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What hurts in type 1 and type 2 diabetes?
Last reviewed: 12.07.2025
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If diabetes, as an endocrine pathology, is associated with a violation of homeostasis of the most important energy substrate in the body - glucose, then various localizations of pain in diabetes arise as a complication due to prolonged hyperglycemia, in which glucose has a toxic effect on many tissues.
Causes of pain in diabetes
From the standpoint of achievements in diabetology, the causes of pain in diabetes and their pathogenesis are considered by endocrinologists as components of a multi-stage biochemical process that occurs with increased glucose levels in the blood of patients with diabetes and affects the entire body.
Excess glucose leads to acceleration of protein glycation, i.e. non-enzymatic binding of the aldehyde group of glucose with the terminal amino group of proteins. At the same time, due to the accumulation of the end products of this reaction in the cells (immunoreactive carbonyl compounds), the protein-containing lipoprotein membranes of red blood cells, proteins of connective tissues (elastin and collagen of the skin, vascular endothelium), and the myelin sheath of nerve fibers undergo structural modification. Its negative result is tissue damage with disruption of their inherent functions.
The causes of pain in diabetes are also associated with the oxidation of excessive amounts of glucose, which brings normal intra-tissue oxidative processes to the level of oxidative stress: with an increase in free radicals, an increase in oxidized lipids, LDL, isoprostanes and diacylglycerol. The latter initiates the expression of the intracellular enzyme protein kinase-C, as a result of which the smooth muscle and connective tissue fibers of the walls of blood vessels come to a state of hypertonicity; platelets undergo increased aggregation; glycosylated plasma albumin delivers the necessary substances to the cells worse and removes metabolites and exogens.
The basal layer of the epithelium lining the capillary walls becomes thicker (the vessels become less elastic), and the endothelium itself hypertrophies due to deposits of lipo- and glycoproteins. This reduces oxygen diffusion and negatively affects the barrier function of the endothelium and microcirculation (capillary blood flow) - with the development of diabetic angiopathy.
Pathogenesis
The pathogenesis of damage to the peripheral and autonomic nervous system – with symptoms of diabetic neuropathy (or polyneuropathy), including pain – is caused by glycation of the basic protein and phospholipids of the myelin sheath of nerve fibers. For this reason, the transmission of nerve impulses from receptors to the brain is disrupted. For more details, see – Pain in diabetic polyneuropathy
Statistics
Statistics on the frequency of pain in patients with diabetes mellitus associated with the development of diabetic polyneuropathy range from 20 to 55%, according to other data – 65% or more.
A third of patients complain of leg pain, of which diabetic osteoarthropathy is observed in more than 6.5% of cases, and diabetic foot syndrome after 15-20 years of illness (most often type 2 diabetes) – in every tenth case.
Kidney problems in diabetes occur in 25-40% of patients.
What hurts with diabetes?
Most often, diabetes affects the legs. Limited mobility and joint pain in diabetes may appear years after the disease is diagnosed in patients with unstable or poorly controlled hyperglycemia levels – due to the development of diabetic osteoarthropathy. Or they may begin much faster, since collagen proteins, proteoglycans and glycoproteins of cartilage tissue are among the first to be exposed to the toxic effects of excess glucose.
Damage to the metatarsophalangeal joints causes dull pain in the toes in diabetes; tarsal joints - pulling or burning pain in the foot in diabetes; and when the subtalar and / or talocalcaneonavicular joints are affected, the heels hurt in diabetes. A burning sensation may be felt in the shins, the feet are constantly cold and often bluish, and also swell greatly (swelling affects the ankle and spreads to the lower part of the shin). The legs hurt when moving, limping (intermittent), cramps in the calf muscles, pain in the knees in diabetes are possible. Over time, the pain becomes increasingly disturbing even at rest. Such symptoms are noted in ischemia of the vessels of the extremities - diabetic microangiopathy and insufficiency of their arterial blood supply (macroangiopathy).
When the etiology of complications is associated with nerve damage, leg pain in diabetes begins only after joint deformation and obvious diabetic foot syndrome (Charcot osteoarthropathy), since in the initial stages, such patients have impaired reflexes and sensitivity of the distal parts of the lower extremities (paresthesia, dysesthesia, hyperesthesia are observed).
Additionally, if the peroneal nerve is compressed, pain may be felt in the thigh area (indicating tarsal tunnel syndrome).
Pain in the hands in diabetes
Quite often, pain in the hands is a concern in type 2 diabetes in the presence of focal mononeuropathy of the upper limbs in the form of osteoarthritis of the finger joints, inflammation of the tendons and joint capsule of the shoulder joint (scapulohumeral periarthritis). And due to the compression of the nerve in the carpal canal, carpal (wrist) syndrome can develop, accompanied by characteristic pain.
Muscle pain in diabetes
With a deficiency of endogenous insulin and the inability of tissues to absorb glucose in patients with type 1 diabetes, a mechanism for obtaining it by breaking down glycogen, which is present not only in the liver but also in the muscles, can be activated. Moderate nagging muscle pain in diabetes can appear for this very reason.
Acute muscle pain localized on the outer surface of the thigh and in the buttock - with simultaneous muscle weakness and problems with movement - is explained in endocrinology by an extremely high level of hyperglycemia and a state of diabetic ketoacidosis.
Back pain in diabetes can be caused by damage to the connective tissue sheaths of the spinal nerves (due to glycation of collagen and elastin proteins). Often, this is lower back pain in diabetes with the capture of the hip area and spread along the entire lower limb; at the same time, weakening of muscle fiber tone and a decrease in their volume are noted. The presence of these symptoms can be a manifestation of the amyotrophic form of diabetic neuropathy or lumbosacral radiculopathy.
Bone pain in diabetes
Specialists associate bone pain with diabetes with two main factors. Firstly, with a decrease in bone mineral density due to high osteoclast activity and the prevalence of resorption processes. At the same time, the process of bone formation – osteoblastogenesis – is noticeably lagging behind due to a lack of insulin (and growth factors associated with its synthesis). So some patients with diabetes experience bone pain due to secondary osteoporosis.
Secondly, problems with joints and ligaments play an important role in the appearance of such pain, since glycation of protein compounds included in their tissues has a negative effect on the entire musculoskeletal system.
Headache in diabetes
As endocrinologists emphasize, headaches in diabetes can occur not only when blood sugar levels are elevated, but also in the opposite situation, as well as with fluctuations and sharp jumps and too large doses of insulin.
Long-term insulin overdose, known as Somogyi syndrome, usually begins with sudden weakness and headache. And if the patient, in addition to these symptoms, suffers from nausea and thirst, then these are the first signs of a dangerous condition - ketoacidosis.
Cardialgia in diabetes mellitus
According to clinical data, ischemic heart disease develops in almost half of elderly patients with diabetes. Therefore, doctors often hear complaints about heart pain with diabetes.
Cardialgia in combination with cardiac rhythm disturbances (tachycardia or bradycardia) is classified as diabetic mononeuropathies with insufficient insulin replacement therapy.
Pain in the abdomen, stomach, pancreas in diabetes
Spontaneous painful cramps in the lower abdomen (short-term, with diarrhea) or moderate distending pain (with constipation) may indicate diabetic enteropathy. But acute abdominal pain in diabetes, accompanied by intense thirst, increased pulse rate, increased diuresis, nausea, vomiting and diarrhea, are signs of such a complication as diabetic ketoacidosis and diabetic ketoacidotic coma.
Many diabetics have various problems with the gastrointestinal tract, and stomach pains with diabetes are not uncommon. Doctors consider this a manifestation of gastrointestinal neuropathy. In cases of damage to the innervation of the stomach, its motility may be impaired and gastroparesis may develop, which causes pain, nausea and vomiting, reflux of gastric contents with heartburn.
As a rule, the pancreas hurts in type 1 diabetes – with autoimmune-induced damage to the β-cells of the islets of Langerhans in the pancreas.
In almost two thirds of patients, this pathology leads to inflammation of these tissues – insulitis with pain in the hypochondrium.
Kidney pain in diabetes
In long-term diabetes of both types, sclerotic changes in the intima of the renal vessels, the structure of the nephrons, glomeruli (glomeruli) and the disruption of their functions lead to the development of nephrosclerosis, nodular or diffuse sclerosis of the glomeruli (glomerulosclerosis), which causes kidney pain in diabetes
Also read the article – Diabetic Nephropathy
Eye pain in diabetes
When eyes hurt due to diabetes, there is a feeling of pressure inside the eyeballs, spots “float” before the eyes and vision deteriorates, ophthalmologists diagnose diabetic retinopathy, that is, a pathological change in the retina caused by damage to its blood vessels.
Who to contact?
Diagnosis of pain in diabetes
Considering the localization of pain syndromes, the diagnosis of pain in diabetes requires a thorough examination with the involvement of doctors of various specializations - from an orthopedist and neurologist to a gastroenterologist and ophthalmologist.
And depending on the specific patient, in each case, tests are prescribed, instrumental and differential diagnostics are carried out.
Full details in the article – Diagnosis of diabetic neuropathy
Treatment of pain in diabetes
From the point of view of etiology, the main treatment for pain in diabetes is adequate insulin replacement and sugar-lowering therapy, that is, treatment of the disease itself. All other pharmacological drugs, including painkillers - for example, Carbamazepine, Gabapentin or Pregabalin - are symptomatic treatment.
It is common to prescribe vitamins in shock doses: thiamine (B1), which acts as a strong antioxidant; pyridoxine (B6), which increases immunity and helps nerve cells absorb glucose; and cyanocobalamin (B12), which supports the body's defenses, hematopoiesis, and the nervous system.
How to get rid of pain in diabetes and what medications should be taken, how physiotherapy treatment is carried out and whether folk treatment of pain syndromes in diabetes is possible, as well as when surgical treatment is necessary - in detail in the material Treatment of diabetic neuropathy
Consequences and complications
As practice shows, foot pain in diabetes is not the worst thing: the appearance of ulcers on the toes, between the toes, on the heels can lead to necrosis of soft tissues, and necrosis - to gangrene.
With insulitis, damage to the tissues of the pancreas can progress to pancreatitis or lead to fibrosis and complete cessation of organ function.
When complications of diabetes affect the kidneys - with nodular or widespread glomerular involvement - the result is most often chronic renal failure.
The consequences and complications of diabetic retinopathy include not only deformation of the vitreous body, but also retinal detachment and irreversible vision loss.
But even more severe consequences – death – are caused by ketoacidotic coma in diabetes, and this condition ends in almost ten cases out of a hundred.
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Prevention
Unfortunately, today, diabetes prevention, despite advice to lead a healthy lifestyle, is impossible.
And the main thing in preventing diabetic polyneuropathy is the constant fight against hyperglycemia and control of blood sugar levels. First of all, these are appropriate drugs, but you should also control your diet. Read - Diet for type 1 diabetes and Diet for type 2 diabetes
Endocrinologists claim that in this way the risk of developing serious complications of diabetes can be reduced by half.