Number 

6 

in a 

Series 

of 7 

Large-print version 

Prevent diabetes problems:
 

Keep your nervous 

system healthy 

U.S. Department 


of Health and
 

Human Services
 

NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse

Prevent diabetes problems:

Keep your nervous 

system healthy

U.S. Department 

of Health and 

Human Services

NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse
Contents 

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

What should I do each day to stay healthy
 

What can I do to prevent diabetes from
 

How can diabetes damage to the peripheral
 

How can diabetes damage to the autonomic
 

How can diabetes damage to the cranial
 

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

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

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

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

How can diabetes hurt my nervous system? ....................... 6
 

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

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

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 
 

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 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. 

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 Central nerves 

from your brain to are in your brain 

your eyes, mouth, and spinal cord. 

ears, and other 

parts of your head. 

Peripheral nerves go 

from your spinal cord Autonomic nerves to your arms, hands, go from your spinal legs, and feet. cord to your lungs, 

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 American 

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, contact the American Dietetic 

Association 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
 

TTY: 1–866–569–1162
 

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 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
 

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 
More in the Series 

The “Prevent Diabetes Problems” Series has seven booklets 

that can help you learn more about how to prevent diabetes 

problems. 

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 on the Internet. 

21 
 

 

 

 

 

 

 

 

 

Acknowledgments 

The National Diabetes Information Clearinghouse thanks the 

people who helped review or field-test 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 

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
 

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 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. 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. 
U.S. DEPARTMENT OF HEALTH 

AND	HuMAN	SeRVIceS

National Institutes of Health 

NIH Publication No. 08–4284L 

March 2008