Four Kinds Of Neuropathy

There are four basic types of neuropathy:

Peripheral neuropathy affects the feet, hands, legs and arms.

Proximal neuropathy, or amyotrophy can cause muscle weakness. It affects the muscles in the upper part of the legs, buttocks, and hips.

Focal neuropathy, by contrast, affects one specific nerve; it’s focused neuropathy. It can also be called mononeuropathy. Focal neuropathy, which comes on suddenly, most often affects nerves in the head (especially ones that go to the eyes). It can also affect the torso and legs.

When focal neuropathy affects the legs, it has different symptoms than proximal neuropathy, which can also affect the legs. Proximal neuropathy, as you can read above, causes muscle weakness in the legs, and it may also cause shooting pain down the leg. Focal neuropathy, however, causes pain in very specific locations on the legs, which you can read more about in the symptoms article.

All of the types of diabetic neuropathy —peripheral, autonomic, focal and proximal—are examples of polyneuropathy. Poly means that they affect many nerves. Autonomic neuropathy is discussed below.

I was diagnosed with peripheral neuropathy in my feet many years ago. More recently I was diagnosed with severe polyneuropathy in my legs. My neurologist used an EMG test to make that diagnosis. My gait is unsteady, and I have dizziness when I stand up from a seated position.

Autonomic Neuropathy (AN) affects the torso, and is especially common after 25 years of diabetes. Here are the more common symptoms from the Mayo Clinic:

"Dizziness and fainting upon standing caused by a drop in blood pressure.

Urinary problems, including difficulty starting urination, urinary incontinence and an inability to completely empty your bladder, which can lead to urinary tract infections.

Sexual difficulties, including problems achieving or maintaining an erection (erectile dysfunction) or ejaculation problems in men, and vaginal dryness and difficulties with arousal and orgasm in women.

Difficulty digesting food, due to abnormal digestive function and slow emptying of the stomach (gastroparesis). This can cause a feeling of fullness after eating little, loss of appetite, diarrhea, constipation, abdominal bloating, nausea, vomiting, difficulty swallowing and heartburn.

Sweating abnormalities, such as excessive or decreased sweating, which affects the ability to regulate body temperature.

Sluggish pupil reaction, making it difficult to adjust from light to dark and causing problems with driving at night.

Exercise intolerance, which may occur if your heart rate remains unchanged instead of appropriately increasing and decreasing in response to your activity level."

My neurologist diagnosed my AN in 2010, after I had mentioned extreme dizziness in the AM, and my occasionally falling down. My BP can drop as much as 30 points after standing, but it is more normal after walking a few steps. I have had some bad falls in the past, but it has been more than a year since the most recent fall. I decreased my BP med to minimum dosage (2.5 mg), and that has helped a lot. I may have to use a walker in the not too distant future.

I have five of the symptoms of AN listed, and they are
gradually becoming more pronounced. Gastroparesis is one of the symptoms, but I do not have that problem at the present time. I hope I never do

Do you have AN, or do you think you do? Feel free to discuss your symptoms, and how you are dealing with them.


Thanks for the detailed information. Our Type 1 hijacks our time and energy and yet demands a deeper understanding of what’s going on or what MAY happen.

I hope to never NEED this information for myself, but, as someone diagnosed at 43, I know that “stuff” happens.

Plus, I am not of the opinion that knowledge (or science) is something suspicious. Knowledge is power to help myself or others.


Autonomic neuropathy is probably the one people think about least. But it doesn’t only affect the torso. A good friend suffers from it and is now confined to a wheelchair, in part because of it.


I get dizzy when my Bg starts to shift. Im not sure if it’s neuropathy. It’s more likely nerve related from something else maybe but definitely from D. I also have vertigo and I get vestibular migraines from low Bg. I have tingling etc in my hands and feet but no loss of sensation. That could be from Raynauds; hashimotos and damage from car accidents. I’ve had it for years. But it’s worse when bg goes high so I try to keep Bg as low as safely possible as much as possible.


Hello, meee. I also have that tingling and numbness in my feet and legs. No loss of sensation, like you. My neurologist diagnosed severe neuroathy.
I have something like vertigo, dizzy when getting up from a seated position. Wobbly when I walk, always afraid I might fall down, especially in the AM. That was diagnosed as autonomic neuropathy.


That’s awful Richard. My vertigo was pretty bad for a while but fortunately It improved a lot and it is mostly the Bg shifts now which seem to bring it on. I had pulsatile tinnitus briefly too. I think my tingling is not really neuropathy because it started after my first car accident years ago when I had nerve damage. The diabetes was many years later but it could be affecting it. My tingling is mostly mild now and gets worse with compression in certain areas too. I think I have carpal tunnel maybe in my right elbow / wrist which hurts constantly now after an injury two years ago. I’m just wearing a brace on it now and the compression made it worse.

Being on bp meds is awful. My father is on them and he feels weak and dizzy a lot too. If you stand up slowly does that help? I have always gotten dizzy at times and I can’t go on any spinning things etc. I think it has to do with migraines.

Yes, getting up slowly is s must for me. I have much less dizziness in the afternoon, and evening. bp. meds have also cause problems. I am on the minimum dosage of 2.5 mg and that has helped a lot. My bp is ok with that dosage. I think my doctor initially prescribed too much. 10 mg caused me to fall several times.
I was very sick after a ferris wheel ride years ago.

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Wow that sounds like way too high a dose. I’m glad you lowered that. Just take your bp multiple times a day and you can adjust it as needed. Me too-i remember being very ill after the last ride I went in years ago.

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@ Mee, heat will help carpal tunnel, wearing a fingerless glove will keep that joint covered and will help reduce the pain.

@Pastelpainter Thanks. I’ll try heat. I’m not sure if this Is really carpal tunnel. My Doc thought so but the pain is in my elbow mostly and shoulder. I have not done the tests because I’m not doing surgery. I can’t wear gloves etc due to raynauds. I’m returning the elbow brace because it’s hurting me. When I injured it I wore a wrist brace which helped. Maybe I’ll try that again.

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Hi Richard, thanks for this post on neuropathy; good information. I have a considerable amount of it after almost 25 years of Type 1, and it’s hateful.


Hi Meee, I am sorry you are in pain and am curious about something you said, why does having Raynauds keep you from wearing gloves?

Gloves are usually a good thing for those with Raynauds, even using them when getting things out of the freezer or holding cold things is usually recommended so I am confused by you not being able to wear them.

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Thanks Stang, what I meant was I can’t wear tight gloves and those ones for ct are usually too tight. I usually only wear mittens or very loose gloves. Also I don’t wear any type of tight clothes etc. Even my knee brace which is adjustable has to be very tight but it falls off too. Somehow I can get away with that for shorter periods. When I had a dvt I had to wear special hose that helped the pain for a few months. It was awful but I got the medium compression. I only wear loose diabetes socks now too.

Thanks for explaining meee. Sorry you have to deal with all of that, it doesn’t sound fun at all. I also have Raynauds so that is why I was wondering about that. I hope you are not in pain most of the time and I wish you lots of good luck dealing with all of it :slight_smile:

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Thanks. :blush: unfortunately I have chronic pain from various sources so I’m in some kind of pain most of the time. It was pretty manageable until D. Raynauds is not too bad for me. Wear loose clothes, avoid the cold and heat my drinks etc.

Thanks for the information. As noted earlier, knowledge is power, and if I know about something, I have the ability both to recognize what is going on and to appropriately respond to the situation. That being said, everyone also must not jump to conclusions. Some of the symptoms of neuropathy can also be caused by other conditions. For example, certain eye problems or sexual changes can simply be a part of the aging process. I am old enough to know that. And many of the weaknesses or pains can be caused by multiple conditions. In 2013 I started to get both weak and to experience great pain in my large muscle groups, in arms, legs, torso, buttocks. I saw three doctors before finally getting to my regular doctor who suggested that rather than neuropathy, I might have a much more serious and life-threatening disease. Two and a half weeks at Mayo Clinic confirmed that I had dermatomyositis – an autoimmune condition where the body attacks the muscles of the body. I have never in my life experienced such pain nor felt such relief once I was on Immuran and Prednisone. I was on those meds for two and one half years and now have been off them for one. I am in “remission,” but know that I could relapse into dermatomyositis at any time. Strangely, both diabetes and dermatomyositis are referred to as “DM.” My daughter works as a statistician at Mayo, and she says that I am just “DM-squared.” (I don’t know how to show the “squared” sign in this post.) Neuropathy is a very serious condition that every diabetic faces, but I caution you to make sure you really know what is going on when you get a diagnosis. My doctor’s correct diagnosis after blood work probably saved my life.


Since type 1 diabetes is caused by a genetic predisposition to autoimmune disease, whenever such a patient is having problems it is always important to rule out other autoimmune conditions which may complicate the clinical picture.

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My muscles start to tire easily in many places in my body (among other things like soreness and pain and falling asleep etc): legs, arms, back, neck, face, and jaw. I am going to see a neurologist soon. Seems like it could be neuropathy, but not sure which ones. Signs also point to myotonic dystrophy or myasthenia Gravis, which are very rare but also auto immune induced to my understanding. I worry the neurologist will just automatically say neuropathy since I am diabetic and not try to rule out anything else. Doctors are often quick to do that.

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@displayname, thanks for your reply. I have the same symptoms that you do, including the sleepiness and pain in legs, back and neck. I have an appointment in May to see a neurologist. I may have another autoimmune condition, like you mentioned. I also have bad pain in my hands, and I am expecting carpal tunnel there. I am also 78 years old now, so my age may part of the cause of my problems.