Diabetic Neuropathy Stages, Types, & Symptoms

Learn more about living with diabetic neuropathy.
Diabetic neuropathy types, symptoms, stages

Diabetic neuropathy is a condition in which nerves in the arms, hands, legs, feet, and other regions of the body are damaged by chronic, uncontrolled diabetes. Healthy nerves serve several important functions throughout the body, providing signaling to and from the brain that enables our five senses, allows us to control the movement of our muscles, and also manages automated bodily functions that we often take for granted, like respiration, digestion, and sweating.

Because our nerves are many and varied, nerve damage from diabetic neuropathy can lead to several distinct symptoms and affect various parts of the body (type of diabetic neuropathy). While numbness and pain in the extremities, especially in the feet, are among the most common diabetic neuropathy symptoms, several other symptoms can occur.

To help you better understand diabetic neuropathy, specialist Dr. Michael Lalezarian and the diabetic neuropathy team at ProVascularMD explain the common types of diabetic neuropathy, the many different diabetic neuropathy symptoms and why they occur, and the stages of diabetic neuropathy.

If you’re ready to see a specialist, we are accepting new diabetic neuropathy patients at ProVascularMD in the greater Los Angeles area.

Diabetic neuropathy specialist Dr. Michael Lalezarian in Los Angeles, California

Diabetic Neuropathy Specialist

Dr. Michael Lalezarian

Painful diabetic neuropathy? We can help you find relief. Dr. Michael Lalezarian is a double-board certified Vascular Interventional Radiologist specializing in neuromodulation therapy for painful diabetic neuropathy, including spinal cord stimulation. He is a committed partner in the battle against the devastating consequences of diabetes.
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“I was referred to Dr. Lalezarian from my orthopedic surgeon for varicose vein treatment options. From the second I walked into the office, I was at ease and felt very welcomed from Kimberly and the staff. Upon meeting the doctor, he was so kind and fully explained my options after the initial ultrasound on both legs. I decided to go with the sclerotherapy and am so happy that I did. The procedures were quick and virtually painless but the results are life changing for me. The pain suffered for so many years and countless sleepless nights are a thing of the past.”

Vickie W, March 2022

Types of Diabetic Neuropathy

Diabetic neuropathy may be labeled depending on the symptoms present, or by which nerves are affected. For example, if diabetic neuropathy symptoms are only present in the far extremities, such as the feet, you may be told that you have peripheral neuropathy. We provide a brief overview of the different types of diabetic neuropathy below. Patients should note that these types are not mutually exclusive, and it’s possible to have multiple types of diabetic neuropathy at the same time.

Diabetic Focal Neuropathy

Diabetic focal neuropathy, also called diabetic mononeuropathy, occurs when a single nerve or a single group of nerves is affected, and symptoms are isolated to a single area somewhere in the body. If a nerve in the chest (a thoracic nerve) is affected, for example, you may experience numbness and pain in the chest that can feel similar to appendicitis, angina, or a heart attack. Focal neuropathy can affect any nerve in the body, and can also cause muscle weakness if the affected nerve is associated with motor function.

Diabetic Polyneuropathy

Diabetic polyneuropathy (DPN) describes when diabetic neuropathy affects multiple peripheral nerves. The peripheral nerves branch from the spinal cord into the arms, hands, legs, and feet, and are responsible for both sensation and muscle movement, among other more subtle functions. Individuals with diabetic polyneuropathy experience symptoms in multiple extremities simultaneously. The longest nerves are typically affected the most, which is why symptoms usually start in the feet.

Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy is another common term that describes when the extremities are affected by diabetic neuropathy, affecting the toes, feet, legs, hands, and arms.

Diabetic Proximal Neuropathy

In medicine, proximal means nearer to the center, usually referring to the trunk of the body or the heart. Accordingly, diabetic proximal neuropathy describes symptoms in the thighs, hips, or buttocks rather than the feet or lower legs. Proximal neuropathy typically affects the nerves’ motor functions, leading to weakness in the legs.

Diabetic Autonomic Neuropathy

Diabetic autonomic neuropathy describes when diabetic neuropathy damages autonomic nerves. Autonomic nerves are responsible for automated functions throughout the body. Heart rate, breathing, digestion, sweating, and several other bodily functions are regulated by autonomic nerve signaling. Damage to autonomic nerves can cause adverse changes in digestion, bowel and bladder function, and sweating. Heart rate and blood pressure can also be affected, as well as nerves in the lungs and the eyes.
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Diabetic Neuropathy Symptoms

Nerves serve many critical roles in our bodies, from basic sensation to muscle control and autonomic functions. It follows that nerve damage can produce many different symptoms, especially as diabetic neuropathy progresses. To ease understanding, we find it helpful to categorize diabetic neuropathy symptoms by which types of nerves are affected.

Sensory Neuropathy Symptoms

The most common diabetic neuropathy symptoms include numbness or tingling in the toes or feet, prickly or sharp pain, burning, pinching, pins and needles, or an exaggerated sensitivity to touch. Over time, the hands may be affected, as well as the legs and the arms. Some individuals with sensory nerve damage are also unable to feel pain, temperature changes, or changes in pressure, or these sensations are dulled due to nerve damage.

If your diabetic neuropathy is affecting your sensory nerves, you may experience any of the following symptoms:

  • Exaggerated sensitivity to touch
  • Burning or shooting pain
  • Prickly or sharp pain
  • Pinching sensation
  • Pins and needles
  • Tingling and numbness
  • Loss of ability to feel pain
  • Loss of ability to feel changes in temperature
  • Loss of ability to feel changes in pressure

Motor Neuropathy Symptoms

Motor nerves are responsible for coordinating movements between your muscles and your brain. Diabetic neuropathy can damage motor nerves as well, causing muscle weakness, loss of muscle tone in the feet or legs, or loss of balance. Motor neuropathy can also lead to changes in the shape or structure of the feet, leading to areas of increased pressure. If your diabetic neuropathy is affecting your motor nerves, you may experience any of the following symptoms:
  • Muscle weakness
  • Muscle wasting (loss of muscle tone)
  • Loss of balance
  • Loss of coordination (unable to the feel the position of your joins)
  • Falling
  • Twitching
  • Cramps
  • Difficulty with fine motor control, such as fastening buttons
  • Changes to the shape and structure of the feet
  • Pressure points on the feet

Autonomic Neuropathy Symptoms

As described above, autonomic nerves are responsible for the body’s automated functions (respiration, digestion, heart rate, blood pressure, sweating). Diabetic damage to autonomic nerves can affect many of the body’s systems, but the most apparent symptom of autonomic neuropathy for diabetics is dry, cracked feet caused by damage to the nerves controlling the sweat glands. If your diabetic neuropathy is affecting your autonomic nerves, you may experience any of the following symptoms:
  • Hypoglycemia unawareness (inability to tell when blood sugar levels are low)
  • Frequent urinary tract infections
  • Loss of bladder control (urinary incontinence) or urinary retention (trouble emptying bladder)
  • Constipation or uncontrolled diarrhea
  • Slow stomach emptying (gastroparesis) leading to nausea, vomiting, sensation of fullness, and loss of appetite
  • Difficulty swallowing
  • Erectile dysfunction in men
  • Vaginal dryness and other sexual difficulties in women
  • Increased or decreased sweating
  • Drops in blood pressure when rising from sitting or lying down that may cause feelings of lightheadedness or fainting
  • Irregular heart beats
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Stages of Diabetic Neuropathy

Diabetic neuropathy is a chronic, progressive disease, meaning that it will typically get worse over time if diabetes is not managed. The typical stages of diabetic neuropathy are described below.

Stage 1: Intermittent Numbness and Pain

Diabetic neuropathy begins with intermittent, often subtle episodes of numbness and pain. If you have diabetes and experience recurring episodes of unexplained numbness or pain, especially in your extremities, you may be in the early stages of diabetic neuropathy. Intermittent symptoms cause many to overlook their condition until it becomes more severe.

Stage 2: Persistent Numbness and Pain

As diabetic neuropathy progresses, intermittent symptoms will become more regular. This is when the majority of diabetic neuropathy patients begin to recognize their condition.

Stage 3: Debilitating Pain

Over time, persistent pain worsens to become debilitating pain, interfering with normal daily activities. It may become difficult to perform basic functions, like walking, without experiencing significant pain.

Stage 4: Complete Numbness and Loss of feeling

As nerve damage progresses even further, the most affected areas can become permanently numb. While this may sound preferable to constant pain, lack of sensation presents many other challenges, such as an inability to feel when you’ve injured your foot. Patients in the advanced stages of diabetic neuropathy need to be vigilant of basic injuries, as minor cuts or bruises can become severe problems if left untreated. In the end stages of diabetic neuropathy, all feeling is lost in the lower legs and feet. Balance is affected, and walking is made extremely difficult without the proper sensory feedback that healthy nerves provide. At this stage, many require a wheelchair for mobility.
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Los Angeles Diabetic Neuropathy Specialist Dr. Michael Lalezarian

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