Diabetic neuropathy

Diabetic neuropathy is nerve damage caused by prolonged high blood glucose. High sugar levels impair nerves' ability to transmit signals and damage the small blood vessels that supply oxygen and nutrients to the nerves. About 50% of people with diabetes develop some form of neuropathy; risk increases the longer diabetes is present.

**There are four main types:**

**1. Peripheral neuropathy** (most common) — affects the feet and legs first, then the arms and hands. Symptoms worsen at night and include: numbness or reduced pain/temperature sensation, tingling, burning, sharp pains or cramps, extreme touch sensitivity, and foot ulcers or infections.

**2. Autonomic neuropathy** — affects nerves controlling internal organs (heart, bladder, digestive system, sexual organs). Can cause: bladder dysfunction, gastroparesis (slow stomach emptying), digestive problems, sexual dysfunction, blood pressure drops on standing, and impaired hypoglycemia awareness.

**3. Proximal neuropathy (diabetic amyotrophy)** — relatively rare (~1% of type 2 diabetes), affects older adults. Causes severe one-sided pain in the upper thigh, hip, or buttock, with thigh muscle weakness and sometimes significant weight loss.

**4. Focal neuropathy (mononeuropathy)** — affects a single nerve, causing double vision, eye pain, facial paralysis (Bell's palsy), chest pain mimicking heart attack, or hand weakness.

**Complications** of diabetic neuropathy include: foot ulcers and amputation risk, urinary tract infections and incontinence, sudden blood pressure drops, digestive problems, and sexual dysfunction.