Painful Diabetic Neuropathy




QUESTION:


My boyfriend has type 1 diabetes and started complaining yesterday that his side hurts. What could be causing the pain, and what should he do?





Quick Answer


New side pain in someone with type 1 diabetes should not automatically be labeled diabetic neuropathy. It may come from a muscle strain, rib or spine problem, kidney stone, kidney infection, stomach or bowel condition, gallbladder disease, shingles, lung problem or another cause. Abdominal or side pain with high glucose, ketones, vomiting, deep breathing, fruity breath, dehydration or drowsiness may indicate diabetic ketoacidosis and needs urgent medical care. Severe, persistent or worsening pain should be assessed promptly.




Answer by Dr. Albana Greca, MD, MMedSc



Hello,



“Side pain” cannot be diagnosed without its location, severity and associated symptoms. In type 1 diabetes, first exclude an acute glucose or ketone emergency.



First Check Glucose and Ketones



He should check glucose now. If it is 240 mg/dL or higher, or he is ill, follow his sick-day plan and check ketones. Do not stop basal insulin unless his diabetes team instructs him.




Seek urgent or emergency care for possible DKA:


Moderate or large ketones, repeated vomiting, abdominal pain, rapid or deep breathing, fruity-smelling breath, marked thirst, frequent urination, severe weakness, dehydration, confusion or unusual drowsiness. Diabetic ketoacidosis can become life-threatening quickly.




Do not give extra insulin beyond his written correction and ketone plan. If he cannot keep fluids down, is confused or has breathing difficulty, do not wait for glucose to improve at home. See our guide to dangerous blood sugar and ketone warning signs.



Where Exactly Is the Pain?



Note whether pain is under the ribs, in the chest, abdomen, flank, back or hip, and whether it is sharp, burning, cramping or tender with movement.




  • Muscle or rib pain: Often follows lifting, coughing, sport or an awkward movement and worsens with twisting or pressing the area.

  • Kidney stone: Severe pain may come in waves from the side or back and travel toward the groin, often with nausea or blood in the urine.

  • Kidney infection: Flank pain may occur with fever, chills, burning urination or frequent urination.

  • Gallbladder problem: Right upper abdominal pain may follow meals and may spread to the back or right shoulder.

  • Appendicitis: Pain may move toward the lower right abdomen and worsen with fever, nausea or loss of appetite.

  • Shingles: Burning or sensitive pain on one side may be followed by a stripe of blisters.

  • Lung or chest condition: Pain may worsen with breathing and occur with cough, fever or shortness of breath.



The old reassurance that a young person “should not worry” is unsafe. Kidney infection, appendicitis, DKA and other urgent conditions can affect young adults.



Could It Be Diabetic Neuropathy?



Possibly, but ordinary diabetic peripheral neuropathy usually begins gradually in both feet with numbness, tingling, burning or electric pain. Sudden isolated side pain is not its typical presentation.



Rare diabetic truncal radiculoneuropathy can cause one-sided burning or band-like chest or abdominal pain with skin sensitivity. It is a diagnosis of exclusion after other causes are considered.



Diabetic neuropathy is more likely after years of diabetes or persistent hyperglycemia, but good glucose control does not rule it out completely. Read our guide to diabetic neuropathy symptoms and other possible causes.



Emergency Warning Signs



Call emergency services for:




  • Chest pressure or pain with breathlessness, sweating, faintness or pain spreading to the arm, jaw, shoulder or back

  • Severe abdominal pain with a rigid abdomen, collapse or repeated vomiting

  • Possible DKA symptoms or moderate to large ketones

  • Sudden weakness, facial drooping, difficulty speaking or loss of coordination

  • Severe pain after an injury or with difficulty breathing



Arrange urgent same-day care for fever with flank pain, blood in the urine, painful urination, a new blistering rash, persistent right lower abdominal pain, or severe pain that comes in waves.



What Can He Do While Arranging Care?




  • Check and record glucose, ketones and temperature.

  • Continue insulin according to his prescribed sick-day plan.

  • Sip sugar-free fluids if glucose is high and he can drink safely.

  • Avoid heavy exercise until DKA, infection and injury are excluded.

  • Do not use leftover antibiotics or another person’s pain medicine.

  • Note the exact location, onset, movement of pain and associated symptoms.



A clinician may examine the chest, abdomen, back, skin and nerves and order targeted tests. Treatment depends entirely on the cause.



If Neuropathic Pain Is Confirmed



Glucose management helps prevent or slow nerve damage but does not immediately remove established pain. Prescription options may include duloxetine, pregabalin, gabapentin or other selected medicines.



These medicines should not be started without a diagnosis. Opioids are generally avoided for chronic diabetic nerve pain because long-term risks can outweigh benefit. Review our page on diabetic nerve pain and treatment.



Related Questions





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This educational answer does not replace examination of new side, chest, flank or abdominal pain.



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