This is a type of nerve damage which can happen if you suffer from diabetes. The high blood sugar (called glucose) can injure nerves throughout the body. This condition mostly affects nerves in your feet and legs. The symptoms of this condition depend on the affected nerves, but they can range from pain and numbness in the legs and feet to problems with heart, blood vessels, urinary tract and digestive system. Some people can have mild symptoms of diabetic neuropathy. For other people, the diabetic neuropathy can be disabling and painful . The diabetic neuropathy is a serious and common complication of diabetes. You can make a healthy lifestyle changes and tight blood sugar control because this can prevent the diabetic neuropathy or slow its progress.
Symptoms of diabetic neuropathy
There are 4 main types of this condition and you can have one or more than one type of neuropathy. The symptoms which you have will depend on the type that you have and which nerves are affected. Usually, the symptoms of diabetic neuropathy develop gradually. There are many people may not notice anything that could be wrong with their bodies until considerable nerve damage has happened.
Peripheral neuropathy: This is the most common type of diabetic neuropathy. It is affecting the legs and feet first, followed by arms and hands. The signs and symptoms of this type of neuropathy often worsen at night and the can include:
- Serious foot problems, such as ulcers, infections, bone and joint pain 
- Loss of balance and coordination
- Loss of reflexes, especially in the ankle
- Muscle weakness
- Increased sensitivity to touch – for some people, event the weight of a bed sheet can be painful
- Sharp pains or cramps
- Tingling or burning sensation
- Reduced ability to feel pain or temperature changes or numbnes
Autonomic neuropathy: We know that the autonomic nervous system is controlling the eyes, sex organs, intestines, stomach, bladder and heart. Diabetes can affect nerves in some of the mentioned areas and it can cause [3,4]:
- Decreased sexual response
- Vaginal dryness
- Erectile dysfunction
- You can have pointed drops in your blood pressure after standing or sitting that may cause you to faint or feel lightheaded
- Increased heart rate at rest
- Changes in the way your eyes adjust from light to dark
- Problems controlling body temperature
- Increased or decreased sweating
- Difficulty swallowing
- Slow stomach emptying (gastroparesis), causing loss of appetite, bloating, vomiting and nausea
- Constipation, uncontrolled diarrhea or both
- Bladder problems, including urinary tract infections or urinary retention or incontinence
- A lack of awareness that blood sugar levels are low (hypoglycemia unawareness)
Radiculoplexus neuropathy (diabetic amyotrophy): This condition is affecting the nerves in legs, buttocks, hips and thighs. This is a more common condition in older adults and people who suffer from type II diabetes. This condition is also known by other names, such as proximal neuropathy, femoral neuropathy and diabetic amyotrophy . The symptoms of this condition usually happen on one side of the body, but in some cases they can spread to other side, such as
- You can have weight loss
- You may have abdominal swelling, if the abdomen is affected
- You can have a difficulty raising from a sitting position
- Also you can have weak and shrinking thigh muscles
- You may have a severe pain in the hip or buttock which happens in a day or more
There are many people who improve at least partially over time but their symptoms can worsen before they get better.
Mononeuropathy: It is also known as focal neuropathy. This is damage to a specific nerve in the face, middle of the body or leg. This is the most common condition in older adults. This condition strikes suddenly and it can cause severe pain. Usually, it does not cause any long – term problems. The symptoms of this condition go away without treatment over a few weeks or months. The specific signs and symptoms depend on which nerve is involved. You can have pain in the:
- Chest or abdomen
- Front or thigh
- Lower back or pelvis
- Shin or foot
Causes of diabetic neuropathy
The exact cause for each type of diabetic neuropathy is different. Doctors are saying that a combination of factors can lead to nerve damage, such as
- Smoking and alcohol abuse
- Genetic factors
- Inflammation in the nerves
 Gillespie EA, Gillespie BW, Stevens MJ. Painful diabetic neuropathy: Impact of an alternative approach. Diabetes Care. 2007;30(4):999-1001.
 Kiziltan ME, Gunduz A, Kiziltan G, et al. Peripheral neuropathy in patients with diabetic foot ulcers: Clinical and nerve conduction study. Journal of the Neurological Sciences. 2007;258(1-2):75-9.
 Matta M, Pavy-Le Traon A, Perez-Lloret S, et al. Predictors of cardiovascular autonomic neuropathy onset and progression in a cohort of Type 1 diabetic patients. Journal of Diabetes Research. 2018.
 Verrotti A, Prezioso G, Scattoni R, Chiarelli F. Autonomic neuropathy in diabetes mellitus. Frontiers in Endocrinology. 2014;5:205.
 Laughlin RS, Dyck JB. Chapter 4 – Diabetic radiculoplexus neuropathies. In Handbook of Clinical Neurology. 2014;126:45-52.