of the body. High blood sugar (glucose) levels can injure the nerves throughout your body. Having high blood sugar, or hyperglycemia, for extended periods of time increases your likelihood^[2] of getting nerve damage. The nerves in the feet are usually the first to be damaged by hyperglycemia. If you notice any pain or loss of feeling in a specific part of your body, your healthcare provider can conduct or order testing to help you determine the cause. Depending on what nerves are affected, diabetic nerve pain can also impact the function of your heart, blood vessels, digestive system, and urinary tract. Some people with diabetic nerve pain have mild symptoms, while for others, the condition can be disabling.Nerves^[3] send signals to and from the brain about sensations like pain, temperature, and touch. They also tell your muscles when and how to move and control the systems that digest food and pass urine. Nerve problems can begin within the first ten years after being diagnosed with diabetes. However, the longer you have diabetes, the greater your risk of developing neuropathy becomes. According to an estimate^[4] from the CDC, 30.3 million people (9.4% of the U.S. population) have diabetes. Roughly 50% of all patients with diabetes will experience some form of nerve damage. Diabetic nerve pain is a common but serious complication of diabetes. It’s often possible to prevent diabetic nerve pain or slow its progression by keeping your blood sugar under control, eating a healthy diet, and getting plenty of exercise.

Diabetic nerve pain causes

Research indicates that high blood sugar levels^[5] damage nerves over time^[6] by interfering with their ability to send signals. Having hyperglycemia also weakens the walls of the small blood vessels (capillaries) that supply the nerves with oxygen and nutrients. This damage is what leads to diabetic nerve pain. Other factors that can lead to diabetic nerve pain include an autoimmune response to the nerves, genetic factors, smoking, and excess alcohol consumption. Anyone with diabetes can develop nerve pain, particularly if they have had diabetes for a long time. Other factors that increase the likelihood of developing nerve damage include:

• Poor blood sugar control, which increases the risk of all diabetes-related complications, including nerve damage.
• Kidney disease, which can cause toxins to be released into the blood, leading to nerve damage.
• Being overweight. Your risk of getting diabetic nerve pain is higher if you have a body mass index (BMI) greater than 24.
• Smoking, which reduces blood flow to the extremities (limbs, hands, and feet) by narrowing and hardening the arteries. When blood flow is decreased, wounds take a longer time to heal, increasing the likelihood of your peripheral nerves being damaged.

Complications from diabetic nerve pain

Diabetic nerve pain can lead to a number of health complications, depending on which nerves are affected. These include:

• Infection: Having diabetic nerve pain in your feet puts you at a greater risk of developing infections in sores or cuts. In severe cases, infections can spread to the bones and lead to tissue death (gangrene), which can potentially require amputation.
• Joint damage: Nerve damage can cause the joints to deteriorate—especially the small joints in the feet. The symptoms of joint damage include loss of sensation, joint swelling, instability, and, in some cases, joint deformity. Prompt treatment is necessary to help you heal and prevent further joint damage from occurring.
• Urinary tract infections: When the nerves that control your bladder are damaged, you may not be able to fully empty your bladder or control your urination. This can cause bacteria to build up in the bladder and kidneys, potentially leading to urinary tract infections.
• Undetected hypoglycemia: If you have autonomic neuropathy, you may not notice the warning signs of low blood sugar, which include shakiness, sweating, and a fast heartbeat.
• Hypotension: It’s harder for your body to regular your blood pressure when the nerves that control blood flow are damaged. This can lead to hypotension, or low blood pressure. One common symptom of hypotension is feeling dizzy when you stand after sitting.
• Digestive problems: Nerve damage in your digestive tract can lead to constipation, diarrhea, and other digestive complications.
• Sexual dysfunction: Nerve damage to in the sex organs can lead to decreased self-lubrication in women and erectile dysfunction in men.
• Irregular sweating: Nerve damage can disrupt how your sweat glands function. You might sweat too much or too little, making it harder for your body to properly regulate its temperature.

Diabetic nerve pain symptoms

The symptoms of diabetic nerve pain develop gradually. You may not notice anything is wrong until considerable nerve damage has already occurred. The symptoms you experience will depend on which nerves are affected. There are four types of diabetic neuropathy: peripheral, autonomic, radiculoplexus, and focal neuropathy. Peripheral neuropathy is the most common form of diabetic neuropathy. This form of the condition first affects the feet and legs, followed by the hands and arms. The signs of peripheral neuropathy are often worse at night, and may include:

• Numbness or a reduced ability to feel pain or temperature changes
• Tingling or burning sensations
• Sharp pains or cramps
• Increased sensitivity to touch
• Weak muscles
• Loss of balance, coordination, or reflexes
• Foot problems such as ulcers, infections, and bone and joint pain

Autonomic neuropathy affects the nerves in the autonomic nervous system, which controls your eyes, heart, stomach, intestines, bladder, and sex organs. Signs of autonomic neuropathy include:

• Changes how your eyes adjust from light to dark
• Quickened heart rate at rest
• Sharp drops in blood pressure after sitting or standing that makes you feel lightheaded
• Slow stomach emptying causing nausea, bloating, or loss of appetite
• Constipation or diarrhea
• Difficulty swallowing
• Not knowing that blood sugar levels are low (undetected hypoglycemia)
• Bladder problems, including incontinence or urinary tract infections
• Irregular sweating and problems controlling body temperature
• Erectile dysfunction
• Vaginal dryness
• Decreased sexual response

Radiculoplexus neuropathy, also known as diabetic amyotrophy or femoral neuropathy, affects the nerves in the thighs, hips, buttocks, or legs. It's more common in older adults and people with type 2 diabetes. The symptoms of radiculoplexus neuropathy usually occur on one side of the body and may include:

• Pain in your hip, thigh, or buttocks that occurs for one or more days
• Difficulty rising from a sitting position
• Abdominal swelling, if the abdomen is affected
• Weight loss
• Eventually, weak and shrinking thigh muscles

Most people with this condition improve at least partially over time, though symptoms may worsen before they get better. Focal neuropathy, or mononeuropathy, is damage that occurs to a single nerve, usually in the refers to face, torso, or leg. The symptoms of mononeuropathy usually go away without treatment within a few weeks or months. Your specific signs and symptoms will depend on which nerve is damaged. You may experience pain in the:

• Shin or foot
• Lower back or pelvis
• Front of the thigh
• Chest or abdomen

Mononeuropathy in the eyes and face could lead to:

• Difficulty focusing
• Double vision
• Aching behind one eye
• Paralysis on one side of the face

Sometimes, mononeuropathy occurs when too much pressure is applied to a nerve by surrounding tissues. Carpal tunnel syndrome is one such type of compression neuropathy. It can make your hands feel weak, and you may struggle to hold on to objects. You should contact your healthcare provider if you notice one or more of these symptoms. While the symptoms don’t necessarily indicate nerve damage, they can be signs of another condition that requires medical care. Diagnosing and treating health conditions like diabetic neuropathy early on gives you the best chance of controlling your diabetes and preventing future health problems.