Neuropathy

Diabetic neuropathy, also called peripheral neuropathy, can affect motor or sensory nerves. Motor nerves supply muscles. Damage to these nerves will cause muscle weakness.

Diabetic neuropathy tends to be symmetrical, meaning it affects both lower limbs and or both hands. It tends to affect the distal parts of the limb and gradually work its way up; hence it is called distal symmetric polyneuropathy. Symptoms of nerve damage include numbness, tingling, burning, itching, cold sensation, walking on cotton, pins-and-needle like sensation, and electric shock-like sensation. These symptoms tend to be worse at night.

When damaged, autonomic nerves may present as erectile dysfunction, loss of urinary bladder control, unexplained drop in blood pressure, or wild fluctuations in blood pressure. It may present as gastroparesis, where there is delayed gastric emptying with wild fluctuations in blood glucose. Sometimes people with diabetes suffer a silent heart attack (without chest pain). Secondary to nerve damage, chest pain is not perceived. If the autonomic nerves to the gut are damaged, it can present as diarrhea or constipation.