Peripheral neuropathy. Signs of peripheral neuropathy include tingling, pain, numbness, or weakness in the feet, legs, and hands. This type of neuropathy occurs in the peripheral nerves of the body, rather than the brain or spinal cord, most commonly affecting the hands and feet.

Autonomic neuropathy. Damage to nerves controlling body functions—those associated with the digestive system, urinary tract, sex organs, heart and blood vessels, sweat glands, and eyes—is called autonomic neuropathy. Symptoms vary, depending upon which autonomic nerves are damaged. Possible symptoms of autonomic neuropathies include:

• Gastroparesis, or delayed stomach emptying, which may lead to bloating and vomiting.
• Diarrhea and constipation due to injury to nerves controlling the intestinal tract.
• Bladder paralysis, causing urine retention and increasing risk of bladder infections.
• Erectile dysfunction in men or vaginal dryness and lack of arousal in women as a result of damage to nerves controlling the reproductive system.
• Fainting, dizziness, or rapid heart rate due to cardiovascular nerve damage.
• Difficulty adjusting to changing light conditions as a result of damage to nerves related to vision.

Less common types of neuropathy include unilateral foot drop, Charcot’s joint (neuropathic arthropathy), cranial neuropathy, femoral neuropathy, thoracic or lumbar radiculopathy, and focal neuropathy.

Properly managing blood sugar levels can greatly reduce neuropathy risk and slow its progression. Here are some important ways to optimize diabetes management:

• Follow a plan for monitoring your blood sugar levels and keeping them within a specific target range. In addition to periodic lab testing, your doctor may recommend you check your blood sugar level at home one or more times per day, especially if you use insulin.
• Monitor hemoglobin A1c (HbA1c) levels two to four times per year, as recommended by your doctor.
• Work with your healthcare provider to adjust doses of insulin and other medications, as well as diet and physical activity to best manage blood sugar levels.
• Develop strategies for managing stress and getting good sleep, since a high stress level and not getting enough high-quality sleep make blood sugar control more challenging.
• Participate in regular screenings for diabetes complications, and don’t ignore new aches and pains, which may signal neuropathy.

(Diabetes Care 2017;40:S93–5)