Prevent diabetes problems

Keep your nervous 

system healthy

Number

6

in a

Series 

of 7

National Diabetes Information 

Clearinghouse

Prevent diabetes problems:

Keep your nervous 

system healthy

Contents

What is my nervous system and what 

does it do?................................................................. 1

How can diabetes affect my nervous

system? ...................................................................... 3

What are the symptoms of nerve damage?............ 4

What are the types of nerve damage 

from diabetes? .......................................................... 4

How will I know if I have nerve damage? ............ 14

How does nerve damage affect my feet? ............. 16

How does smoking affect my diabetes 

and nervous system? .............................................. 17

What is the treatment for nerve damage 

from diabetes? ........................................................ 18

How can I keep my nervous system 

healthy? ................................................................... 20

Eating, Diet, and Nutrition ................................... 22

Pronunciation Guide.............................................. 23

For More Information ........................................... 25

More in the Series.................................................. 28

Acknowledgments.................................................. 29

 1

What is my nervous system and what 

does it do?

Your nervous system carries signals between your 

brain and other parts of your body through your 

spinal cord. Nerves are bundles of special tissues 

that transmit these signals. 

The signals share information between your brain 

and body about how things feel. The signals also 

send information between your brain and body 

to control automatic body functions, such as 

breathing and digestion, and to move your body 

parts. 

The nerves in your spinal cord branch out to all 

of your organs and body parts. All your nerves 

together make up your nervous system.
2 

Your nervous system is composed of the

● central nervous system—your brain and spinal cord

● cranial* nerves—nerves that connect your brain 

to your head, neck, and face

● peripheral nervous system—nerves that connect 

your spinal cord to your entire body, including 

your organs and your arms, hands, legs, and feet 

*See the Pronunciation Guide for tips on how to 

say the words in bold type.

Your nervous system carries signals 

between your brain and other parts of 

your body through your spinal cord.
 3

How can diabetes affect my 

nervous system?

Over time, too much fat and glucose, also called 

sugar, in your blood from diabetes can damage 

your nerves. High blood glucose also can damage 

the small blood vessels that nourish your nerves 

with oxygen and nutrients. Without enough 

oxygen and nutrients, nerves cannot function well. 

Damaged nerves may stop sending signals, or they 

may send signals too slowly or at the wrong times. 

Nerve damage from diabetes is called diabetic 

neuropathy. 

If you have diabetes, you can develop nerve 

damage at any time; however, you are more likely 

to have it the older you are and the longer you 

have diabetes. Nerve damage is also more likely if 

you 

● have high cholesterol and blood fat 

● have high blood pressure 

● are overweight

● have kidney disease

● smoke 

● drink too many alcoholic beverages
4 

What are the symptoms of nerve 

damage? 

Nerve damage symptoms depend on which nerves 

have damage. Some people have no symptoms or 

mild symptoms. Other people have painful and 

long-lasting symptoms. As most nerve damage 

develops over many years, a person may not notice 

mild cases for a long time. In some people, the 

onset of pain may be sudden and severe.

What are the types of nerve damage 

from diabetes? 

Peripheral Neuropathy 

Peripheral neuropathy is the most common type 

of diabetic neuropathy, and it affects the sensory

nerves of your feet, legs, hands, and arms. These 

areas of your body may feel 

● numb 

● weak

● cold

● burning or tingling, like “pins and needles” 
 5

You may feel extreme pain in these areas of your 

body, even when they are touched lightly. You also 

may feel pain in your legs and feet when walking. 

These feelings are often worse at night and can 

make it hard to sleep. Most of the time, you will 

have these feelings on both sides of your body, 

such as in both feet; however, they can occur just 

on one side. 
6 

You might have other problems, such as 

● swollen feet

● loss of balance

● loss of muscle tone in your hands and feet

● a deformity or shape change in your toes and 

feet

● calluses or open sores on your feet

Autonomic Neuropathy 

Autonomic neuropathy can affect your

● digestive system

● sex organs

● bladder

● sweat glands

● eyes

● heart rate and blood pressure

● ability to sense low blood glucose
 7

Digestive system. Damage to nerves in your 

stomach, intestines, and other parts of your 

digestive system may

● make it hard to swallow both solid food and 

liquids

● cause stomach pain, nausea, vomiting, 

constipation, or diarrhea

● make it hard to keep your blood glucose under 

control

Your doctor or dietitian may advise you to eat 

smaller, more frequent meals; avoid fatty foods; 

and eat less fiber. 

Sex organs. Damage to nerves in the sex organs may

● prevent a man’s penis from getting firm when he 

wants to have sex, called erectile dysfunction or 

impotence. Many men who have had diabetes 

for several years have impotence.

● prevent a woman’s vagina from getting wet when 

she wants to have sex. A woman might also have 

less feeling around her vagina.
8 

Bladder. Damage to nerves in your bladder may 

make it hard to know when you need to urinate 

and when your bladder is empty. This damage can 

cause you to hold urine for too long, which can 

lead to bladder infections. You also might leak 

drops of urine. 
 9

Sweat glands. Damage to nerves in your sweat 

glands may prevent them from working properly. 

Nerve damage can cause you to sweat a lot at night 

or while eating.

Eyes. Damage to nerves in your pupils, the parts 

of your eyes that react to changes in light and 

darkness, may make them slow to respond to these 

changes. You may have trouble seeing the lights 

of other cars when driving at night. Your eyes may 

take longer to adjust when you enter a dark room.
10 

Heart rate and blood pressure. Damage to nerves 

that control your heart rate and blood pressure 

may make these nerves respond more slowly to 

changes in position, stress, physical activity, sleep, 

and breathing patterns. You might feel dizzy or 

pass out when you go from lying down to standing 

up or when you do physical activity. You also 

might have shortness of breath or swelling in 

your feet.
 11

Ability to sense low blood glucose. Autonomic 

nerves also let you know when your blood glucose 

is low. Damage to these nerves can prevent you 

from feeling the symptoms of low blood glucose, 

also called hypoglycemia. This kind of nerve 

damage is more likely to happen if you have had 

diabetes for a long time or if your blood glucose 

has often been too low. Low blood glucose can 

make you

● hungry

● dizzy or shaky

● confused

● pale

● sweat more

● weak

● anxious or cranky

● have headaches

● have a fast heartbeat
12 

Severe hypoglycemia can cause you to pass out. If 

that happens, you’ll need help bringing your blood 

glucose level back to normal. Your health care 

team can teach your family members and friends 

how to give you an injection of glucagon, a hormone 

that raises blood glucose levels quickly. If glucagon 

is not available, someone should call 911 to get you 

to the nearest emergency room for treatment.

Consider wearing a diabetes medical alert 

identification bracelet or necklace. If you have 

hypoglycemia and are not able to communicate, 

the emergency team will know you have diabetes 

and get you the proper treatment. You can find 

these bracelets or necklaces at your pharmacy 

or on the Internet. You can also ask your doctor 

for information on available products.
 13

Other Neuropathies

Other types of neuropathies from diabetes can 

cause

● damage to the joint and bones of your foot, 

called Charcot’s foot, in which you cannot sense 

pain or the position of your foot

● carpal tunnel syndrome, in which a nerve in your 

forearm is compressed at your wrist, causing 

numbness, swelling, and pain in your fingers

● paralysis on one side of your face, called 

Bell’s palsy

● double vision or not being able to focus 

your eyes

● aching behind one eye
14 

How will I know if I have nerve 

damage?

Your doctor can tell whether you have nerve 

damage by asking about your symptoms and 

checking your 

● blood pressure

● heart rate

● muscle strength

● reflexes

● response to vibrations and changes in 

temperature 

● feet

Your doctor also may check

● your response to light touch on your feet with a 

soft nylon string, called a monofilament test

● how well your muscles respond to electrical 

signals by ordering a test called an 

electromyogram (EMG) 
 15

● how well and how fast your nerves can send 

electrical signals by ordering a test called a nerve 

conduction velocity test 

● how your heart rate responds to deep breathing

● how your blood pressure responds when you go 

from lying down to sitting or standing 

● whether your organs look healthy by ordering a 

test called an ultrasound

Tell your doctor if you have one or more symptoms 

of nerve damage.
16 

How does nerve damage affect 

my feet? 

The nerves to your feet are the longest in your 

body and are the most affected by nerve damage. 

If you have damage to these nerves, you may 

not feel pain, heat, or cold in your legs and feet. 

You might not notice sores or injuries, which can 

become infected. If you have any sores on your 

feet, see your doctor right away. Prompt attention 

to any sore or infection on your toe or foot can 

prevent more serious problems with your toes, feet, 

or parts of your legs.

Remind your doctor to check your feet at every 

office visit. See your doctor at least once a year 

for a foot exam, or more often if you have foot 

problems. 

Check your feet every day 

for problems. If you have 

problems with your feet, your 

doctor may send you to a foot 

doctor, called a podiatrist.

Read more in Prevent 

diabetes problems: Keep 

your feet healthy at 

www.diabetes.niddk.nih.gov.

Check your feet every 

day for problems.
 17

How does smoking affect my diabetes 

and nervous system?

Smoking can narrow and harden the blood vessels 

that nourish your nerves with oxygen and nutrients. 

Smoking and diabetes are a dangerous mix. 

Smoking raises your risk for many diabetes 

problems. If you quit smoking, 

● you will lower your risk for heart attack, stroke, 

nerve disease, kidney disease, and amputation

● your cholesterol and blood pressure levels might 

improve 

● your blood circulation will improve 

If you smoke, stop smoking. Ask for help so that 

you don’t have to do it alone. You can start by 

calling 1–800–QUITNOW or 1–800–784–8669.
18 

What is the treatment for nerve 

damage from diabetes? 

The treatment for nerve damage from diabetes 

is based on your symptoms. No treatment can 

reverse nerve damage; however, it can help you 

feel better. Your doctor might suggest taking low 

doses of medicines that both treat other health 

problems and help the pain of neuropathy. Some 

of these medicines include 

● antidepressants 

● anticonvulsants, or anti-seizure medicines

Other treatment options include 

● creams or patches on your skin for burning pain

● over-the-counter pain medicines

● acupuncture, a form of pain treatment that 

uses needles inserted into your body at certain 

pressure points 
 19

● physical therapy, which helps with muscle 

weakness and loss of balance

● relaxation exercises, such as yoga

● special shoes to fit softly around sore feet or feet 

that have changed shape

Your doctor also can prescribe medicines to 

help with problems caused by nerve damage in 

other areas of your body, such as poor digestion, 

dizziness, sexual problems, and lack of bladder 

control.

Stopping smoking and drinking alcoholic beverages 

also may help with symptoms. 
20 

How can I keep my nervous system 

healthy? 

You can keep your nervous system healthy by 

taking these steps:

● Keep your blood glucose numbers as close to 

your target as possible. If you already have 

nerve damage, doing so will help you prevent 

more nerve damage and may decrease pain or 

other symptoms. Your doctor will work with you 

to set your target blood glucose numbers and 

teach you what to do if your numbers are too 

high or too low. 

● Be physically active and take your diabetes 

medicines, as advised by your doctor.

● If you smoke, stop smoking.
 21

● Tell your doctor right away about any problems 

you have with 

•	 your hands, arms, feet, or legs

•	 your stomach, bowels, or bladder

•	having sex 

•	knowing when your blood glucose is too low

•	feeling dizzy when you go from lying down to 

sitting or standing

● Take care of your feet.

● Remind your doctor to check your feet at every 

office visit. See your doctor at least once a year 

for a foot exam, or more often if you have foot 

problems. 
22 

Eating, Diet, and Nutrition

You can keep your nervous system healthy by 

taking these steps:

● Eat healthy meals and follow the meal plan 

that you and your doctor or dietitian have 

worked out.

● If you drink alcoholic beverages, limit your 

intake to no more than one drink per day 

for women and two drinks per day for men. 

Drinking too many alcoholic beverages can make 

nerve damage worse. 

Read more in What I need to know about Eating 

and Diabetes at www.diabetes.niddk.nih.gov.
 23

Pronunciation Guide

acupuncture (AK-yoo-PUNK-chur)

anticonvulsants (AN-tee-kon-VUHL-sants)

antidepressants (AN-tee-dee-PRESS-uhnts)

autonomic (AW-toh-NOM-ik)

Charcot’s (SHAHR-kohz)

cholesterol (koh-LESS-tur-ol)

circulation (SUR-kyoo-LAY-shuhn)

conduction velocity (kon-DUHK-shuhn)

 (vuh-LOS-ih-tee)

cranial (KRAY-nee-uhl)

dietitian (DY-uh-TISH-shuhn)

electromyogram (ee-lek-troh-MY-oh-gram)

erectile dysfunction (ee-REK-tyl) 

 (diss-FUHNK-shuhn)
24 

glucagon (GLOO-kuh-gon)

glucose (GLOO-kohss)

hypoglycemia (HY-poh-gly-SEE-mee-uh)

impotence (IM-puh-tenss)

monofilament (mon-oh-FIL-uh-ment)

neuropathy (noo-ROP-uh-thee)

peripheral (puh-RIF-ur-uhl)

podiatrist (poh-DIE-uh-trist)

sensory (SEN-suh-ree)

ultrasound (UHL-truh-sound)
 25

For More Information

To find diabetes educators (nurses, dietitians, 

pharmacists, and other health care providers), 

contact

American Association of Diabetes Educators 

200 West Madison Street, Suite 800 

Chicago, IL 60606 

Phone: 1–800–338–3633 

Internet: www.diabeteseducator.org 

To find dietitians, contact

Academy of Nutrition and Dietetics 

120 South Riverside Plaza, Suite 2000

Chicago, IL 60606–6995

Internet: www.eatright.org 

Click on “Find a Registered Dietitian.”
26 

To learn more about nervous system problems, 

contact

National Institute of Neurological Disorders 

and Stroke 

NIH Neurological Institute

P.O. Box 5801

Bethesda, MD 20824

Phone: 1–800–352–9424 or 301–496–5751

Telecommunications Relay Services: 7–1–1

Internet: www.ninds.nih.gov

To get more information about taking care of 

diabetes, contact

National Diabetes Information Clearinghouse

1 Information Way

Bethesda, MD 20892–3560

Phone: 1–800–860–8747

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: ndic@info.niddk.nih.gov

Internet: www.diabetes.niddk.nih.gov
 27

National Diabetes Education Program

1 Diabetes Way

Bethesda, MD 20814–9692

Phone: 1–888–693–NDEP (1–888–693–6337)

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: ndep@mail.nih.gov

Internet: www.ndep.nih.gov

www.yourdiabetesinfo.org

American Diabetes Association

1701 North Beauregard Street

Alexandria, VA 22311

Phone: 1–800–DIABETES (1–800–342–2383)

Email: askADA@diabetes.org

Internet: www.diabetes.org

JDRF

26 Broadway, 14th Floor

New York, NY 10004

Phone: 1–800–533–CURE (1–800–533–2873)

Fax: 212–785–9595

Email: info@jdrf.org

Internet: www.jdrf.org
28 

More in the Series

The Prevent Diabetes Problems Series includes 

seven booklets that can help you learn more about 

how to prevent diabetes problems:

● Prevent diabetes problems: Keep your diabetes 

under control

● Prevent diabetes problems: Keep your eyes healthy

● Prevent diabetes problems: Keep your feet healthy

● Prevent diabetes problems: Keep your heart and 

blood vessels healthy

● Prevent diabetes problems: Keep your kidneys 

healthy

● Prevent diabetes problems: Keep your mouth 

healthy

● Prevent diabetes problems: Keep your nervous 

system healthy
 29

For free single copies of these booklets, write, call, 

fax, or email the

National Diabetes Information Clearinghouse

1 Information Way

Bethesda, MD 20892–3560

Phone: 1–800–860–8747

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: ndic@info.niddk.nih.gov 

These booklets are also available at www.diabetes.

niddk.nih.gov.

Acknowledgments

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists 

and outside experts. The National Diabetes 

Information Clearinghouse (NDIC) thanks 

Robin Conwit, M.D., program director, Division 

of Extramural Research, National Institute of 

Neurological Disorders and Stroke, National 

Institutes of Health, for reviewing the updated 

version of this publication. 
30 

The NDIC also thanks the following people who 

helped review or field-test the original version of 

this publication:

For the American Association 

of Diabetes Educators

Lynn Grieger, R.D., C.D.E.

Arlington, VT

Celia Levesque, R.N., C.D.E.

Montgomery, AL

Teresa McMahon, 

Pharm.D., C.D.E.

Seattle, WA

Barbara Schreiner, R.N., 

M.N., C.D.E.

Galveston, TX

For the American Diabetes 

Association

Phyllis Barrier, M.S., R.D., 

C.D.E.

Alexandria, VA

Linda Haas, Ph.C., R.N., 

C.D.E.

Seattle, WA

Kathleen Mahoney, M.S.N.,

R.N., C.D.E.

Drexel Hill, PA

Randi Kington, M.S., R.N., 

C.S., C.D.E.

Hartford, CT 

For the Centers for Medicare 

& Medicaid Services

Baltimore, MD

Jan Drass, R.N., C.D.E.

For the Diabetes Research 

Centers

Albert Einstein School 

of Medicine

Norwalk Hospital

Norwalk, CT

Jill Ely, R.N., C.D.E.

Sam Engel, M.D.

Pam Howard, A.P.R.N., 

C.D.E.

Indiana University School

of Medicine

Indianapolis, IN

Madelyn Wheeler, M.S., 

R.D., F.A.D.A., C.D.E.

VA/JDF Diabetes Research 

Center

Vanderbilt School of 

Medicine

Nashville, TN

Ok Chon Allison, M.S.N., 

R.N.C.S., A.N.P., C.D.E.

Barbara Backer, B.S.

James W. Pichert, Ph.D.

Alvin Powers, M.D.

Melissa E. Schweikhart

Michael B. Smith

Kathleen Wolffe, R.N.

For the Grady Health System

Diabetes Clinic

Atlanta, GA

Ernestine Baker, R.N., 

F.N.P., C.D.E.

Kris Ernst, R.N., C.D.E.

Margaret Fowke, R.D., L.D.

Kay Mann, R.N., C.D.E.

For the Indian Health 

Service

Albuquerque, NM

Ruth Bear, R.D., C.D.E.

Dorinda Bradley, R.N., 

C.D.E.

Terry Fisher, R.N.

Lorraine Valdez, R.N., 

C.D.E.

Red Lake, MN

Charmaine Branchaud, 

B.S.N., R.N., C.D.E.

For the Medlantic Research 

Center

Washington, D.C.

Resa Levetan, M.D.

For the Texas Diabetes 

Council

Texas Department of Health

Austin, TX

Luby Garza-Abijaoude, 

M.S., R.D., L.D.
 31

National Diabetes Education Program

1 Diabetes Way

Bethesda, MD 20814–9692

Phone: 1–888–693–NDEP (1–888–693–6337)

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: ndep@mail.nih.gov

Internet: www.ndep.nih.gov

www.yourdiabetesinfo.org

The National Diabetes Education Program is a 

federally funded program sponsored by the U.S. 

Department of Health and Human Services’ 

National Institutes of Health and the Centers for 

Disease Control and Prevention and includes over 

200 partners at the federal, state, and local levels, 

working together to reduce the morbidity and 

mortality associated with diabetes.

National Diabetes Information 

Clearinghouse

1 Information Way

Bethesda, MD 20892–3560

Phone: 1–800–860–8747

TTY: 1–866–569–1162

Fax: 703–738–4929

Email: ndic@info.niddk.nih.gov

Internet: www.diabetes.niddk.nih.gov

The National Diabetes Information Clearinghouse (NDIC) is 

a service of the National Institute of Diabetes and Digestive 

and Kidney Diseases (NIDDK). The NIDDK is part of the 

National Institutes of Health of the U.S. Department of Health 

and Human Services. Established in 1978, the Clearinghouse 

provides information about diabetes to people with diabetes and 

to their families, health care professionals, and the public. The 

NDIC answers inquiries, develops and distributes publications, 

and works closely with professional and patient organizations 

and Government agencies to coordinate resources about 

diabetes. 

This publication is not copyrighted. The Clearinghouse 

encourages users of this publication to duplicate and 

distribute as many copies as desired.

This publication is available at www.diabetes.niddk.nih.gov.

This publication may contain information about medications 

and, when taken as prescribed, the conditions they treat. When 

prepared, this publication included the most current information 

available. For updates or for questions about any medications, 

contact the U.S. Food and Drug Administration toll-free at 

1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. 

Consult your health care provider for more information.
NIH Publication No. 14–4284

February 2014

The NIDDK prints on recycled paper with bio-based ink.