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Diabetic Proximal Neuropathy

Last updated Aug. 24, 2018

Approved by: Krish Tangella MD, MBA, FCAP

Diabetic Neuropathy is a type of nerve damage that affects individuals who have diabetes. Diabetic Proximal Neuropathy is a motor neuropathy that affects one’s movement. It is the second most common kind of Diabetic Neuropathy, the most common being diabetic peripheral neuropathy.

What are the other Names for this Condition? (Also known as/Synonyms)

  • Diabetic Amyotrophy
  • Diabetic Femoral Neurophagy
  • Proximal Neuropathy due to Diabetes

What is Diabetic Proximal Neuropathy? (Definition/Background Information)

Diabetic Neuropathy is a type of nerve damage that affects individuals who have diabetes. The term neuropathy indicates nerve dysfunction causing symptoms such as weakness and loss of sensation.

There are four types of Diabetes-Related Neuropathy. These include:

  • Diabetic Peripheral Neuropathy
  • Diabetic Autonomic Neuropathy
  • Diabetic Proximal Neuropathy
  • Diabetic Focal Neuropathy

Diabetic Proximal Neuropathy is a motor neuropathy that affects one’s movement. It is the second most common kind of Diabetic Neuropathy, the most common being diabetic peripheral neuropathy.

  • Elevated levels of blood sugar cause injury to nerve fibers throughout the body. The underlying pathology of the condition is not clearly understood
  • The symptoms of Proximal Neuropathy due to Diabetes vary from mild to disabling, and could include sudden severe pain in the thighs, hips, buttocks and legs
  • The condition usually affects one side of the body, but may spread to the other side as well. A weakness in the legs is also reported in Proximal Neuropathy
  • Medication and physical therapy may help in controlling the muscle weakness or pain

Who gets Diabetic Proximal Neuropathy? (Age and Sex Distribution)

  • Individuals with non-insulin dependent diabetes mellitus (NIDDM) appear to have an earlier onset of Diabetic Proximal Neuropathy symptoms than those with insulin-dependent diabetes mellitus (IDDM)
  • The symptoms are more prevalent in those with type-2 diabetes
  • Prevalence of Diabetic Neuropathy is reported to increase the longer an individual has had diabetes. Diabetic Proximal Neuropathy is more common in older adults
  • It has been reported that men develop Proximal Neuropathy symptoms earlier than women. Though, according to a study conducted in the United Kingdom, the symptoms of Diabetic Proximal Neuropathy are more prevalent in women
  • African-Americans and Native-Americans develop Diabetic Proximal Neuropathy earlier than Caucasians. When compared to Europeans, Asian Indians have a lower risk of developing neuropathy. However, despite a lower risk of developing neuropathy associated with diabetes, the South Asians are reported to have more painful symptoms

What are the Risk Factors for Diabetic Proximal Neuropathy? (Predisposing Factors)

Any individual with diabetes may develop Diabetic Proximal Neuropathy. However, the following factors could make one more susceptible to nerve damage:

  • Poor glycemic control
  • The time period (years) one has had diabetes
  • Poor body weight management, obesity
  • Racial preference: African and native Americans appear to be more susceptible to Diabetic Proximal Neuropathy
  • Hypertension
  • Smoking
  • Diabetic nephropathy (or diabetic kidney disease) is a risk factor, as it could lead to toxin build-up in blood. These toxins could potentially affect the nervous system

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Diabetic Proximal Neuropathy? (Etiology)

The following factors may be responsible for Proximal Neuropathy due to Diabetes:

  • Poor glycemic control is a key factor contributing to Diabetic Proximal Neuropathy. High blood sugar over an extended period of time could cause nerve damage
  • Smoking, which has been proved to be a causative agent for diabetes, could also lead to narrowing of the blood vessels, thereby restricting blood flow. Poor circulation could lead to nerve dysfunction
  • Some studies have shown unique gene expression profiles in individuals with Diabetic Neuropathy. Thus, genes related or unrelated to diabetes, could potentially contribute to nerve damage
  • Nerve inflammation, as a response to an autoimmune disorder in the individual affected by diabetes, could also lead to Proximal Neuropathy

What are the Signs and Symptoms of Diabetic Proximal Neuropathy? 

Diabetic Proximal Neuropathy, also known as Diabetic Motor Neuropathy, affects mainly the thigh muscles. The signs and symptoms could be:

  • Pain in the hips, buttocks, thighs, and legs. Less commonly, the pain could affect the shoulders as well
  • Muscle weaknesses
  • Trouble getting up from a seated position
  • If the condition affects the abdomen, there may be swelling in the abdominal area
  • Weight loss

How is Diabetic Proximal Neuropathy Diagnosed?

A healthcare provider may diagnose Diabetic Proximal Neuropathy after carefully evaluating the individual based on their medical history, duration of diabetes, glycemic control, and symptoms reported. Additionally, the physician will also check for muscle strength and muscle tone, tendon reflexes, and sensitivity to touch, temperature, and vibration.

Based on an individual’s symptoms, a physician may require one or a combination of the following tests to be performed, in order to arrive at an accurate diagnosis:

  • Blood tests that include fasting plasma glucose, hemoglobin A1c, and complete blood count (CBC)
  • Electrolytes and liver panel (complete metabolic panel)
  • Genetic screens
  • Sequential multiple analysis-7 (renal function and electrolyte imbalances)
  • Some possible tests for sensation such as temperature, touch, and vibration, to assess how well an individual feels or responds to stimuli
  • Nerve conduction velocity (NCV) test to determine how fast nerve impulses travel
  • An electromyography (EMG) test in conjunction with NCV test to see how well the muscles receive signals from the nerves

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Diabetic Proximal Neuropathy?

Diabetic Proximal Neuropathy or Diabetic Amyotrophy could potentially occur in diabetic patients with chronic hyperglycemia. Prolonged high blood sugar and neuropathy could result in Proximal Neuropathy. The possible complications are:

  • Inability to stand up without help
  • Extreme muscle weakness (in the legs) and muscle wasting
  • Continuous Proximal Neuropathy could result in a condition called “quadriparesis”, in which the individual suffers muscle wasting in all four limbs

How is Diabetic Proximal Neuropathy Treated?

Although a reversal of nerve damage is not possible, muscle weakness owing to Diabetic Proximal Neuropathy could be resolved over time with treatment.

Pain management:

  • Capsaicin: Made from chili peppers, capsaicin cream can reduce pain in some individuals. The side effects may include a burning feeling and skin irritation
  • Alpha-lipoic acid: An antioxidant, it is found in some foods and may help relieve the symptoms of Proximal Neuropathy
  • Acupuncture: Acupuncture may be able to offer help in relieving the pain of neuropathy. No side effects have been reported with this technique. One will likely require more than one session for pain relief
  • Transcutaneous electrical nerve stimulation (TENS): TENS delivers tiny electrical impulses to specific nerve pathways through small electrodes placed on the skin. It is considered safe and painless, but TENS does not work for every individual, or for all types of pain
  • Anti-seizure medications have been successfully used for pain management
  • Anti-depressants: These medications interfere with an individual’s ability to feel pain. Anti-depressants have been used successfully to relieve mild to moderate nerve pain

The progression of Diabetic Proximal Neuropathy could be slowed by the following approaches:

  • Proper glycemic control: Could be achieved by medication and maintaining overall health
  • Proper nutrition
  • Keeping blood pressure under control
  • Physical activity: Getting plenty of exercise
  • Achieving and maintaining a healthy body weight
  • Smoking cessation
  • Reducing consumption of alcohol
  • Good foot-care

How can Diabetic Proximal Neuropathy be Prevented?

The following measures could help diabetics prevent or delay the onset of Proximal Diabetic Neuropathy:

  • Maintaining good glycemic control: Following the recommended medication regimen and steadily maintaining blood sugar in the target range, go a long way in preventing or delaying neuropathy. Blood tests to check for A1c levels could help the patient and physician monitor blood sugar levels
  • Maintaining a healthy lifestyle: Avoiding a sedentary lifestyle and maintaining a healthy body weight play important roles in managing diabetes
  • Smoking cessation
  • Reducing alcohol consumption

What is the Prognosis of Diabetic Proximal Neuropathy? (Outcomes/Resolutions)

  • The prognosis for Diabetic Proximal Neuropathy is generally good
  • Good glycemic control and a healthy lifestyle, in combination with proper vigilance, could help one manage or reverse the symptoms successfully

Additional and Relevant Useful Information for Diabetic Proximal Neuropathy:

  • Type 2 diabetes is a chronic disease in which the blood contains high levels of glucose (sugar), the body’s main source of fuel

The following article link will help you understand type 2 diabetes:


What are some Useful Resources for Additional Information?

References and Information Sources used for the Article:

Helpful Peer-Reviewed Medical Articles:

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 18, 2015
Last updated: Aug. 24, 2018