There are many symptoms of diabetic neuropathy resulting from loss of sensation. The following are the major types in the order of the frequency with which they occur.
Distal polyneuropathy is the most common sensory neuropathy. It involves the nerves of the feet and legs and often the hands as well. It is believed to be caused by a metabolic abnormality, since other diseases that involve a metabolic abnormality can show evidence of a distal polyneuropathy as well (like kidney disease).
The primary signs and symptoms of distal polyneuropathy include the following:
- Numbness of the feet and legs and inability to know whether the feet are bent forward or back due to loss of large fibers
- Diminished ability to feel pain and heat or cold due to loss of small fibers
- Mild weakness
- Tingling and burning
- Painful sensitivity to light touch such as the bed covers on your legs
- Loss of balance and coordination
- Worsening of symptoms at night
A patient with this condition may not know if he has been burned by hot water, for example, or has stepped on a tack. Most patients who have this condition do not realize it and need to have studies of nerve conduction in order to evaluate it.
Get yourself a 10 gram filament and test your sensation at least monthly. If you can’t feel your feet, you must use your eyes to discover lesions. To avoid distal polyneuropathy you must achieve very good control of your blood glucose so that you have a hemoglobin A1c of 7 percent or less. Once neuropathy is present, examine your feet regularly. If you have it, ask your doctor to check your feet at each visit.
Polyradiculopathy-diabetic amyotrophy is a combination of pain on one side from the hip to the thigh and loss of motor nerve activity to the upper leg so that the patient can’t straighten the knee. It does not respond to improved blood glucose control but usually has a short course.
Radiculopathy-nerve root involvement
Sometimes the pattern of pain suggests that the whole nerve is affected from its beginning at the spinal cord. The pain is felt along a horizontal line from the spinal column to the front of the chest or abdomen. This pain can be confused with an internal abdominal emergency. But the pain goes away in 6 months to 2 years and it does improve with better glucose control.