Proximal diabetic neuropathy

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Proximal diabetic neuropathy, also called diabetic amyotrophy, is a nerve problem in people with diabetes. It mainly affects the nerves that control the hips, buttocks, thighs, and sometimes the lower legs. It is more common in people with type 2 diabetes and is less common than the better-known distal diabetic neuropathy that affects the feet.

What it feels like
- Sudden, sometimes severe pain in the buttocks, hips, thighs, or legs. The pain often starts on one side but can affect both sides.
- Weakness in the muscles close to the body (thighs and hips) after the pain starts.
- Muscle twitching (fasciculations) and sometimes weight loss.
- Numbness or tingling can occur but is less prominent than the pain and weakness.

What may cause it
- Damage to nerves in the lumbosacral plexus (the network of nerves that send signals to the hip and thigh).
- Possible factors include damage to small blood vessels supplying nerves (ischemia) related to high blood sugar, or immune-related changes causing inflammation of the small vessels.
- It can occur in people with type 2 diabetes and, rarely, in people without diabetes (a non-diabetic form).

How it’s diagnosed
- Diagnosis is based on symptoms and tests of nerve function.
- Nerve conduction studies (NCS) and electromyography (EMG) help show problems in the lumbosacral nerves.
- Doctors may rule out other causes of hip and thigh pain.

Prevention and management
- Good blood sugar control may help prevent it and can support recovery.
- Pain relief medicines such as gabapentin or pregabalin are commonly used.
- Physical therapy and targeted exercises can help restore strength and mobility.

Outlook
- Proximal diabetic neuropathy is often a one-time (monophasic) event and may improve over time.
- Pain and weakness may persist for some people and can affect walking and daily activities, even with treatment.