Diabetic Neuropathies: 

The Nerve Damage 

of Diabetes 

National Diabetes Information Clearinghouse 

U.S. Department 

of Health and 

Human Services 

NATIONAL 

INSTITUTES 

OF HEALTH 

What are diabetic 

neuropathies? 

Diabetic neuropathies are a family of nerve 

disorders caused by diabetes. People with 

diabetes can, over time, develop nerve damage throughout the body. Some people with 

nerve damage have no symptoms. Others 

may have symptoms such as pain, tingling, 

or numbness—loss of feeling—in the hands, 

arms, feet, and legs. Nerve problems can 

occur in every organ system, including the 

digestive tract, heart, and sex organs. 

About 60 to 70 percent of people with diabetes have some form of neuropathy. People 

with diabetes can develop nerve problems at 

any time, but risk rises with age and longer 

duration of diabetes. The highest rates of 

neuropathy are among people who have 

had diabetes for at least 25 years. Diabetic 

neuropathies also appear to be more common in people who have problems controlling their blood glucose, also called blood 

sugar, as well as those with high levels of 

blood fat and blood pressure and those who 

are overweight. 

What causes diabetic 

neuropathies? 

The causes are probably different for different types of diabetic neuropathy. Researchers are studying how prolonged exposure to 

high blood glucose causes nerve damage. 

Nerve damage is likely due to a combination 

of factors: 

•	 metabolic factors, such as high blood 

glucose, long duration of diabetes, 

abnormal blood fat levels, and possibly 

low levels of insulin 

•	 neurovascular factors, leading to damage to the blood vessels that carry 

oxygen and nutrients to nerves 

•	 autoimmune factors that cause inflammation in nerves 

•	 mechanical injury to nerves, such as 


carpal tunnel syndrome
 

•	 inherited traits that increase susceptibility to nerve disease 

•	 lifestyle factors, such as smoking or 


alcohol use 


What are the symptoms of 

diabetic neuropathies? 

Symptoms depend on the type of neuropathy 

and which nerves are affected. Some people 

with nerve damage have no symptoms at all. 

For others, the first symptom is often numbness, tingling, or pain in the feet. Symptoms 

are often minor at first, and because most 

nerve damage occurs over several years, 

mild cases may go unnoticed for a long time. 

Symptoms can involve the sensory, motor, 

and autonomic—or involuntary—nervous 

systems. In some people, mainly those with 

focal neuropathy, the onset of pain may be 

sudden and severe. 

Symptoms of nerve damage may include 

•	 numbness, tingling, or pain in the toes, 

feet, legs, hands, arms, and fingers 

•	 wasting of the muscles of the feet or 


hands
 

•	 indigestion, nausea, or vomiting 

•	 diarrhea or constipation 

•	 dizziness or faintness due to a drop in 

blood pressure after standing or sitting up 
•	 problems with urination 

•	 erectile dysfunction in men or vaginal 

dryness in women 

•	 weakness 

Symptoms that are not due to neuropathy, 

but often accompany it, include weight loss 

and depression. 

What are the types of 

diabetic neuropathy? 

Diabetic neuropathy can be classified as 

peripheral, autonomic, proximal, or focal. 

Each affects different parts of the body in 

various ways. 

•	 Peripheral neuropathy, the most 

common type of diabetic neuropathy, 

causes pain or loss of feeling in the toes, 

feet, legs, hands, and arms. 

•	 Autonomic neuropathy causes changes 

in digestion, bowel and bladder function, sexual response, and perspiration. 

It can also affect the nerves that serve 

the heart and control blood pressure, 

as well as nerves in the lungs and eyes. 

Autonomic neuropathy can also cause 

hypoglycemia unawareness, a condition 

in which people no longer experience 

the warning symptoms of low blood 

glucose levels. 

•	 Proximal neuropathy causes pain in the 

thighs, hips, or buttocks and leads to 

weakness in the legs. 

•	 Focal neuropathy results in the sudden weakness of one nerve or a group 

of nerves, causing muscle weakness or 

pain. Any nerve in the body can be 

affected. 

Neuropathy Affects Nerves 

Throughout the Body 

Peripheral neuropathy affects 

•	 toes 

•	 feet 

•	 legs 

•	 hands 

•	 arms 

Autonomic neuropathy affects 

•	 heart and blood vessels 

•	 digestive system 

•	 urinary tract 

•	 sex organs 

•	 sweat glands 

•	 eyes 

•	 lungs 

Proximal neuropathy affects 

•	 thighs 

•	 hips 

•	 buttocks 

•	 legs 

Focal neuropathy affects 

•	 eyes 

•	 facial muscles 

•	 ears 

•	 pelvis and lower back 

•	 chest 

•	 abdomen 

•	 thighs 

•	 legs 

•	 feet 

2 Diabetic Neuropathies: The Nerve Damage of Diabetes 
What is peripheral 

neuropathy? 

Peripheral neuropathy, also called distal 

symmetric neuropathy or sensorimotor 

neuropathy, is nerve damage in the arms and 

legs. Feet and legs are likely to be affected 

before hands and arms. Many people with 

diabetes have signs of neuropathy that a doctor could note but feel no symptoms themselves. Symptoms of peripheral neuropathy 

may include 

•	 numbness or insensitivity to pain or 


temperature
 

•	 a tingling, burning, or prickling 


sensation
 

•	 sharp pains or cramps 

•	 extreme sensitivity to touch, even light 

touch 

•	 loss of balance and coordination 

These symptoms are often worse at night. 

Peripheral neuropathy may also cause muscle weakness and loss of reflexes, especially 

at the ankle, leading to changes in the way 

a person walks. Foot deformities, such as 

hammertoes and the collapse of the midfoot, 

may occur. Blisters and sores may appear on 

numb areas of the foot because pressure or 

injury goes unnoticed. If an infection occurs 

and is not treated promptly, the infection 

may spread to the bone, and the foot may 

then have to be amputated. Many amputations are preventable if minor problems are 

caught and treated in time. 

Peripheral neuropathy affects the nerves in the toes, 

feet, legs, hands, and arms. 

3 Diabetic Neuropathies: The Nerve Damage of Diabetes 
 

 

What is autonomic 

neuropathy? 

Autonomic neuropathy affects the nerves 

that control the heart, regulate blood pressure, and control blood glucose levels. 

Autonomic neuropathy also affects other 

internal organs, causing problems with 

digestion, respiratory function, urination, 

sexual response, and vision. In addition, the 

system that restores blood glucose levels to 

normal after a hypoglycemic episode may 

be affected, resulting in loss of the warning 

symptoms of hypoglycemia. 

Autonomic neuropathy affects the nerves in the 

heart, stomach, intestines, bladder, sex organs, sweat 

glands, eyes, and lungs. 

Hypoglycemia Unawareness 

Normally, symptoms such as shakiness, 

sweating, and palpitations occur when blood 

glucose levels drop below 70 mg/dL. In 

people with autonomic neuropathy, symptoms may not occur, making hypoglycemia 

difficult to recognize. Problems other than 

neuropathy can also cause hypoglycemia 

unawareness. 

Heart and Blood Vessels 

The heart and blood vessels are part of the 

cardiovascular system, which controls blood 

circulation. Damage to nerves in the cardiovascular system interferes with the body’s 

ability to adjust blood pressure and heart 

rate. As a result, blood pressure may drop 

sharply after sitting or standing, causing a 

person to feel light-headed or even to faint. 

Damage to the nerves that control heart 

rate can mean that the heart rate stays high, 

instead of rising and falling in response to 

normal body functions and physical activity. 

Digestive System 

Nerve damage to the digestive system most 

commonly causes constipation. Damage can 

also cause the stomach to empty too slowly, 

a condition called gastroparesis. Severe 

gastroparesis can lead to persistent nausea 

and vomiting, bloating, and loss of appetite. 

Gastroparesis can also make blood glucose 

levels fluctuate widely due to abnormal food 

digestion. 

Nerve damage to the esophagus may make 

swallowing difficult, while nerve damage to 

the bowels can cause constipation alternating with frequent, uncontrolled diarrhea, 

especially at night. Problems with the digestive system can lead to weight loss. 

4 Diabetic Neuropathies: The Nerve Damage of Diabetes 
Urinary Tract and Sex Organs 

Autonomic neuropathy often affects the 

organs that control urination and sexual 

function. Nerve damage can prevent the 

bladder from emptying completely, allowing 

bacteria to grow in the bladder and kidneys 

and causing urinary tract infections. When 

the nerves of the bladder are damaged, 

urinary incontinence may result because a 

person may not be able to sense when the 

bladder is full or control the muscles that 

release urine. 

Autonomic neuropathy can also gradually decrease sexual response in men and 

women, although the sex drive may be 

unchanged. A man may be unable to have 

erections or may reach sexual climax without ejaculating normally. A woman may 

have difficulty with arousal, lubrication, or 

orgasm. 

Sweat Glands 

Autonomic neuropathy can affect the nerves 

that control sweating. When nerve damage prevents the sweat glands from working properly, the body cannot regulate its 

temperature as it should. Nerve damage can 

also cause profuse sweating at night or while 

eating. 

Eyes 

Finally, autonomic neuropathy can affect the 

pupils of the eyes, making them less responsive to changes in light. As a result, a person 

may not be able to see well when a light 

is turned on in a dark room or may have 

trouble driving at night. 

What is proximal 

neuropathy? 

Proximal neuropathy, sometimes called lumbosacral plexus neuropathy, femoral neuropathy, or diabetic amyotrophy, starts with pain 

in the thighs, hips, buttocks, or legs, usually 

on one side of the body. This type of neuropathy is more common in those with type 2 

diabetes and in older adults with diabetes. 

Proximal neuropathy causes weakness in the 

legs and the inability to go from a sitting to 

a standing position without help. Treatment 

for weakness or pain is usually needed. The 

length of the recovery period varies, depending on the type of nerve damage. 

What is focal neuropathy? 

Focal neuropathy appears suddenly and 

affects specific nerves, most often in the 

head, torso, or leg. Focal neuropathy may 

cause 

•	 inability to focus the eye 

•	 double vision 

•	 aching behind one eye 

•	 paralysis on one side of the face, called 

Bell’s palsy 

•	 severe pain in the lower back or pelvis 

•	 pain in the front of a thigh 

•	 pain in the chest, stomach, or side 

•	 pain on the outside of the shin or inside 

of the foot 

•	 chest or abdominal pain that is sometimes mistaken for heart disease, a 

heart attack, or appendicitis 

Focal neuropathy is painful and unpredictable and occurs most often in older adults 

with diabetes. However, it tends to improve 

by itself over weeks or months and does not 

cause long-term damage. 

5 Diabetic Neuropathies: The Nerve Damage of Diabetes 
People with diabetes also tend to develop 

nerve compressions, also called entrapment 

syndromes. One of the most common is 

carpal tunnel syndrome, which causes numbness and tingling of the hand and sometimes 

muscle weakness or pain. Other nerves 

susceptible to entrapment may cause pain on 

the outside of the shin or the inside of the 

foot. 

Can diabetic neuropathies 

be prevented? 

The best way to prevent neuropathy is to 

keep blood glucose levels as close to the 

normal range as possible. Maintaining safe 

blood glucose levels protects nerves throughout the body. 

How are diabetic 

neuropathies diagnosed? 

Doctors diagnose neuropathy on the basis of 

symptoms and a physical exam. During the 

exam, the doctor may check blood pressure, 

heart rate, muscle strength, reflexes, and 

sensitivity to position changes, vibration, 

temperature, or light touch. 

Foot Exams 

Experts recommend that people with diabetes have a comprehensive foot exam each 

year to check for peripheral neuropathy. 

People diagnosed with peripheral neuropathy need more frequent foot exams. 

A comprehensive foot exam assesses the 

skin, muscles, bones, circulation, and sensation of the feet. The doctor may assess 

protective sensation or feeling in the feet by 

touching them with a nylon monofilament— 

similar to a bristle on a hairbrush—attached 

to a wand or by pricking them with a pin. 

People who cannot sense pressure from a 

pinprick or monofilament have lost protective sensation and are at risk for developing 

foot sores that may not heal properly. The 

doctor may also check temperature perception or use a tuning fork, which is more sensitive than touch pressure, to assess vibration 

perception. 

Other Tests 

The doctor may perform other tests as part 

of the diagnosis. 

•	 Nerve conduction studies or electromyography are sometimes used to help 

determine the type and extent of nerve 

damage. Nerve conduction studies 

check the transmission of electrical current through a nerve. Electromyography shows how well muscles respond to 

electrical signals transmitted by nearby 

nerves. These tests are rarely needed to 

diagnose neuropathy. 

•	 A check of heart rate variability shows 

how the heart responds to deep breathing and to changes in blood pressure 

and posture. 

•	 Ultrasound uses sound waves to produce an image of internal organs. An 

ultrasound of the bladder and other 

parts of the urinary tract, for example, 

can be used to assess the structure 

of these organs and show whether 

the bladder empties completely after 

urination. 

6 Diabetic Neuropathies: The Nerve Damage of Diabetes 
How are diabetic 

neuropathies treated? 

The first treatment step is to bring blood 

glucose levels within the normal range to 

help prevent further nerve damage. Blood 

glucose monitoring, meal planning, physical 

activity, and diabetes medicines or insulin 

will help control blood glucose levels. Symptoms may get worse when blood glucose is 

first brought under control, but over time, 

maintaining lower blood glucose levels helps 

lessen symptoms. Good blood glucose control may also help prevent or delay the onset 

of further problems. As scientists learn 

more about the underlying causes of neuropathy, new treatments may become available 

to help slow, prevent, or even reverse nerve 

damage. 

As described in the following sections, 

additional treatment depends on the type of 

nerve problem and symptom. 

Pain Relief 

Doctors usually treat painful diabetic neuropathy with oral medications, although 

other types of treatments may help some 

people. People with severe nerve pain may 

benefit from a combination of medications 

or treatments and should consider talking 

with a health care provider about treatment 

options. 

Medications used to help relieve diabetic 

nerve pain include 

•	 tricyclic antidepressants, such as amitriptyline, imipramine, and desipramine 

(Norpramin, Pertofrane) 

•	 other types of antidepressants, such as 

duloxetine (Cymbalta), venlafaxine, 

bupropion (Wellbutrin), paroxetine 

(Paxil), and citalopram (Celexa) 

•	 anticonvulsants, such as pregabalin 

(Lyrica), gabapentin (Gabarone, Neurontin), carbamazepine, and lamotrigine (Lamictal) 

•	 opioids and opioidlike drugs, such as 

controlled-release oxycodone, an opioid; and tramadol (Ultram), an opioid 

that also acts as an antidepressant 

Duloxetine and pregabalin are approved by 

the U.S. Food and Drug Administration specifically for treating painful diabetic peripheral neuropathy. 

People do not have to be depressed for an 

antidepressant to help relieve their nerve 

pain. All medications have side effects, and 

some are not recommended for use in older 

adults or those with heart disease. Because 

over-the-counter pain medicines such as 

acetaminophen and ibuprofen may not work 

well for treating most nerve pain and can 

have serious side effects, some experts recommend avoiding these medications. 

Treatments that are applied to the skin— 

typically to the feet—include capsaicin 

cream and lidocaine patches (Lidoderm, 

Lidopain). Studies suggest that nitrate 

sprays or patches for the feet may relieve 

pain. Studies of alpha-lipoic acid, an 

antioxidant, and evening primrose oil 

suggest they may help relieve symptoms and 

improve nerve function in some patients. 

A device called a bed cradle can keep sheets 

and blankets from touching sensitive feet 

and legs. Acupuncture, biofeedback, or 

physical therapy may help relieve pain in 

some people. Treatments that involve electrical nerve stimulation, magnetic therapy, 

and laser or light therapy may be helpful but 

need further study. Researchers are also 

studying several new therapies in clinical 

trials. 

7 Diabetic Neuropathies: The Nerve Damage of Diabetes 
Gastrointestinal Problems 

To relieve mild symptoms of gastroparesis— 

indigestion, belching, nausea, or vomiting— 

doctors suggest eating small, frequent 

meals; avoiding fats; and eating less fiber. 

When symptoms are severe, doctors may 

prescribe erythromycin to speed digestion, 

metoclopramide to speed digestion and help 

relieve nausea, or other medications to help 

regulate digestion or reduce stomach acid 

secretion. 

To relieve diarrhea or other bowel problems, doctors may prescribe an antibiotic 

such as tetracycline, or other medications as 

appropriate. 

Dizziness and Weakness 

Sitting or standing up slowly may help 

prevent the light-headedness, dizziness, or 

fainting associated with blood pressure and 

circulation problems. Raising the head of 

the bed or wearing elastic stockings may also 

help. Some people benefit from increased 

salt in the diet and treatment with saltretaining hormones. Others benefit from 

high blood pressure medications. Physical 

therapy can help when muscle weakness or 

loss of coordination is a problem. 

Urinary and Sexual Problems 

To clear up a urinary tract infection, the 

doctor will probably prescribe an antibiotic. 

Drinking plenty of fluids will help prevent 

another infection. People who have incontinence should try to urinate at regular 

intervals—every 3 hours, for example— 

because they may not be able to tell when 

the bladder is full. 

To treat erectile dysfunction in men, the doctor will first do tests to rule out a hormonal 

cause. Several methods are available to treat 

erectile dysfunction caused by neuropathy. 

Medicines are available to help men have 

and maintain erections by increasing blood 

flow to the penis. Some are oral medications and others are injected into the penis 

or inserted into the urethra at the tip of the 

penis. Mechanical vacuum devices can also 

increase blood flow to the penis. Another 

option is to surgically implant an inflatable 

or semirigid device in the penis. 

Vaginal lubricants may be useful for women 

when neuropathy causes vaginal dryness. To treat problems with arousal and 

orgasm, the doctor may refer women to a 

gynecologist. 

Foot Care 

People with neuropathy need to take special 

care of their feet. The nerves to the feet 

are the longest in the body and are the ones 

most often affected by neuropathy. Loss 

of sensation in the feet means that sores or 

injuries may not be noticed and may become 

ulcerated or infected. Circulation problems 

also increase the risk of foot ulcers. Smoking increases the risk of foot problems and 

amputation. A health care provider may be 

able to provide help with quitting smoking. 

More than 60 percent of all nontraumatic 

lower-limb amputations in the United States 

occur in people with diabetes. Nontraumatic 

amputations are those not caused by trauma 

such as severe injuries from an accident. 

In 2004, about 71,000 nontraumatic amputations were performed in people with diabetes. Comprehensive foot care programs can 

reduce amputation rates by 45 to 85 percent. 

8 Diabetic Neuropathies: The Nerve Damage of Diabetes 
Careful foot care involves 

•	 cleaning the feet daily using warm— 

not hot—water and a mild soap. Soaking the feet should be avoided. A soft 

towel can be used to dry the feet and 

between the toes. 

•	 inspecting the feet and toes every day 

for cuts, blisters, redness, swelling, 

calluses, or other problems. Using a 

mirror—handheld or placed on the 

floor—may be helpful in checking the 

bottoms of the feet, or another person 

can help check the feet. A health care 

provider should be notified of any 

problems. 

•	 using lotion to moisturize the feet. 

Getting lotion between the toes should 

be avoided. 

•	 filing corns and calluses gently with a 

pumice stone after a bath or shower. 

•	 cutting toenails to the shape of the 

toes and filing the edges with an emery 

board each week or when needed. 

•	 always wearing shoes or slippers to protect feet from injuries. Wearing thick, 

soft, seamless socks can prevent skin 

irritation. 

•	 wearing shoes that fit well and allow the 

toes to move. New shoes can be broken 

in gradually by first wearing them for 

only an hour at a time. 

•	 looking shoes over carefully before putting them on and feeling the insides to 

make sure the shoes are free of tears, 

sharp edges, or objects that might injure 

the feet. 

People who need help taking care of their 

feet should consider making an appointment 

to see a foot doctor, also called a podiatrist. 

Points to Remember 

•	 Diabetic neuropathies are nerve 

disorders caused by many of the 

abnormalities common to diabetes, 

such as high blood glucose. 

•	 Neuropathy can affect nerves 

throughout the body, causing 

numbness and sometimes pain in 

the hands, arms, feet, or legs, and 

problems with the digestive tract, 

heart, sex organs, and other body 

systems. 

•	 Treatment first involves bringing 

blood glucose levels within the 

normal range. Good blood glucose 

control may help prevent or delay 

the onset of further problems. 

•	 Foot care is an important part of 

treatment. People with neuropathy 

need to inspect their feet daily for 

any injuries. Untreated injuries 

increase the risk of infected foot 

sores and amputation. 

•	 Treatment also includes pain relief 

and other medications as needed, 

depending on the type of nerve 

damage. 

•	 Smoking increases the risk of foot 

problems and amputation. A 

health care provider may be able to 

provide help with quitting. 

Hope through Research 

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) conducts 

and supports research to help people with 

diabetes. 

Participants in clinical trials can play a more 

active role in their own health care, gain access 

to new research treatments before they are 

widely available, and help others by contributing to medical research. For information about 

current studies, visit www.ClinicalTrials.gov. 

9 Diabetic Neuropathies: The Nerve Damage of Diabetes 
10 Diabetic Neuropathies: The Nerve Damage of Diabetes

For More Information

See the following publications from the 

NIDDK for more information about topics 

related to diabetic neuropathies:

• Gastroparesis—stomach nerve damage—available online at www.digestive.niddk.nih.gov/ddiseases/pubs/

gastroparesis

• Hypoglycemia—available online at 

www.diabetes.niddk.nih.gov/dm/pubs/

hypoglycemia

• Nerve Disease and Bladder Control—

available online at www.kidney.niddk.

nih.gov/kudiseases/pubs/nervedisease

• Prevent diabetes problems: Keep your 

feet and skin healthy and Prevent diabetes problems: Keep your nervous system 

healthy, two publications in the Prevent 

Diabetes Problems Series—available 

online at www.diabetes.niddk.nih.gov/

dm/pubs/complications

• Sexual and Urologic Problems of 

Diabetes—available online at www.

diabetes.niddk.nih.gov/dm/pubs/sup

• Take Care of Your Feet for a Lifetime, 

available from the National Diabetes Education Program by calling 

1–888–693–NDEP (6337) or visiting 

www.ndep.nih.gov/campaigns/Feet/ 

Feet_overview.htm

These publications are also available by calling 1–800–860–8747.

For more information, contact the following 

organizations:

American Diabetes Association 

1701 North Beauregard Street 

Alexandria, VA 22311 

Phone: 1–800–DIABETES (342–2383) 

Email: AskADA@diabetes.org 

Internet: www.diabetes.org

American Podiatric Medical Association

9312 Old Georgetown Road 

Bethesda, MD 20814–1621 

Phone: 1–800–FOOTCARE (366–8227) 

or 301–581–9200 

Fax: 301–530–2752 

Email: askapma@apma.org 

Internet: www.apma.org

American Urological Association 

Foundation

1000 Corporate Boulevard 

Linthicum, MD 21090 

Phone: 1–800–828–7866 

or 410–689–3700 

Fax: 410–689–3998 

Email: auafoundation@auafoundation.org

Internet: www.UrologyHealth.org

Centers for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health Promotion 

Division of Diabetes Translation 

4770 Buford Highway NE, Mail Stop K–10 

Atlanta, GA 30341–3717 

Phone: 1–800–CDC–INFO (232–4636) 

or 770–488–5000 

Email: cdcinfo@cdc.gov 

Internet: www.cdc.gov/diabetes
11 Diabetic Neuropathies: The Nerve Damage of Diabetes

Juvenile Diabetes Research Foundation 

International

26 Broadway, 14th Floor 

New York, NY 10004 

Phone: 1–800–533–CURE (2873) 

Fax: 212–785–9595 

Email: info@jdrf.org 

Internet: www.jdrf.org

Lower Extremity Amputation Prevention 

Program

Health Resources and Services 

Administration 

5600 Fishers Lane 

Rockville, MD 20857 

Phone: 1–888–ASK–HRSA (275–4772) 

Internet: www.hrsa.gov/leap

National Diabetes Education Program 

1 Diabetes Way 

Bethesda, MD 20814–9692 

Phone: 1–888–693–NDEP (6337) 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: ndep@mail.nih.gov 

Internet: www.ndep.nih.gov

National Digestive Diseases Information 

Clearinghouse

2 Information Way 

Bethesda, MD 20892–3570 

Phone: 1–800–891–5389 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: nddic@info.niddk.nih.gov 

Internet: www.digestive.niddk.nih.gov

National Heart, Lung, and Blood Institute 

Information Center 

P.O. Box 30105 

Bethesda, MD 20824–0105 

Phone: 301–592–8573 

Fax: 240–629–3246 

Email: nhlbiinfo@nhlbi.nih.gov 

Internet: www.nhlbi.nih.gov

National Institute of Neurological Disorders 

and Stroke

P.O. Box 5801 

Bethesda, MD 20824 

Phone: 1–800–352–9424 

or 301–496–5751 

Internet: www.ninds.nih.gov

National Kidney and Urologic Diseases 

Information Clearinghouse

3 Information Way 

Bethesda, MD 20892–3580 

Phone: 1–800–891–5390 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: nkudic@info.niddk.nih.gov 

Internet: www.kidney.niddk.nih.gov

Pedorthic Footwear Association

2025 M Street NW, Suite 800 

Washington, DC 20036 

Phone: 1–800–673–8447 

or 202–367–1145 

Fax: 202–367–2145 

Email: info@pedorthics.org 

Internet: www.pedorthics.org
You may also find additional information about this 

topic by visiting MedlinePlus at www.medlineplus.gov.

This publication may contain information about medications. 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 (463–6332) or visit www.fda.gov. 

Consult your doctor for more information.

The U.S. Government does not endorse or favor any 

specific commercial product or company. Trade, 

proprietary, or company names appearing in this 

document are used only because they are considered 

necessary in the context of the information provided. 

If a product is not mentioned, the omission does not 

mean or imply that the product is unsatisfactory.

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.

Publications produced by the Clearinghouse are 

carefully reviewed by both NIDDK scientists and 

outside experts. This publication was originally 

reviewed by Peter J. Dyck, M.D., Peripheral 

Neuropathy Research Laboratory, Mayo Clinic 

Rochester, Rochester, MN; Eva L. Feldman, 

M.D., Ph.D., Department of Neurology, 

University of Michigan, Ann Arbor, MI; and 

Aaron I. Vinik, M.D., Ph.D., Strelitz Diabetes 

Research Institute, Eastern Virginia Medical 

School, Norfolk, VA. Dr. Feldman also reviewed 

the updated version of the publication.

This publication is not copyrighted. The Clearinghouse 

encourages users of this fact sheet to duplicate and 

distribute as many copies as desired.

This fact sheet is also available at 

www.diabetes.niddk.nih.gov.

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES

National Institutes of Health

NIH Publication No. 09–3185

February 2009