Other Diabetes Nerve Damage

Last updated: 13 Aug 2025

Other Forms of Diabetic Nerve Damage in Type 1 Diabetes

Placeholder: image showing different areas affected by autonomic, proximal, or focal neuropathy (e.g., digestive system, heart, a single nerve pathway

Introduction

While peripheral neuropathy affecting the feet and hands is the most common type of nerve damage in Type 1 Diabetes (T1D), other forms can also occur, impacting various bodily functions and causing a diverse range of symptoms.[11] These include autonomic neuropathy, proximal neuropathy, and focal neuropathy (mononeuropathy). For older Victorians with T1D, understanding these less common but potentially significant types of nerve damage is important for recognition, appropriate management, and maintaining overall health.

Autonomic Neuropathy

Autonomic neuropathy affects the autonomic nerves, which control involuntary bodily functions. Damage to these nerves can disrupt the normal operation of many organs and systems.[11, 12]

Symptoms and Affected Systems:

• Digestive System (Gastroparesis and Enteropathy):
  • Symptoms: Nausea, vomiting (especially of undigested food), feeling full quickly, bloating, abdominal pain, erratic blood glucose levels due to unpredictable food absorption, diarrhoea (often at night), or constipation.[1, 11, 12]
  • Management: Dietary changes (small, frequent meals, low-fat/low-fibre), medications to speed stomach emptying (e.g., metoclopramide, erythromycin) or manage symptoms, and careful blood glucose monitoring and insulin adjustment.[12, 13]
• Cardiovascular System (Cardiovascular Autonomic Neuropathy - CAN):
  • Symptoms: Resting fast heart rate, dizziness or lightheadedness upon standing (orthostatic hypotension), inability to sense chest pain (silent myocardial ischemia), exercise intolerance.[12, 13]
  • Management: Gradual changes in posture, compression stockings, increased salt and fluid intake (if advised by a doctor), medications to raise blood pressure if needed, and careful management of cardiovascular risk factors.[13] CAN can increase the risk of cardiovascular events and mortality.[13]
• Urinary System:
  • Symptoms: Difficulty emptying the bladder completely (leading to urinary tract infections), urinary incontinence (leakage), increased urinary frequency, or reduced sensation of bladder fullness.[11]
  • Management: Timed voiding schedules, medications, and in some cases, intermittent self-catheterisation.
• Sexual Function:
  • Men: Erectile dysfunction (difficulty achieving or maintaining an erection).[1, 11]
  • Women: Vaginal dryness, reduced sexual response or sensation.[11]
  • Management: Medications (e.g., phosphodiesterase inhibitors for erectile dysfunction), lubricants, counselling, and addressing underlying blood glucose control.[12, 13]
• Sweat Glands:
  • Symptoms: Either excessive sweating (especially at night or while eating certain foods) or decreased/absent sweating (anhidrosis), leading to dry skin and difficulty regulating body temperature.[12]
  • Management: Medications (e.g., glycopyrrolate for excessive sweating, though often not fully effective), skin care for dryness, and strategies to avoid overheating.[13]
• Eyes:
  • Symptoms: Difficulty with eyes adjusting from light to dark, or vice versa.[11]
• Hypoglycaemia Unawareness:
  • Symptoms: The normal warning signs of low blood glucose (like shakiness, sweating, palpitations) may be diminished or absent, increasing the risk of severe hypoglycaemia.[12]
  • Management: Frequent blood glucose monitoring (CGM is particularly helpful), education for the individual and family, and adjustment of diabetes treatment to minimise hypoglycaemia risk.

Proximal Neuropathy (Diabetic Amyotrophy or Lumbosacral Radiculoplexus Neuropathy)

This is a less common but often very painful form of neuropathy that typically affects older adults, sometimes even those with recently diagnosed or well-controlled diabetes.[11, 12]

• Symptoms:
  • Severe, deep aching or burning pain, usually starting in the hip, buttock, or thigh on one side of the body.[11, 12] Pain may spread to the leg.
  • Significant muscle weakness and wasting (atrophy) in the affected muscles, making it difficult to stand up from a sitting position or climb stairs.[10, 12]
  • Weight loss can occur.[12]
  • Rarely, it can affect the arm.[12]
• Natural History: Symptoms often improve gradually over months to a couple of years, but some residual weakness may persist.[10]
• Management: Primarily focused on pain control (often requiring strong analgesics), physical therapy to maintain muscle strength and function, and good blood glucose management.[12]

Focal Neuropathy (Mononeuropathy)

Focal neuropathies involve damage to a single nerve, often occurring suddenly.[10, 11] They are more common in older adults.[10]

• Symptoms: Depend on the specific nerve affected. Examples include:
  • Cranial Neuropathies:
    • Sudden double vision, pain behind one eye, difficulty moving an eye (often affecting cranial nerves III, VI).[10, 12]
    • Facial drooping on one side (Bell’s palsy, affecting cranial nerve VII).[10, 12]
    • Hearing problems.[12]
  • Entrapment Syndromes: Nerves can be compressed in narrow passages.
    • Carpal Tunnel Syndrome: Numbness, tingling, pain, and weakness in the hand and fingers (median nerve compression at the wrist). More common in people with diabetes.[10]
    • Other nerves in the arms or legs can also be affected (e.g., ulnar nerve, peroneal nerve).[10]
  • Thoracic/Abdominal Neuropathy: Pain in the chest, side, or abdominal wall that can mimic angina, heart attack, or appendicitis.[12]
• Natural History: Many focal neuropathies, especially cranial ones, tend to improve and resolve on their own over weeks to months.[10] Entrapment syndromes may require specific treatment.
• Management:
  • Pain relief.
  • For entrapment syndromes: Rest, splints, local steroid injections, or sometimes surgery if conservative measures fail.[10]
  • Eye patch for double vision.
  • Supportive care.

Diagnosis and General Management Principles

Diagnosis of these neuropathies involves a careful medical history, neurological examination, and sometimes specialised tests like nerve conduction studies, EMG, or imaging.

General management principles for all types of neuropathy include:

• Optimal Blood Glucose Control: The cornerstone to prevent progression.[12]
• Pain Management: As appropriate for the type and severity of pain.[12]
• Protecting Affected Areas: For example, careful foot care with peripheral neuropathy, or protecting areas with sensory loss.
• Supportive Therapies: Physical therapy, occupational therapy.
• Regular Follow-up: With your GP, endocrinologist, and neurologist if needed.

Key Takeaways

• Beyond peripheral neuropathy, T1D can cause autonomic neuropathy (affecting internal organ functions), proximal neuropathy (severe pain and weakness in hips/thighs), and focal neuropathy (affecting single nerves).[11, 12]
• Symptoms vary widely depending on the nerves affected and can impact digestion, heart function, bladder control, sexual health, and cause specific pain syndromes.[1, 11, 12]
• Good blood glucose control is fundamental in managing all types of diabetic neuropathy.[12]
• Specific treatments target symptoms and aim to improve quality of life.

Where to Get Help in Victoria

• Your GP (Doctor): For initial assessment, management, and referrals.
• Endocrinologist: Specialist in diabetes care.
• Neurologist: Specialist in nerve disorders.
• Gastroenterologist: For digestive system issues related to autonomic neuropathy.
• Urologist: For bladder or sexual function problems.
• Cardiologist: For cardiovascular autonomic neuropathy.
• Physiotherapist/Occupational Therapist: For managing pain, weakness, and functional limitations.
• Diabetes Victoria: For information and support.

References

• [1] Mayo Clinic. (n.d.). Type 1 diabetes.
• [13] NCBI Bookshelf. (n.d.). Diabetic Peripheral Neuropathy. (Provides some information on autonomic neuropathy management).
• [10] PMC. (2009). Diabetic Neuropathies: An Update.
• [12] Johns Hopkins Medicine. (n.d.). Diabetic Neuropathy (Nerve Problems).
• [11] Centers for Disease Control and Prevention (CDC). (n.d.). Diabetes and Nerve Damage.