U.S. Department 

of Health and 

Human Services 

Prevent diabetes problems


Number 

6 

in a 

Series 

of 7 

Keep your nervous 

system healthy 

Keep your nervous 

system healthy

NATIONAL INSTITUTES OF HEALTH 

National Diabetes Information Clearinghouse 
Prevent diabetes problems: 

Keep your nervous 

system healthy 

NATIONAL INSTITUTES OF HEALTH 

National Diabetes Information Clearinghouse 
Contents 

What are diabetes problems?.................................. 1


What should I do each day to stay


healthy with diabetes?.............................................. 2


What can I do to prevent diabetes


How can diabetes hurt


from damaging my nervous system?....................... 3


What can I do to take care of my feet? .................. 4


What does my nervous system do? ......................... 6


my nervous system?.................................................. 6


How can diabetes damage to the 


peripheral nerves affect me?................................... 8


How can diabetes damage to the 


autonomic nerves affect me? ................................ 10


How can diabetes damage to the 


cranial nerves affect me? ....................................... 16


How do I know if I have 


nerve damage?........................................................ 17


Pronunciation Guide ...............................................18


For More Information ........................................... 19


More in the Series .................................................. 21


Acknowledgments .................................................. 22

What are diabetes problems? 

Too much glucose in the blood 


for a long time can cause 


diabetes problems. This high 


blood glucose, also called 


blood sugar, can damage 


many parts of the body, 


such as the heart, blood 


vessels, eyes, and kidneys. 


Heart and blood vessel 


disease can lead to heart 


attacks and strokes. You 


can do a lot to prevent 


or slow down diabetes 


problems.


This booklet is about nerve 

problems that can be caused 

by diabetes. You will learn 

the things you can do each day 

and during each year to stay 

healthy and prevent diabetes 

problems. 

High blood glucose can 

cause nerve problems. 

1 
What should I do each day to stay 

healthy with diabetes? 

Follow the healthy eating plan that 

you and your doctor or dietitian have 

worked out. 

Be active a total of 30 minutes most 

days. Ask your doctor what activities 

are best for you. 

Take your medicines as directed. 

Check your blood glucose every day. 

Each time you check your blood 

glucose, write the number in your 

record book. 

Check your feet every day for cuts, 

blisters, sores, swelling, redness, or 

sore toenails. 

Brush and floss your teeth every day. 

Control your blood pressure and 

cholesterol. 

Don’t smoke.


2 
What can I do to prevent diabetes 

from damaging my nervous system? 

Research has shown that people who kept their 

blood glucose close to normal were able to lower 

their risk of nerve damage. 

Here is what you can do to prevent nerve damage: 

●	 Keep your blood glucose as close to normal as 

you can. 

●	 Limit the amount of alcohol you drink. 

●	 Don’t smoke. 

●	 Take care of your feet (see pages 4 and 5). 

●	 Tell your doctor about any problems you 

have with 

• your hands, arms, feet, or legs 

• your stomach, bowels, or bladder 

●	 Also tell your doctor if you 

• have problems when you have sex 

• cannot always tell when your blood


glucose is too low


• feel dizzy when you go from lying 


down to sitting or standing


3 
What can I do to 


take care of my feet?


●	 Wash your feet in warm 


water every day. Make 


sure the water is not 


too hot by testing the 


temperature with your 


elbow. Do not soak 


your feet. Dry your 


feet well, especially 


between your toes.


●	 Look at your feet every 

day to check for cuts, 

sores, blisters, redness, 

calluses, or other 

problems. Checking 

every day is even more 

important if you have nerve damage or poor 

blood flow. If you cannot bend over or pull 

your feet up to check them, use a mirror. If you 

cannot see well, ask someone else to check your 

feet. 

●	 If your skin is dry, rub lotion on your feet after 

you wash and dry them. Do not put lotion 

between your toes. 

Look at your feet every day 

to check for problems. 

4 
● File corns and calluses gently with an emery 

board or pumice stone. Do this 

after your bath or shower. 

●	 Cut your toenails once a 

week or when needed. Cut 

toenails when they are soft from washing. Cut 

them to the shape of the toe and not too short. 

File the edges with an emery board. If you 

cannot cut your own toenails, ask someone who 

can or go to a foot doctor. 

●	 Always wear shoes or slippers to protect your 

feet from injuries. 

●	 Always wear socks or stockings to avoid blisters. 

Do not wear socks or knee-high stockings that 

are too tight below your knee. 

●	 Wear shoes that fit well. Shop for shoes at the 

end of the day when your feet are bigger. Break 

in shoes slowly. Wear them 1 to 2 

hours each day for the first 1 to 2 

weeks. 

●	 Make sure your doctor 

checks your feet at each 

checkup. 

Always wear slippers or 

shoes to protect your feet. 

5 
the body. For example, when you step on a tack, 

the nerve in your foot tells the brain about the 

pain. Other nerves tell the body what to do. For 

example, nerves from the brain tell your stomach 

when it is time to move food into your intestines. 

What does my nervous system do? 

Nerves carry messages back and forth between 

the brain and other parts of the body. All of your 

nerves together make up the nervous system. 

Some nerves tell the brain what is happening in 

How can diabetes hurt 

my nervous system? 

Having high blood glucose for many years can 

damage the blood vessels that bring oxygen to 

some nerves. High blood glucose can also hurt the 

covering on the nerves. Damaged nerves may stop 

sending messages. Or they may send messages too 

slowly or at the wrong times. 

Diabetic neuropathy* is the medical term for 

damage to the nervous system from diabetes. 

*See page 18 for tips on how to say the words in bold type. 

6 
Cranial nerves go from Central nerves 

your brain to are in your 

your eyes, brain and 

mouth, ears, spinal cord. 

and other 

parts of 

your head. 

Peripheral 

nerves go from 

your spinal cord Autonomic nerves 

to your arms, go from your spinal hands, legs, cord to your lungs, and feet. heart, stomach, 

intestines, bladder, 

and sex organs. 

The nervous system has four main parts—cranial, central, 

peripheral, and autonomic. Diabetes can damage the 

peripheral, autonomic, and cranial nerves. 

7 
How can diabetes damage to the 


peripheral nerves affect me?


●	 Peripheral nerves go to the arms, hands, legs, 

and feet. Damage to these nerves can make 

your arms, hands, legs, or feet feel numb. Also, 

you might not be able to feel pain, heat, or cold 

when you should. You may feel shooting pains 

or burning or tingling, like “pins and needles.” 

These feelings are often worse at night. They 

can make it hard to sleep. Most of the time these 

feelings are on both sides of your body, such as 

in both of your feet. But they can be on just one 

side. 

Peripheral nerve damage can change the shape of 

your feet. Foot muscles get weak and the tendons 

in the foot get shorter. You can get special shoes 

that are made to fit softly around your sore feet 

or feet that have changed shape. These special 

shoes help protect your feet. Medicare and other 

health insurance programs may pay for special 

shoes. Talk with your doctor about how and 

where to get these shoes. 

Nerve damage from diabetes can increase your 

risk for carpal tunnel syndrome, which occurs 

when a nerve from your forearm to your hand is 

compressed. Carpal tunnel syndrome can cause 

numbness, tingling, pain, and weakness in your 

hand and arm. 

8 
Peripheral Nerves 

Peripheral nerves go from your spinal cord to your arms, 

hands, legs, and feet. 

9 
How can diabetes damage to the 


autonomic nerves affect me?


●	 Autonomic nerves help you know your blood 

glucose is low. Some people take diabetes 

medicines that can accidentally make their blood 

glucose too low. Damage to the autonomic 

nerves can make it hard for them to feel the 

symptoms of hypoglycemia, also called low blood 

glucose. 

This kind of damage is more likely to happen 

if you have had diabetes for a long time. It can 

also happen if your blood glucose has been too 

low very often. 

10

Autonomic Nerves 

Autonomic nerves go from your spinal cord to your lungs, 

heart, stomach, intestines, bladder, and sex organs. 

11 
●	 Autonomic nerves go to the stomach, intestines, 

and other parts of the digestive system. Damage 

to these nerves can make food pass through the 

digestive system too slowly or too quickly. Nerve 

problems can cause nausea —feeling sick to your 

stomach— vomiting, constipation, or diarrhea. 

Nerve damage to your stomach is called 

gastroparesis. When nerves to the stomach are 

damaged, the muscles of the stomach do not 

work well and food may stay in the stomach too 

long. Gastroparesis makes it hard to keep blood 

glucose under control. 

12 
●	 Autonomic nerves go to the penis. Damage to 

these nerves can prevent a man’s penis from 

getting firm when he wants to have sex. This 

condition is called erectile dysfunction or 

impotence. Many men who have had diabetes 

for several years experience it. 

●	 Autonomic nerves go to the vagina. Damage 

to these nerves can prevent a woman’s vagina 

from getting wet when she wants to have sex. 

A woman might also have less feeling around 

her vagina. 

Damage to autonomic nerves from diabetes 

may cause problems with having sex. 

13 
●	 Autonomic nerves go to the heart. Damage to 

these nerves might make your heart beat faster 

or at different speeds. 

●	 Autonomic nerves go to the bladder. Damage 

to these nerves can make it hard to know when 

you should go to the bathroom. The damage 

can also make it hard to feel when your bladder 

is empty. Both problems can cause you to hold 

urine for too long, which can lead to bladder 

infections. Another problem can be leaking 

drops of urine accidentally. 

Damage to autonomic nerves from 

diabetes can cause bladder and 

stomach problems. 

14 
●	 Autonomic nerves go to the blood vessels that 

keep your blood pressure steady. Damage to 

these nerves can make your blood move too 

slowly to keep your blood pressure steady when 

you change position. When you go from lying 

down to standing up or when you exercise a lot, 

the sudden changes in blood pressure can make 

you dizzy. 

Diabetes can damage autonomic nerves that help 

keep your blood pressure steady. 

15 
How can diabetes damage to the 


cranial nerves affect me?


●	 Cranial nerves go to the eye muscles. Damage 

to these nerves usually occurs in one eye, causing 

double vision. This problem happens all of a 

sudden and most often lasts for a short time. 

●	 Cranial nerves go to the sides of the face. 

Damage to these nerves usually happens on 

only one side of the face. This nerve damage 

causes that side of the face to hang lower or 

sag. Usually the lips and lower eyelid sag. This 

problem is called Bell’s palsy. It happens all of 

a sudden. 

Cranial Nerves 

Cranial nerves go from your brain 

to your eyes, mouth, ears, and 

other parts of your head. 

16

How do I know if I have nerve 


damage?


If you have one or more of the problems mentioned 

in this booklet, you may have some nerve damage 

from diabetes. Tell your doctor about the problem. 

Ask your doctor what you can do to make the 

problem better and to stop it from getting worse. 

Ask your doctor what you can do about the 

problems from diabetes nerve damage. 

17 
Pronunciation Guide 

autonomic (AW-toh-NOM-ik)


central (SEN-truhl)


cranial (KRAY-nee-uhl)


erectile dysfunction (ee-REK-tyl) (diss-FUHNK-shuhn)


gastroparesis (GASS-troh-puh-REE-siss)


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


impotence (IM-puh-tenss)


neuropathy (noo-ROP-uh-thee)


peripheral (puh-RIF-ur-uhl)


18

For More Information 

Diabetes Teachers (nurses, dietitians, pharmacists, 

and other health professionals) 

To find a diabetes teacher 

near you, call the Amer ican 

Association of Diabetes 

Educators toll-free at 

1–800–TEAMUP4 (832–6874), 

or look on the Internet at 

www.diabeteseducator.org and click on “Find a 

Diabetes Educator.” 

Dietitians 

To find a dietitian near you, call the American 

Dietetic Association toll-free at 1–800–877–1600, 

or look on the Internet at www.eatright.org and 

click on “Find a Nutrition Professional.” 

Government 

The National Institute of Neurological Disorders 

and Stroke is part of the National Institutes of 

Health (NIH). To learn more about nervous system 

problems, write or call the NIH Neurological 

Institute at P.O. Box 5801, Bethesda, MD 20824, 

1–800–352–9424; or see www.ninds.nih.gov on the 

Internet. 

19

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


Fax: 703–738– 4929


Email: ndic@info.niddk.nih.gov


Internet: www.diabetes.niddk.nih.gov


National Diabetes Education Program 

1 Diabetes Way


Bethesda, MD 20892–3560


Phone: 1–800 – 438–5383


Fax: 703–738– 4929


Internet: www.ndep.nih.gov


American Diabetes Association 

1701 North Beauregard Street


Alexandria, VA 22311


Phone: 1–800–DIABETES (342–2383)


Internet: www.diabetes.org


Juvenile Diabetes Research Foundation


International


120 Wall Street


New York, NY 10005–4001


Phone: 1–800–533–CURE (2873)


Internet: www.jdrf.org


20 
The “Prevent Diabetes Problems” Series has seven 

booklets that can help you learn more about how 

to prevent diabetes problems. 

More in the Series 

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 

Fax: 703–738–4929 

Email: ndic@info.niddk.nih.gov 

These booklets are also available at 

www.diabetes.niddk.nih.gov on the Internet. 

21 
Acknowledgments 

this publication: 

The National Diabetes Information Clearinghouse 


thanks the people who helped review or fi eld-test 


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 

and Training 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, DC 

Resa Levetan, M.D. 

For the Texas Diabetes 

Council 

Texas Department of

 Health 

Austin, TX 

Luby Garza-Abijaoude, 

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

22

National Diabetes 

Information Clearinghouse 

1 Information Way 

Bethesda, MD 20892–3560 

Phone: 1–800–860–8747 

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 is not copyrighted. The Clearinghouse 

encourages users of this booklet to duplicate and distribute as 

many copies as desired. 

This booklet is also available at www.diabetes.niddk.nih.gov. 

This publication may contain information about medications used 

to treat a health condition. When this publication was prepared, 

the NIDDK included the most current information available. 

Occasionally, new information about medication is released. For 

updates or for questions about any medications, please contact the 

U.S. Food and Drug Administration at 1–888–INFO–FDA 

(463–6332), a toll-free call, or visit their website at www.fda.gov. 

Consult your doctor for more information. 
U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 08–4284 

March 2008