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.

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 "What can I do to take care of my feet?").
• 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

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.

  
  Look at your feet every day to check for problems.

• If your skin is dry, rub lotion on your feet after you wash and dry them. Do not put lotion between your toes.

• 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 slippers or shoes to protect your feet.

• 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.

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.

The nervous system has four main parts—cranial, central, peripheral, and autonomic. Diabetes can damage the peripheral, autonomic, and cranial nerves.

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.

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

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.

  
  Autonomic nerves go from your spinal cord to your lungs, heart, stomach, intestines, bladder, and sex organs.

• 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.

• 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.

• 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.

• 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.

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 go from your brain to your eyes, mouth, ears, and other parts of your head.

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.

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)

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 (1–800–832–6874) or 1–800–338–3633, 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 Registered Dietitian.”

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, 301–496–5751; or see www.ninds.nih.gov on the Internet.

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 (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

Juvenile Diabetes Research Foundation International
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

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.

Acknowledgments

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. 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.

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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 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 (1–888–463–6332) or visit www.fda.gov. Consult your health care provider for more information.

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NIH Publication No. 08-4284
March 2008