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?
Diabeticneuropathiesareafamilyofnerve
disorderscausedbydiabetes. Peoplewith
diabetescan,overtime,developnervedam-
agethroughoutthebody. Somepeoplewith
nervedamagehavenosymptoms. Others
mayhavesymptomssuchaspain,tingling,
ornumbnesslossoffeelinginthehands,
arms,feet,andlegs. Nerveproblemscan
occurineveryorgansystem,includingthe
digestivetract,heart,andsexorgans.
About60to70percentofpeoplewithdiabe-
teshavesomeformofneuropathy. People
withdiabetescandevelopnerveproblemsat
anytime,butriskriseswithageandlonger
durationofdiabetes. Thehighestratesof
neuropathyareamongpeoplewhohave
haddiabetesforatleast25years. Diabetic
neuropathiesalsoappeartobemorecom-
moninpeoplewhohaveproblemscontrol-
lingtheirbloodglucose,alsocalledblood
sugar,aswellasthosewithhighlevelsof
bloodfatandbloodpressureandthosewho
areoverweight.
What causes diabetic
neuropathies?
Thecausesareprobablydifferentfordiffer-
enttypesofdiabeticneuropathy. Research-
ersarestudyinghowprolongedexposureto
highbloodglucosecausesnervedamage.
Nervedamageislikelyduetoacombination
offactors:
metabolicfactors,suchashighblood
glucose,longdurationofdiabetes,
abnormalbloodfatlevels,andpossibly
lowlevelsofinsulin
neurovascularfactors,leadingtodam-
agetothebloodvesselsthatcarry
oxygenandnutrientstonerves
autoimmunefactorsthatcauseinam-
mationinnerves
mechanicalinjurytonerves,suchas
carpaltunnelsyndrome
inheritedtraitsthatincreasesusceptibil-
itytonervedisease
lifestylefactors,suchassmokingor
alcoholuse
What are the symptoms of
diabetic neuropathies?
Symptomsdependonthetypeofneuropathy
andwhichnervesareaffected. Somepeople
withnervedamagehavenosymptomsatall.
Forothers,therstsymptomisoftennumb-
ness,tingling,orpaininthefeet. Symptoms
areoftenminoratrst,andbecausemost
nervedamageoccursoverseveralyears,
mildcasesmaygounnoticedforalongtime.
Symptomscaninvolvethesensory,motor,
andautonomicorinvoluntarynervous
systems. Insomepeople,mainlythosewith
focalneuropathy,theonsetofpainmaybe
suddenandsevere.
Symptomsofnervedamagemayinclude
numbness,tingling,orpaininthetoes,
feet,legs,hands,arms,andngers
wastingofthemusclesofthefeetor
hands
indigestion,nausea,orvomiting
diarrheaorconstipation
dizzinessorfaintnessduetoadropin
bloodpressureafterstandingorsittingup

problemswithurination
erectiledysfunctioninmenorvaginal
drynessinwomen
weakness
Symptomsthatarenotduetoneuropathy,
butoftenaccompanyit,includeweightloss
anddepression.
What are the types of
diabetic neuropathy?
Diabeticneuropathycanbeclassiedas
peripheral,autonomic,proximal,orfocal.
Eachaffectsdifferentpartsofthebodyin
variousways.
Peripheralneuropathy,themost
commontypeofdiabeticneuropathy,
causespainorlossoffeelinginthetoes,
feet,legs,hands,andarms.
Autonomicneuropathycauseschanges
indigestion,bowelandbladderfunc-
tion,sexualresponse,andperspiration.
Itcanalsoaffectthenervesthatserve
theheartandcontrolbloodpressure,
aswellasnervesinthelungsandeyes.
Autonomicneuropathycanalsocause
hypoglycemiaunawareness,acondition
inwhichpeoplenolongerexperience
thewarningsymptomsoflowblood
glucoselevels.
Proximalneuropathycausespaininthe
thighs,hips,orbuttocksandleadsto
weaknessinthelegs.
Focalneuropathyresultsinthesud-
denweaknessofonenerveoragroup
ofnerves,causingmuscleweaknessor
pain. Anynerveinthebodycanbe
affected.
Neuropathy Affects Nerves
Throughout the Body
Peripheral neuropathy affects
toes
feet
legs
hands
arms
Autonomic neuropathy affects
heartandbloodvessels
digestivesystem
urinarytract
sexorgans
sweatglands
eyes
lungs
Proximal neuropathy affects
thighs
hips
buttocks
legs
Focal neuropathy affects
eyes
facialmuscles
ears
pelvisandlowerback
chest
abdomen
thighs
legs
feet
2 DiabeticNeuropathies: TheNerveDamageofDiabetes

What is peripheral
neuropathy?
Peripheralneuropathy,alsocalleddistal
symmetricneuropathyorsensorimotor
neuropathy,isnervedamageinthearmsand
legs. Feetandlegsarelikelytobeaffected
beforehandsandarms. Manypeoplewith
diabeteshavesignsofneuropathythatadoc-
torcouldnotebutfeelnosymptomsthem-
selves. Symptomsofperipheralneuropathy
mayinclude
numbnessorinsensitivitytopainor
temperature
atingling,burning,orprickling
sensation
sharppainsorcramps
extremesensitivitytotouch,evenlight
touch
lossofbalanceandcoordination
Thesesymptomsareoftenworseatnight.
Peripheralneuropathymayalsocausemus-
cleweaknessandlossofreexes,especially
attheankle,leadingtochangesintheway
apersonwalks. Footdeformities,suchas
hammertoesandthecollapseofthemidfoot,
mayoccur. Blistersandsoresmayappearon
numbareasofthefootbecausepressureor
injurygoesunnoticed. Ifaninfectionoccurs
andisnottreatedpromptly,theinfection
mayspreadtothebone,andthefootmay
thenhavetobeamputated. Manyamputa-
tionsarepreventableifminorproblemsare
caughtandtreatedintime.
Peripheralneuropathyaffectsthenervesinthetoes,
feet,legs,hands,andarms.
3 DiabeticNeuropathies: TheNerveDamageofDiabetes


What is autonomic
neuropathy?
Autonomicneuropathyaffectsthenerves
thatcontroltheheart,regulatebloodpres-
sure,andcontrolbloodglucoselevels.
Autonomicneuropathyalsoaffectsother
internalorgans,causingproblemswith
digestion,respiratoryfunction,urination,
sexualresponse,andvision. Inaddition,the
systemthatrestoresbloodglucoselevelsto
normalafterahypoglycemicepisodemay
beaffected,resultinginlossofthewarning
symptomsofhypoglycemia.
Autonomicneuropathyaffectsthenervesinthe
heart,stomach,intestines,bladder,sexorgans,sweat
glands,eyes,andlungs.
Hypoglycemia Unawareness
Normally,symptomssuchasshakiness,
sweating,andpalpitationsoccurwhenblood
glucoselevelsdropbelow70mg/dL. In
peoplewithautonomicneuropathy,symp-
tomsmaynotoccur,makinghypoglycemia
difculttorecognize. Problemsotherthan
neuropathycanalsocausehypoglycemia
unawareness.
Heart and Blood Vessels
Theheartandbloodvesselsarepartofthe
cardiovascularsystem,whichcontrolsblood
circulation. Damagetonervesinthecar-
diovascularsysteminterfereswiththebodys
abilitytoadjustbloodpressureandheart
rate. Asaresult,bloodpressuremaydrop
sharplyaftersittingorstanding,causinga
persontofeellight-headedoreventofaint.
Damagetothenervesthatcontrolheart
ratecanmeanthattheheartratestayshigh,
insteadofrisingandfallinginresponseto
normalbodyfunctionsandphysicalactivity.
Digestive System
Nervedamagetothedigestivesystemmost
commonlycausesconstipation. Damagecan
alsocausethestomachtoemptytooslowly,
aconditioncalledgastroparesis. Severe
gastroparesiscanleadtopersistentnausea
andvomiting,bloating,andlossofappetite.
Gastroparesiscanalsomakebloodglucose
levelsuctuatewidelyduetoabnormalfood
digestion.
Nervedamagetotheesophagusmaymake
swallowingdifcult,whilenervedamageto
thebowelscancauseconstipationalternat-
ingwithfrequent,uncontrolleddiarrhea,
especiallyatnight. Problemswiththediges-
tivesystemcanleadtoweightloss.
4 DiabeticNeuropathies: TheNerveDamageofDiabetes
Urinary Tract and Sex Organs
Autonomicneuropathyoftenaffectsthe
organsthatcontrolurinationandsexual
function. Nervedamagecanpreventthe
bladderfromemptyingcompletely,allowing
bacteriatogrowinthebladderandkidneys
andcausingurinarytractinfections. When
thenervesofthebladderaredamaged,
urinaryincontinencemayresultbecausea
personmaynotbeabletosensewhenthe
bladderisfullorcontrolthemusclesthat
releaseurine.
Autonomicneuropathycanalsogradu-
allydecreasesexualresponseinmenand
women,althoughthesexdrivemaybe
unchanged. Amanmaybeunabletohave
erectionsormayreachsexualclimaxwith-
outejaculatingnormally. Awomanmay
havedifcultywitharousal,lubrication,or
orgasm.
Sweat Glands
Autonomicneuropathycanaffectthenerves
thatcontrolsweating. Whennervedam-
agepreventsthesweatglandsfromwork-
ingproperly,thebodycannotregulateits
temperatureasitshould. Nervedamagecan
alsocauseprofusesweatingatnightorwhile
eating.
Eyes
Finally,autonomicneuropathycanaffectthe
pupilsoftheeyes,makingthemlessrespon-
sivetochangesinlight. Asaresult,aperson
maynotbeabletoseewellwhenalight
isturnedoninadarkroomormayhave
troubledrivingatnight.
What is proximal
neuropathy?
Proximalneuropathy,sometimescalledlum-
bosacralplexusneuropathy,femoralneurop-
athy,ordiabeticamyotrophy,startswithpain
inthethighs,hips,buttocks,orlegs,usually
ononesideofthebody. Thistypeofneu-
ropathyismorecommoninthosewithtype2
diabetesandinolderadultswithdiabetes.
Proximalneuropathycausesweaknessinthe
legsandtheinabilitytogofromasittingto
astandingpositionwithouthelp. Treatment
forweaknessorpainisusuallyneeded. The
lengthoftherecoveryperiodvaries,depend-
ingonthetypeofnervedamage.
What is focal neuropathy?
Focalneuropathyappearssuddenlyand
affectsspecicnerves,mostofteninthe
head,torso,orleg. Focalneuropathymay
cause
inabilitytofocustheeye
doublevision
achingbehindoneeye
paralysisononesideoftheface,called
Bellspalsy
severepaininthelowerbackorpelvis
paininthefrontofathigh
paininthechest,stomach,orside
painontheoutsideoftheshinorinside
ofthefoot
chestorabdominalpainthatissome-
timesmistakenforheartdisease,a
heartattack,orappendicitis
Focalneuropathyispainfulandunpredict-
ableandoccursmostofteninolderadults
withdiabetes. However,ittendstoimprove
byitselfoverweeksormonthsanddoesnot
causelong-termdamage.
5 DiabeticNeuropathies: TheNerveDamageofDiabetes
Peoplewithdiabetesalsotendtodevelop
nervecompressions,alsocalledentrapment
syndromes. Oneofthemostcommonis
carpaltunnelsyndrome,whichcausesnumb-
nessandtinglingofthehandandsometimes
muscleweaknessorpain. Othernerves
susceptibletoentrapmentmaycausepainon
theoutsideoftheshinortheinsideofthe
foot.
Can diabetic neuropathies
be prevented?
Thebestwaytopreventneuropathyisto
keepbloodglucoselevelsasclosetothe
normalrangeaspossible. Maintainingsafe
bloodglucoselevelsprotectsnervesthrough-
outthebody.
How are diabetic
neuropathies diagnosed?
Doctorsdiagnoseneuropathyonthebasisof
symptomsandaphysicalexam. Duringthe
exam,thedoctormaycheckbloodpressure,
heartrate,musclestrength,reexes,and
sensitivitytopositionchanges,vibration,
temperature,orlighttouch.
Foot Exams
Expertsrecommendthatpeoplewithdia-
beteshaveacomprehensivefootexameach
yeartocheckforperipheralneuropathy.
Peoplediagnosedwithperipheralneuropa-
thyneedmorefrequentfootexams.
Acomprehensivefootexamassessesthe
skin,muscles,bones,circulation,andsen-
sationofthefeet. Thedoctormayassess
protectivesensationorfeelinginthefeetby
touchingthemwithanylonmonolament
similartoabristleonahairbrushattached
toawandorbyprickingthemwithapin.
Peoplewhocannotsensepressurefroma
pinprickormonolamenthavelostprotec-
tivesensationandareatriskfordeveloping
footsoresthatmaynothealproperly. The
doctormayalsochecktemperaturepercep-
tionoruseatuningfork,whichismoresen-
sitivethantouchpressure,toassessvibration
perception.
Other Tests
Thedoctormayperformothertestsaspart
ofthediagnosis.
Nerve conduction studies or electro-
myographyaresometimesusedtohelp
determinethetypeandextentofnerve
damage. Nerveconductionstudies
checkthetransmissionofelectricalcur-
rentthroughanerve. Electromyogra-
physhowshowwellmusclesrespondto
electricalsignalstransmittedbynearby
nerves. Thesetestsarerarelyneededto
diagnoseneuropathy.
A check of heart rate variabilityshows
howtheheartrespondstodeepbreath-
ingandtochangesinbloodpressure
andposture.
Ultrasound usessoundwavestopro-
duceanimageofinternalorgans. An
ultrasoundofthebladderandother
partsoftheurinarytract,forexample,
canbeusedtoassessthestructure
oftheseorgansandshowwhether
thebladderemptiescompletelyafter
urination.
6 DiabeticNeuropathies: TheNerveDamageofDiabetes
How are diabetic
neuropathies treated?
Thersttreatmentstepistobringblood
glucoselevelswithinthenormalrangeto
helppreventfurthernervedamage. Blood
glucosemonitoring,mealplanning,physical
activity,anddiabetesmedicinesorinsulin
willhelpcontrolbloodglucoselevels. Symp-
tomsmaygetworsewhenbloodglucoseis
rstbroughtundercontrol,butovertime,
maintaininglowerbloodglucoselevelshelps
lessensymptoms. Goodbloodglucosecon-
trolmayalsohelppreventordelaytheonset
offurtherproblems. Asscientistslearn
moreabouttheunderlyingcausesofneurop-
athy,newtreatmentsmaybecomeavailable
tohelpslow,prevent,orevenreversenerve
damage.
Asdescribedinthefollowingsections,
additionaltreatmentdependsonthetypeof
nerveproblemandsymptom.
Pain Relief
Doctorsusuallytreatpainfuldiabeticneu-
ropathywithoralmedications,although
othertypesoftreatmentsmayhelpsome
people. Peoplewithseverenervepainmay
benetfromacombinationofmedications
ortreatmentsandshouldconsidertalking
withahealthcareproviderabouttreatment
options.
Medicationsusedtohelprelievediabetic
nervepaininclude
tricyclicantidepressants,suchasami-
triptyline,imipramine,anddesipramine
(Norpramin,Pertofrane)
othertypesofantidepressants,suchas
duloxetine(Cymbalta),venlafaxine,
bupropion(Wellbutrin),paroxetine
(Paxil),andcitalopram(Celexa)
anticonvulsants,suchaspregabalin
(Lyrica),gabapentin(Gabarone,Neu-
rontin),carbamazepine,andlamotrig-
ine(Lamictal)
opioidsandopioidlikedrugs,suchas
controlled-releaseoxycodone,anopi-
oid;andtramadol(Ultram),anopioid
thatalsoactsasanantidepressant
Duloxetineandpregabalinareapprovedby
theU.S.FoodandDrugAdministrationspe-
cicallyfortreatingpainfuldiabeticperiph-
eralneuropathy.
Peopledonothavetobedepressedforan
antidepressanttohelprelievetheirnerve
pain. Allmedicationshavesideeffects,and
somearenotrecommendedforuseinolder
adultsorthosewithheartdisease. Because
over-the-counterpainmedicinessuchas
acetaminophenandibuprofenmaynotwork
wellfortreatingmostnervepainandcan
haveserioussideeffects,someexpertsrec-
ommendavoidingthesemedications.
Treatmentsthatareappliedtotheskin
typicallytothefeetincludecapsaicin
creamandlidocainepatches(Lidoderm,
Lidopain). Studiessuggestthatnitrate
spraysorpatchesforthefeetmayrelieve
pain. Studiesofalpha-lipoicacid,an
antioxidant,andeveningprimroseoil
suggesttheymayhelprelievesymptomsand
improvenervefunctioninsomepatients.
Adevicecalledabedcradlecankeepsheets
andblanketsfromtouchingsensitivefeet
andlegs. Acupuncture,biofeedback,or
physicaltherapymayhelprelievepainin
somepeople. Treatmentsthatinvolveelec-
tricalnervestimulation,magnetictherapy,
andlaserorlighttherapymaybehelpfulbut
needfurtherstudy. Researchersarealso
studyingseveralnewtherapiesinclinical
trials.
7 DiabeticNeuropathies: TheNerveDamageofDiabetes

Gastrointestinal Problems
Torelievemildsymptomsofgastroparesis
indigestion,belching,nausea,orvomiting
doctorssuggesteatingsmall,frequent
meals;avoidingfats;andeatinglessber.
Whensymptomsaresevere,doctorsmay
prescribeerythromycintospeeddigestion,
metoclopramidetospeeddigestionandhelp
relievenausea,orothermedicationstohelp
regulatedigestionorreducestomachacid
secretion.
Torelievediarrheaorotherbowelprob-
lems,doctorsmayprescribeanantibiotic
suchastetracycline,orothermedicationsas
appropriate.
Dizziness and Weakness
Sittingorstandingupslowlymayhelp
preventthelight-headedness,dizziness,or
faintingassociatedwithbloodpressureand
circulationproblems. Raisingtheheadof
thebedorwearingelasticstockingsmayalso
help. Somepeoplebenetfromincreased
saltinthedietandtreatmentwithsalt-
retaininghormones. Othersbenetfrom
highbloodpressuremedications. Physical
therapycanhelpwhenmuscleweaknessor
lossofcoordinationisaproblem.
Urinary and Sexual Problems
Toclearupaurinarytractinfection,the
doctorwillprobablyprescribeanantibiotic.
Drinkingplentyofuidswillhelpprevent
anotherinfection. Peoplewhohaveincon-
tinenceshouldtrytourinateatregular
intervalsevery3hours,forexample
becausetheymaynotbeabletotellwhen
thebladderisfull.
Totreaterectiledysfunctioninmen,thedoc-
torwillrstdoteststoruleoutahormonal
cause. Severalmethodsareavailabletotreat
erectiledysfunctioncausedbyneuropathy.
Medicinesareavailabletohelpmenhave
andmaintainerectionsbyincreasingblood
owtothepenis. Someareoralmedica-
tionsandothersareinjectedintothepenis
orinsertedintotheurethraatthetipofthe
penis. Mechanicalvacuumdevicescanalso
increasebloodowtothepenis. Another
optionistosurgicallyimplantaninatable
orsemirigiddeviceinthepenis.
Vaginallubricantsmaybeusefulforwomen
whenneuropathycausesvaginaldry-
ness. Totreatproblemswitharousaland
orgasm,thedoctormayreferwomentoa
gynecologist.
Foot Care
Peoplewithneuropathyneedtotakespecial
careoftheirfeet. Thenervestothefeet
arethelongestinthebodyandaretheones
mostoftenaffectedbyneuropathy. Loss
ofsensationinthefeetmeansthatsoresor
injuriesmaynotbenoticedandmaybecome
ulceratedorinfected. Circulationproblems
alsoincreasetheriskoffootulcers. Smok-
ingincreasestheriskoffootproblemsand
amputation. Ahealthcareprovidermaybe
abletoprovidehelpwithquittingsmoking.
Morethan60percentofallnontraumatic
lower-limbamputationsintheUnitedStates
occurinpeoplewithdiabetes. Nontraumatic
amputationsarethosenotcausedbytrauma
suchassevereinjuriesfromanaccident.
In2004,about71,000nontraumaticamputa-
tionswereperformedinpeoplewithdiabe-
tes. Comprehensivefootcareprogramscan
reduceamputationratesby45to85percent.
8 DiabeticNeuropathies: TheNerveDamageofDiabetes

Carefulfootcareinvolves
cleaningthefeetdailyusingwarm
nothotwaterandamildsoap. Soak-
ingthefeetshouldbeavoided. Asoft
towelcanbeusedtodrythefeetand
betweenthetoes.
inspectingthefeetandtoeseveryday
forcuts,blisters,redness,swelling,
calluses,orotherproblems. Usinga
mirrorhandheldorplacedonthe
oormaybehelpfulincheckingthe
bottomsofthefeet,oranotherperson
canhelpcheckthefeet. Ahealthcare
providershouldbenotiedofany
problems.
usinglotiontomoisturizethefeet.
Gettinglotionbetweenthetoesshould
beavoided.
lingcornsandcallusesgentlywitha
pumicestoneafterabathorshower.
cuttingtoenailstotheshapeofthe
toesandlingtheedgeswithanemery
boardeachweekorwhenneeded.
alwayswearingshoesorslipperstopro-
tectfeetfrominjuries. Wearingthick,
soft,seamlesssockscanpreventskin
irritation.
wearingshoesthattwellandallowthe
toestomove. Newshoescanbebroken
ingraduallybyrstwearingthemfor
onlyanhouratatime.
lookingshoesovercarefullybeforeput-
tingthemonandfeelingtheinsidesto
makesuretheshoesarefreeoftears,
sharpedges,orobjectsthatmightinjure
thefeet.
Peoplewhoneedhelptakingcareoftheir
feetshouldconsidermakinganappointment
toseeafootdoctor,alsocalledapodiatrist.
Points to Remember
Diabeticneuropathiesarenerve
disorderscausedbymanyofthe
abnormalitiescommontodiabetes,
suchashighbloodglucose.
Neuropathycanaffectnerves
throughoutthebody,causing
numbnessandsometimespainin
thehands,arms,feet,orlegs,and
problemswiththedigestivetract,
heart,sexorgans,andotherbody
systems.
Treatmentrstinvolvesbringing
bloodglucoselevelswithinthe
normalrange. Goodbloodglucose
controlmayhelppreventordelay
theonsetoffurtherproblems.
Footcareisanimportantpartof
treatment. Peoplewithneuropathy
needtoinspecttheirfeetdailyfor
anyinjuries. Untreatedinjuries
increasetheriskofinfectedfoot
soresandamputation.
Treatmentalsoincludespainrelief
andothermedicationsasneeded,
dependingonthetypeofnerve
damage.
Smokingincreasestheriskoffoot
problemsandamputation. A
healthcareprovidermaybeableto
providehelpwithquitting.
Hope through Research
TheNationalInstituteofDiabetesandDiges-
tiveandKidneyDiseases(NIDDK)conducts
andsupportsresearchtohelppeoplewith
diabetes.
Participantsinclinicaltrialscanplayamore
activeroleintheirownhealthcare,gainaccess
tonewresearchtreatmentsbeforetheyare
widelyavailable,andhelpothersbycontribut-
ingtomedicalresearch. Forinformationabout
currentstudies,visitwww.ClinicalTrials.gov.
9 DiabeticNeuropathies: TheNerveDamageofDiabetes
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:
Gastroparesisstomach nerve dam-
ageavailable online at www.diges-
tive.niddk.nih.gov/ddiseases/pubs/
gastroparesis
Hypoglycemiaavailable 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 diabe-
tes problems: Keep your nervous system
healthy, two publications in the Prevent
Diabetes Problems Seriesavailable
online at www.diabetes.niddk.nih.gov/
dm/pubs/complications
Sexual and Urologic Problems of
Diabetesavailable online at www.
diabetes.niddk.nih.gov/dm/pubs/sup
Take Care of Your Feet for a Lifetime,
available from the National Diabe-
tes Education Program by calling
1888693NDEP (6337) or visiting
www.ndep.nih.gov/campaigns/Feet/
Feet_overview.htm
These publications are also available by call-
ing 18008608747.
For more information, contact the following
organizations:
American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
Phone: 1800DIABETES (3422383)
Email: [email protected]
Internet: www.diabetes.org
American Podiatric Medical Association
9312 Old Georgetown Road
Bethesda, MD 208141621
Phone: 1800FOOTCARE (3668227)
or 3015819200
Fax: 3015302752
Email: [email protected]
Internet: www.apma.org
American Urological Association
Foundation
1000 Corporate Boulevard
Linthicum, MD 21090
Phone: 18008287866
or 4106893700
Fax: 4106893998
Email: [email protected]
Internet: www.UrologyHealth.org
Centers for Disease Control and Prevention
National Center for Chronic Disease Pre-
vention and Health Promotion
Division of Diabetes Translation
4770 Buford Highway NE, Mail Stop K10
Atlanta, GA 303413717
Phone: 1800CDCINFO (2324636)
or 7704885000
Email: [email protected]
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: 1800533CURE (2873)
Fax: 2127859595
Email: [email protected]
Internet: www.jdrf.org
Lower Extremity Amputation Prevention
Program
Health Resources and Services
Administration
5600 Fishers Lane
Rockville, MD 20857
Phone: 1888ASKHRSA (2754772)
Internet: www.hrsa.gov/leap
National Diabetes Education Program
1 Diabetes Way
Bethesda, MD 208149692
Phone: 1888693NDEP (6337)
TTY: 18665691162
Fax: 7037384929
Email: [email protected]
Internet: www.ndep.nih.gov
National Digestive Diseases Information
Clearinghouse
2 Information Way
Bethesda, MD 208923570
Phone: 18008915389
TTY: 18665691162
Fax: 7037384929
Email: [email protected]
Internet: www.digestive.niddk.nih.gov
National Heart, Lung, and Blood Institute
Information Center
P.O. Box 30105
Bethesda, MD 208240105
Phone: 3015928573
Fax: 2406293246
Email: [email protected]
Internet: www.nhlbi.nih.gov
National Institute of Neurological Disorders
and Stroke
P.O. Box 5801
Bethesda, MD 20824
Phone: 18003529424
or 3014965751
Internet: www.ninds.nih.gov
National Kidney and Urologic Diseases
Information Clearinghouse
3 Information Way
Bethesda, MD 208923580
Phone: 18008915390
TTY: 18665691162
Fax: 7037384929
Email: [email protected]
Internet: www.kidney.niddk.nih.gov
Pedorthic Footwear Association
2025 M Street NW, Suite 800
Washington, DC 20036
Phone: 18006738447
or 2023671145
Fax: 2023672145
Email: [email protected]
Internet: www.pedorthics.org
You may also nd additional information about this
topic by visiting MedlinePlus at www.medlineplus.gov.
This publication may contain information about med-
ications. 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
1888INFOFDA (4636332) or visit www.fda.gov.
Consult your doctor for more information.
The U.S. Government does not endorse or favor any
specic 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 208923560
Phone: 18008608747
TTY: 18665691162
Fax: 7037384929
Email: [email protected]
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. 093185
February 2009