Preventing Diabetes Problems

Return to Overview Page

Diabetes, Heart Disease, and Stroke

Having diabetes means that you are more likely to develop heart disease and have a greater chance of a heart attack or a stroke. People with diabetes are also more likely to have certain conditions, or risk factors, that increase the chances of having heart disease or stroke, such as high blood pressure or high cholesterol. If you have diabetes, you can protect your heart and health by managing your blood glucose, also called blood sugar, as well as your blood pressure and cholesterol. If you smoke, get help to stop.

What is the link between diabetes, heart disease, and stroke?

Over time, high blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. The longer you have diabetes, the higher the chances that you will develop heart disease.1

People with diabetes tend to develop heart disease at a younger age than people without diabetes. In adults with diabetes, the most common causes of death are heart disease and stroke. Adults with diabetes are nearly twice as likely to die from heart disease or stroke as people without diabetes.2

The good news is that the steps you take to manage your diabetes also help to lower your chances of having heart disease or stroke.

What else increases my chances of heart disease or stroke if I have diabetes?

If you have diabetes, other factors add to your chances of developing heart disease or having a stroke.

Smoking

Smoking raises your risk of developing heart disease. If you have diabetes, it is important to stop smoking because both smoking and diabetes narrow blood vessels. Smoking also increases your chances of developing other long-term problems such as lung disease. Smoking also can damage the blood vessels in your legs and increase the risk of lower leg infections, ulcers, and amputation.

High blood pressure

If you have high blood pressure, your heart must work harder to pump blood. High blood pressure can strain your heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.

Abnormal cholesterol levels

Cholesterol is a type of fat produced by your liver and found in your blood. You have two kinds of cholesterol in your blood: LDL and HDL.

LDL, often called “bad” cholesterol, can build up and clog your blood vessels. High levels of LDL cholesterol raise your risk of developing heart disease.

Another type of blood fat, triglycerides, also can raise your risk of heart disease when the levels are higher than recommended by your health care team.

Obesity and belly fat

Being overweight or obese can affect your ability to manage your diabetes and increase your risk for many health problems, including heart disease and high blood pressure. If you are overweight, a healthy eating plan with reduced calories often will lower your glucose levels and reduce your need for medications.

Excess belly fat around your waist, even if you are not overweight, can raise your chances of developing heart disease.

Health care professional measures a man’s waistline.
Even if you are a normal weight, excess belly fat can raise your risk for heart disease.

You have excess belly fat if your waist measures

  • more than 40 inches and you are a man
  • more than 35 inches and you are a woman

Learn how to correctly measure your waist.

Family history of heart disease

A family history of heart disease may also add to your chances of developing heart disease. If one or more of your family members had a heart attack before age 50, you may have an even higher chance of developing heart disease.3

You can’t change whether heart disease runs in your family, but if you have diabetes, it’s even more important to take steps to protect yourself from heart disease and decrease your chances of having a stroke.

How can I lower my chances of a heart attack or stroke if I have diabetes?

Taking care of your diabetes is important to help you take care of your heart. You can lower your chances of having a heart attack or stroke by taking the following steps to manage your diabetes to keep your heart and blood vessels healthy.

Manage your diabetes ABCs

Knowing your diabetes ABCs will help you manage your blood glucose, blood pressure, and cholesterol. Stopping smoking if you have diabetes is also important to lower your chances for heart disease.

A is for the A1C test. The A1C test shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks that you do every day. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months. High levels of blood glucose can harm your heart, blood vessels, kidneys, feet, and eyes.

The A1C goal for many people with diabetes is below 7 percent. Some people may do better with a slightly higher A1C goal. Ask your health care team what your goal should be.

B is for blood pressure. Blood pressure is the force of your blood against the wall of your blood vessels. If your blood pressure gets too high, it makes your heart work too hard. High blood pressure can cause a heart attack or stroke and damage your kidneys and eyes.

The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask what your goal should be.

C is for cholesterol. You have two kinds of cholesterol in your blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog your blood vessels. Too much bad cholesterol can cause a heart attack or stroke. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels.

Ask your health care team what your cholesterol numbers should be. If you are over 40 years of age, you may need to take medicine such as a statin to lower your cholesterol and protect your heart. Some people with very high LDL (“bad”) cholesterol may need to take medicine at a younger age.

S is for stop smoking. Not smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels, so your heart has to work harder.

If you quit smoking

  • you will lower your risk for heart attack, stroke, nerve disease, kidney disease, eye disease, and amputation
  • your blood glucose, blood pressure, and cholesterol levels may improve
  • your blood circulation will improve
  • you may have an easier time being physically active

If you smoke or use other tobacco products, stop. Ask for help so you don’t have to do it alone. You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to Smokefree.gov.

Ask your health care team about your goals for A1C, blood pressure, and cholesterol, and what you can do to reach these goals.

Develop or maintain healthy lifestyle habits

Developing or maintaining healthy lifestyle habits can help you manage your diabetes and prevent heart disease.

  • Follow your healthy eating plan.
  • Make physical activity part of your routine.
  • Stay at or get to a healthy weight
  • Get enough sleep.

Learn more about these tips to manage diabetes.

Smiling couple walking in a park.
Develop or maintain healthy lifestyle habits. Physical activity can help you manage your diabetes and may help you cope with stress.

Watch a video about what you can do to keep your heart healthy.

Learn to manage stress

Managing diabetes is not always easy. Feeling stressed, sad, or angry is common when you are living with diabetes. You may know what to do to stay healthy but may have trouble sticking with your plan over time. Long-term stress can raise your blood glucose and blood pressure, but you can learn ways to lower your stress. Try deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music. Learn more about healthy ways to cope with stress.

Take medicine to protect your heart

Medicines may be an important part of your treatment plan. Your doctor will prescribe medicine based on your specific needs. Medicine may help you

  • meet your A1C (blood glucose), blood pressure, and cholesterol goals.
  • reduce your risk of blood clots, heart attack, or stroke.
  • treat angina, or chest pain that is often a symptom of heart disease. (Angina can also be an early symptom of a heart attack.)

Ask your doctor whether you should take aspirin. Aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take.

Statins can reduce the risk of having a heart attack or stroke in some people with diabetes. Statins are a type of medicine often used to help people meet their cholesterol goals. Talk with your doctor to find out whether taking a statin is right for you.

Talk with your doctor if you have questions about your medicines. Before you start a new medicine, ask your doctor about possible side effects and how you can avoid them. If the side effects of your medicine bother you, tell your doctor. Don’t stop taking your medicines without checking with your doctor first.

Woman taking her medicine.
Take medicines as prescribed.

How do doctors diagnose heart disease in diabetes?

Doctors diagnose heart disease in diabetes based on

  • your symptoms
  • your medical and family history
  • how likely you are to have heart disease
  • a physical exam
  • results from tests and procedures

Tests used to monitor your diabetes—A1C, blood pressure, and cholesterol—help your doctor decide whether it is important to do other tests to check your heart health.

Doctor using a stethoscope to examine a patient.
Your health care provider will do a physical exam.

What are the warning signs of heart attack and stroke?

Call 9-1-1 right away if you have warning signs of a heart attack:

  • pain or pressure in your chest that lasts longer than a few minutes or goes away and comes back
  • pain or discomfort in one or both of your arms or shoulders; or your back, neck, or jaw
  • shortness of breath
  • sweating or light-headedness
  • indigestion or nausea (feeling sick to your stomach)
  • feeling very tired

Treatment works best when it is given right away. Warning signs can be different in different people. You may not have all of these symptoms.

If you have angina, it’s important to know how and when to seek medical treatment.

Women sometimes have nausea and vomiting, feel very tired (sometimes for days), and have pain in the back, shoulders, or jaw without any chest pain.

People with diabetes-related nerve damage may not notice any chest pain.

Call 9-1-1 right away if you have warning signs of a stroke, including sudden

  • weakness or numbness of your face, arm, or leg on one side of your body
  • confusion, or trouble talking or understanding
  • dizziness, loss of balance, or trouble walking
  • trouble seeing out of one or both eyes
  • sudden severe headache

If you have any one of these warning signs, call 9-1-1. You can help prevent permanent damage by getting to a hospital within an hour of a stroke.

Red button with “911 Emergency”
Call 9-1-1 if you have the warning signs of a heart attack or stroke. Treatment works best when given right away.

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Low Blood Glucose (Hypoglycemia)

What is hypoglycemia?

Hypoglycemia, also called low blood glucose or low blood sugar, occurs when the level of glucose in your blood drops below normal. For many people with diabetes, that means a level of 70 milligrams per deciliter (mg/dL) or less. Your numbers might be different, so check with your health care provider to find out what level is too low for you.

What are the symptoms of hypoglycemia?

Symptoms of hypoglycemia tend to come on quickly and can vary from person to person. You may have one or more mild-to-moderate symptoms listed in the table below. Sometimes people don’t feel any symptoms.

Severe hypoglycemia is when your blood glucose level becomes so low that you’re unable to treat yourself and need help from another person. Severe hypoglycemia is dangerous and needs to be treated right away. This condition is more common in people with type 1 diabetes.

Hypoglycemia Symptoms
Mild-to-Moderate Severe
  • Shaky or jittery
  • Sweaty
  • Hungry
  • Headachy
  • Blurred vision
  • Sleepy or tired
  • Dizzy or lightheaded
  • Confused or disoriented
  • Pale
  • Uncoordinated
  • Irritable or nervous
  • Argumentative or combative
  • Changed behavior or personality
  • Trouble concentrating
  • Weak
  • Fast or irregular heart beat
  • Unable to eat or drink
  • Seizures or convulsions (jerky movements)
  • Unconsciousness

Some symptoms of hypoglycemia during sleep are

  • crying out or having nightmares
  • sweating enough to make your pajamas or sheets damp
  • feeling tired, irritable, or confused after waking up

What causes hypoglycemia in diabetes?

Hypoglycemia can be a side effect of insulin or other types of diabetes medicines that help your body make more insulin. Two types of diabetes pills can cause hypoglycemia: sulfonylureas and meglitinides. Ask your health care team if your diabetes medicine can cause hypoglycemia.

Although other diabetes medicines don’t cause hypoglycemia by themselves, they can increase the chances of hypoglycemia if you also take insulin, a sulfonylurea, or a meglitinide.

Prescription bottle with pills; syringe and vial of insulin.
If you take insulin or some other diabetes medicines, your blood glucose level can drop too low.

What other factors contribute to hypoglycemia in diabetes?

If you take insulin or diabetes medicines that increase the amount of insulin your body makes—but don’t match your medications with your food or physical activity—you could develop hypoglycemia. The following factors can make hypoglycemia more likely:

Not eating enough carbohydrates (carbs)

When you eat foods containing carbohydrates, your digestive system breaks down the sugars and starches into glucose. Glucose then enters your bloodstream and raises your blood glucose level. If you don’t eat enough carbohydrates to match your medication, your blood glucose could drop too low.

Skipping or delaying a meal

If you skip or delay a meal, your blood glucose could drop too low. Hypoglycemia also can occur when you are asleep and haven’t eaten for several hours.

Increasing physical activity

Increasing your physical activity level beyond your normal routine can lower your blood glucose level for up to 24 hours after the activity.

Drinking too much alcohol without enough food

Alcohol makes it harder for your body to keep your blood glucose level steady, especially if you haven’t eaten in a while. The effects of alcohol can also keep you from feeling the symptoms of hypoglycemia, which may lead to severe hypoglycemia.

Being sick

When you’re sick, you may not be able to eat as much or keep food down, which can cause low blood glucose. Learn more about taking care of your diabetes when you’re sick.

How can I prevent hypoglycemia if I have diabetes?

If you are taking insulin, a sulfonylurea, or a meglitinide, using your diabetes management plan and working with your health care team to adjust your plan as needed can help you prevent hypoglycemia. The following actions can also help prevent hypoglycemia:

Check blood glucose levels

Knowing your blood glucose level can help you decide how much medicine to take, what food to eat, and how physically active to be. To find out your blood glucose level, check yourself with a blood glucose meter as often as your doctor advises.

Hypoglycemia unawareness. Sometimes people with diabetes don’t feel or recognize the symptoms of hypoglycemia, a problem called hypoglycemia unawareness. If you have had hypoglycemia without feeling any symptoms, you may need to check your blood glucose more often so you know when you need to treat your hypoglycemia or take steps to prevent it. Be sure to check your blood glucose before you drive.

If you have hypoglycemia unawareness or have hypoglycemia often, ask your health care provider about a continuous glucose monitor (CGM). A CGM checks your blood glucose level at regular times throughout the day and night. CGMs can tell you if your blood glucose is falling quickly and sound an alarm if your blood glucose falls too low. CGM alarms can wake you up if you have hypoglycemia during sleep.

Eat regular meals and snacks

Your meal plan is key to preventing hypoglycemia. Eat regular meals and snacks with the correct amount of carbohydrates to help keep your blood glucose level from going too low. Also, if you drink alcoholic beverages, it’s best to eat some food at the same time.

Be physically active safely

Physical activity can lower your blood glucose during the activity and for hours afterward. To help prevent hypoglycemia, you may need to check your blood glucose before, during, and after physical activity and adjust your medicine or carbohydrate intake. For example, you might eat a snack before being physically active or decrease your insulin dose as directed by your health care provider to keep your blood glucose from dropping too low.

Work with your health care team

Tell your health care team if you have had hypoglycemia. Your health care team may adjust your diabetes medicines or other aspects of your management plan. Learn about balancing your medicines, eating plan, and physical activity to prevent hypoglycemia. Ask if you should have a glucagon emergency kit to carry with you at all times.

Woman talking with her doctor.
You can help prevent hypoglycemia by working with your health care team.

How do I treat hypoglycemia?

If you begin to feel one or more hypoglycemia symptoms, check your blood glucose. If your blood glucose level is below your target or less than 70, eat or drink 15 grams of carbohydrates right away. Examples include

  • four glucose tablets or one tube of glucose gel
  • 1/2 cup (4 ounces) of fruit juice—not low-calorie or reduced sugar*
  • 1/2 can (4 to 6 ounces) of soda—not low-calorie or reduced sugar
  • 1 tablespoon of sugar, honey, or corn syrup
  • 2 tablespoons of raisins

Wait 15 minutes and check your blood glucose again. If your glucose level is still low, eat or drink another 15 grams of glucose or carbohydrates. Check your blood glucose again after another 15 minutes. Repeat these steps until your glucose level is back to normal.

If your next meal is more than 1 hour away, have a snack to keep your blood glucose level in your target range. Try crackers or a piece of fruit.

*People who have kidney disease shouldn’t drink orange juice for their 15 grams of carbohydrates because it contains a lot of potassium. Apple, grape, or cranberry juice are good options.

Woman drinking a glass of apple juice.
If your blood glucose is below your target, take 15 grams of glucose or carbohydrates right away.

Treating hypoglycemia if you take acarbose or miglitol

If you take acarbose or miglitol along with diabetes medicines that can cause hypoglycemia, you will need to take glucose tablets or glucose gel if your blood glucose level is too low. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough.

What if I have severe hypoglycemia and can’t treat myself?

Someone will need to give you a glucagon injection if you have severe hypoglycemia. An injection of glucagon will quickly raise your blood glucose level. Talk with your health care provider about when and how to use a glucagon emergency kit. If you have an emergency kit, check the date on the package to make sure it hasn’t expired.

If you are likely to have severe hypoglycemia, teach your family, friends, and coworkers when and how to give you a glucagon injection. Also, tell your family, friends, and coworkers to call 911 right away after giving you a glucagon injection or if you don’t have a glucagon emergency kit with you.

If you have hypoglycemia often or have had severe hypoglycemia, you should wear a medical alert bracelet or pendant. A medical alert ID tells other people that you have diabetes and need care right away. Getting prompt care can help prevent the serious problems that hypoglycemia can cause.

Nerve Damage (Diabetic Neuropathies)

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

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.

Outline of a body with shaded lines showing the location of nerves affected by peripheral neuropathy. Peripheral nerves are in the toes, feet, legs, hands, and arms.
Peripheral neuropathy affects the nerves in your toes, feet, legs, hands, and arms.

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.

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.

Outline of a body with shaded lines showing the location of nerves affected by autonomic neuropathy. Autonomic nerves are in the heart, stomach, intestines, bladder, sex organs, sweat glands, eyes, and lungs.
Autonomic neuropathy affects the nerves in your 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.

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.

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.

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.

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 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 salt-retaining 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.

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.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Diabetic Kidney Disease

What is diabetic kidney disease?

Diabetic kidney disease is a type of kidney disease caused by diabetes.

Diabetes is the leading cause of kidney disease. About 1 out of 4 adults with diabetes has kidney disease.1

The main job of the kidneys is to filter wastes and extra water out of your blood to make urine. Your kidneys also help control blood pressure and make hormones that your body needs to stay healthy.

Illustration of an upper body showing the location of the kidneys.
Your kidneys are located in the middle of your back, just below your rib cage.

When your kidneys are damaged, they can’t filter blood like they should, which can cause wastes to build up in your body. Kidney damage can also cause other health problems.

Kidney damage caused by diabetes usually occurs slowly, over many years. You can take steps to protect your kidneys and to prevent or delay kidney damage.

Watch a video about Diabetes and Kidney Disease.

What are other names for diabetic kidney disease?

Diabetic kidney disease is also called DKD, chronic kidney disease, CKD, kidney disease of diabetes, or diabetic nephropathy.

How does diabetes cause kidney disease?

High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys. Learn more about high blood pressure and kidney disease.

What increases my chances of developing diabetic kidney disease?

Having diabetes for a longer time increases the chances that you will have kidney damage. If you have diabetes, you are more likely to develop kidney disease if your

  • blood glucose is too high
  • blood pressure is too high

African Americans, American Indians, and Hispanics/Latinos develop diabetes, kidney disease, and kidney failure at a higher rate than Caucasians.

You are also more likely to develop kidney disease if you have diabetes and

  • smoke
  • don’t follow your diabetes eating plan
  • eat foods high in salt
  • are not active
  • are overweight
  • have heart disease
  • have a family history of kidney failure
A woman having her blood pressure checked by a health care professional.
If you have diabetes, you are more likely to develop kidney disease if you have high blood pressure.

How can I tell if I have diabetic kidney disease?

Most people with diabetic kidney disease do not have symptoms. The only way to know if you have diabetic kidney disease is to get your kidneys checked.

Health care professionals use blood and urine tests to check for diabetic kidney disease. Your health care professional will check your urine for albumin and will also do a blood test to see how well your kidneys are filtering your blood.

You should get tested every year for kidney disease if you

One vial with a blood sample and another vial with a urine sample.
Health care professionals use blood and urine tests to check for kidney disease.

How can I keep my kidneys healthy if I have diabetes?

The best way to slow or prevent diabetes-related kidney disease is to try to reach your blood glucose and blood pressure goals. Healthy lifestyle habits and taking your medicines as prescribed can help you achieve these goals and improve your health overall.

Reach your blood glucose goals

Your health care professional will test your A1C. The A1C is a blood test that shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks that you may do yourself. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months.

The A1C goal for many people with diabetes is below 7 percent. Ask your health care team what your goal should be. Reaching your goal numbers will help you protect your kidneys.

To reach your A1C goal, your health care professional may ask you to check your blood glucose levels. Work with your health care team to use the results to guide decisions about food, physical activity, and medicines. Ask your health care team how often you should check your blood glucose level.

Man measuring the level of glucose in his blood.
Protect your kidneys by keeping your blood glucose under control.

Control your blood pressure

Blood pressure is the force of your blood against the wall of your blood vessels. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.

Your health care team will also work with you to help you set and reach your blood pressure goal. The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask your health care team what your goal should be.

Man having his blood pressure checked by a health care professional.
Protect your kidneys by keeping your blood pressure under control.

Medicines that lower blood pressure can also help slow kidney damage. Two types of blood pressure medicines, ACE inhibitors and ARBs, play a special role in protecting your kidneys. Each has been found to slow kidney damage in people with diabetes who have high blood pressure and DKD. The names of these medicines end in –pril or –sartan. ACE inhibitors and ARBs are not safe for women who are pregnant.

Develop or maintain healthy lifestyle habits

Healthy lifestyle habits can help you reach your blood glucose and blood pressure goals. Following the steps below will also help you keep your kidneys healthy:

  • Stop smoking.
  • Work with a dietitian to develop a diabetes meal plan and limit salt and sodium.
  • Make physical activity part of your routine.
  • Stay at or get to a healthy weight.
  • Get enough sleep. Aim for 7 to 8 hours of sleep each night.

Learn more about these tips to manage diabetes.

Take medicines as prescribed

Medicines may be an important part of your treatment plan. Your health care professional will prescribe medicine based on your specific needs. Medicine can help you meet your blood glucose and blood pressure goals. You may need to take more than one kind of medicine to control your blood pressure.

Couple talking with a pharmacist.
Talk to your health care professional or pharmacist about all of the medicines you take, including over-the-counter medicines.

How can I cope with the stress of managing my diabetes?

Managing diabetes isn’t always easy. Feeling stressed, sad, or angry is common when you are living with diabetes. You may know what to do to stay healthy but may have trouble sticking with your plan over time. Long-term stress can raise your blood glucose and blood pressure, but you can learn ways to lower your stress. Try deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music. Learn more about healthy ways to cope with stress.

Does diabetic kidney disease get worse over time?

Kidney damage from diabetes can get worse over time. However, you can take steps to keep your kidneys healthy and help slow kidney damage to prevent or delay kidney failure. Kidney failure means that your kidneys have lost most of their ability to function—less than 15 percent of normal kidney function. However, most people with diabetes and kidney disease don’t end up with kidney failure.

If your kidneys become damaged as a result of diabetes, learn how to manage kidney disease.

References

Diabetes and Foot Problems

Foot problems are common in people with diabetes. You might be afraid you’ll lose a toe, foot, or leg to diabetes, or know someone who has, but you can lower your chances of having diabetes-related foot problems by taking care of your feet every day. Managing your blood glucose levels, also called blood sugar, can also help keep your feet healthy.

How can diabetes affect my feet?

Over time, diabetes may cause nerve damage, also called diabetic neuropathy, that can cause tingling and pain, and can make you lose feeling in your feet. When you lose feeling in your feet, you may not feel a pebble inside your sock or a blister on your foot, which can lead to cuts and sores. Cuts and sores can become infected.

Diabetes also can lower the amount of blood flow in your feet. Not having enough blood flowing to your legs and feet can make it hard for a sore or an infection to heal. Sometimes, a bad infection never heals. The infection might lead to gangrene.

Gangrene and foot ulcers that do not get better with treatment can lead to an amputation of your toe, foot, or part of your leg. A surgeon may perform an amputation to prevent a bad infection from spreading to the rest of your body, and to save your life. Good foot care is very important to prevent serious infections and gangrene.

Although rare, nerve damage from diabetes can lead to changes in the shape of your feet, such as Charcot’s foot. Charcot’s foot may start with redness, warmth, and swelling. Later, bones in your feet and toes can shift or break, which can cause your feet to have an odd shape, such as a “rocker bottom.”

Illustration of Charcot’s foot showing an enlarged sole of the foot with a rounded shape.
Charcot’s foot can cause your feet to have an odd shape, such as a “rocker bottom.”

What can I do to keep my feet healthy?

Work with your health care team to make a diabetes self-care plan, which is an action plan for how you will manage your diabetes. Your plan should include foot care. A foot doctor, also called a podiatrist, and other specialists may be part of your health care team.

Include these steps in your foot care plan:

Check your feet every day

You may have foot problems, but feel no pain in your feet. Checking your feet each day will help you spot problems early before they get worse. A good way to remember is to check your feet each evening when you take off your shoes. Also check between your toes. If you have trouble bending over to see your feet, try using a mirror to see them, or ask someone else to look at your feet.

Look for problems such as

  • cuts, sores, or red spots
  • swelling or fluid-filled blisters
  • ingrown toenails, in which the edge of your nail grows into your skin
  • corns or calluses, which are spots of rough skin caused by too much rubbing or pressure on the same spot
  • plantar warts, which are flesh-colored growths on the bottom of the feet
  • athlete’s foot
  • warm spots
Someone checking the bottom of their bare foot.

If you have certain foot problems that make it more likely you will develop a sore on your foot, your doctor may recommend taking the temperature of the skin on different parts of your feet. A “hot spot” can be the first sign that a blister or an ulcer is starting.

Cover a blister, cut, or sore with a bandage. Smooth corns and calluses as explained below.

Wash your feet every day

Wash your feet with soap in warm, not hot, water. Test the water to make sure it is not too hot. You can use a thermometer (90° to 95° F is safe) or your elbow to test the warmth of the water. Do not soak your feet because your skin will get too dry.

Photo of a person’s bare foot with hands examining the toes.

After washing and drying your feet, put talcum powder or cornstarch between your toes. Skin between the toes tends to stay moist. Powder will keep the skin dry to help prevent an infection.

Smooth corns and calluses gently

Thick patches of skin called corns or calluses can grow on the feet. If you have corns or calluses, talk with your foot doctor about the best way to care for these foot problems. If you have nerve damage, these patches can become ulcers.

Photo of a woman smoothing the bottom of her foot with a pumice stone.

If your doctor tells you to, use a pumice stone to smooth corns and calluses after bathing or showering. A pumice stone is a type of rock used to smooth the skin. Rub gently, only in one direction, to avoid tearing the skin.

Do NOT

  • cut corns and calluses
  • use corn plasters, which are medicated pads
  • use liquid corn and callus removers

Cutting and over-the counter corn removal products can damage your skin and cause an infection.

To keep your skin smooth and soft, rub a thin coat of lotion, cream, or petroleum jelly on the tops and bottoms of your feet. Do not put lotion or cream between your toes because moistness might cause an infection.

Trim your toenails straight across

Trim your toenails, when needed, after you wash and dry your feet. Using toenail clippers, trim your toenails straight across. Do not cut into the corners of your toenail. Gently smooth each nail with an emery board or nonsharp nail file. Trimming this way helps prevent cutting your skin and keeps the nails from growing into your skin.

Photo of someone clipping their toenails.

Have a foot doctor trim your toenails if

  • you cannot see, feel, or reach your feet
  • your toenails are thick or yellowed
  • your nails curve and grow into the skin

If you want to get a pedicure at a salon, you should bring your own nail tools to prevent getting an infection. You can ask your health care provider what other steps you can take at the salon to prevent infection.

Wear shoes and socks at all times

Wear shoes and socks at all times. Do not walk barefoot or in just socks – even when you are indoors. You could step on something and hurt your feet. You may not feel any pain and may not know that you hurt yourself.

Check the inside of your shoes before putting them on, to make sure the lining is smooth and free of pebbles or other objects.

Photo of a man feeling inside his shoe.

Make sure you wear socks, stockings, or nylons with your shoes to keep from getting blisters and sores. Choose clean, lightly padded socks that fit well. Socks with no seams are best.

Wear shoes that fit well and protect your feet. Here are some tips for finding the right type of shoes:

  • Walking shoes and athletic shoes are good for daily wear. They support your feet and allow them to “breathe.”
  • Do not wear vinyl or plastic shoes, because they do not stretch or “breathe.”
  • When buying shoes, make sure they feel good and have enough room for your toes. Buy shoes at the end of the day, when your feet are the largest, so that you can find the best fit.
  • If you have a bunion, or hammertoes, which are toes that curl under your feet, you may need extra-wide or deep shoes.1 Do not wear shoes with pointed toes or high heels, because they put too much pressure on your toes.
  • If your feet have changed shape, such as from Charcot’s foot, you may need special shoes or shoe inserts, called orthotics. You also may need inserts if you have bunions, hammertoes, or other foot problems.

When breaking in new shoes, only wear them for a few hours at first and then check your feet for areas of soreness.

Medicare Part B insurance and other health insurance programs may help pay for these special shoes or inserts. Ask your insurance plan if it covers your special shoes or inserts.

Protect your feet from hot and cold

If you have nerve damage from diabetes, you may burn your feet and not know you did. Take the following steps to protect your feet from heat:

  • Wear shoes at the beach and on hot pavement.
  • Put sunscreen on the tops of your feet to prevent sunburn.
  • Keep your feet away from heaters and open fires.
  • Do not put a hot water bottle or heating pad on your feet.
Photo of someone’s feet wearing shoes and walking on the sand.

Wear socks in bed if your feet get cold. In the winter, wear lined, waterproof boots to keep your feet warm and dry.

Keep the blood flowing to your feet

Try the following tips to improve blood flow to your feet:

  • Put your feet up when you are sitting.
  • Wiggle your toes for a few minutes throughout the day. Move your ankles up and down and in and out to help blood flow in your feet and legs.
  • Do not wear tight socks or elastic stockings. Do not try to hold up loose socks with rubber bands.
  • Be more physically active. Choose activities that are easy on your feet, such as walking, dancing, yoga or stretching, swimming, or bike riding.
  • Stop smoking.
Photo of a man sitting reading a book with his feet resting on footstool.

Smoking can lower the amount of blood flow to your feet. If you smoke, ask for help to stop. You can get help by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to SmokeFree.gov.

Get a foot check at every health care visit

Ask your health care team to check your feet at each visit. Take off your shoes and socks when you’re in the exam room so they will remember to check your feet. At least once a year, get a thorough foot exam, including a check of the feeling and pulses in your feet.

Photo of a doctor examining someone’s bare feet.

Get a thorough foot exam at each health care visit if you have

  • changes in the shape of your feet
  • loss of feeling in your feet
  • peripheral artery disease
  • had foot ulcers or an amputation in the past1

Ask your health care team to show you how to care for your feet.

When should I see my health care provider about foot problems?

Call your health care provider right away if you have

  • a cut, blister, or bruise on your foot that does not start to heal after a few days
  • skin on your foot that becomes red, warm, or painful—signs of a possible infection
  • a callus with dried blood inside of it,which often can be the first sign of a wound under the callus
  • a foot infection that becomes black and smelly—signs you might have gangrene

Ask your provider to refer you to a foot doctor, or podiatrist, if needed.

References

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?

Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?

Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

Diabetic Eye Disease

What is diabetic eye disease?

Diabetic eye disease is a group of eye problems that can affect people with diabetes. These conditions include diabetic retinopathy, diabetic macular edema, cataracts, and glaucoma.

Over time, diabetes can cause damage to your eyes that can lead to poor vision or even blindness. But you can take steps to prevent diabetic eye disease, or keep it from getting worse, by taking care of your diabetes.

The best ways to manage your diabetes and keep your eyes healthy are to

Eye doctor examines a man's eyes for signs of eye disease during a full, yearly eye exam.
Photo courtesy of the National Eye Institute, NIH.
Your eyes may seem fine, but having a full, dilated eye exam is the only way to know for sure.

Often, there are no warning signs of diabetic eye disease or vision loss when damage first develops. A full, dilated eye exam helps your doctor find and treat eye problems early—often before much vision loss can occur.

How does diabetes affect my eyes?

Diabetes affects your eyes when your blood glucose, also called blood sugar, is too high.

In the short term, you are not likely to have vision loss from high blood glucose. People sometimes have blurry vision for a few days or weeks when they’re changing their diabetes care plan or medicines. High glucose can change fluid levels or cause swelling in the tissues of your eyes that help you to focus, causing blurred vision. This type of blurry vision is temporary and goes away when your glucose level gets closer to normal.

If your blood glucose stays high over time, it can damage the tiny blood vessels in the back of your eyes. This damage can begin during prediabetes, when blood glucose is higher than normal, but not high enough for you to be diagnosed with diabetes. Damaged blood vessels may leak fluid and cause swelling. New, weak blood vessels may also begin to grow. These blood vessels can bleed into the middle part of the eye, lead to scarring, or cause dangerously high pressure inside your eye.

Most serious diabetic eye diseases begin with blood vessel problems. The four eye diseases that can threaten your sight are

Diabetic retinopathy

The retina is the inner lining at the back of each eye. The retina senses light and turns it into signals that your brain decodes, so you can see the world around you. Damaged blood vessels can harm the retina, causing a disease called diabetic retinopathy.

In early diabetic retinopathy, blood vessels can weaken, bulge, or leak into the retina. This stage is called nonproliferative diabetic retinopathy.

If the disease gets worse, some blood vessels close off, which causes new blood vessels to grow, or proliferate, on the surface of the retina. This stage is called proliferative diabetic retinopathy. These abnormal new blood vessels can lead to serious vision problems.

Two boys hold rubber balls and smile at the viewer.
Photo courtesy of the National Eye Institute, NIH.
Normal vision of two boys playing.
This photo shows how retinopathy might affect vision. Dark spots hang over a view of two boys with rubber balls. The spots block their faces.
Photo courtesy of the National Eye Institute, NIH.
Same scene, as viewed by a person with diabetic retinopathy.

Diabetic macular edema

The part of your retina that you need for reading, driving, and seeing faces is called the macula. Diabetes can lead to swelling in the macula, which is called diabetic macular edema. Over time, this disease can destroy the sharp vision in this part of the eye, leading to partial vision loss or blindness. Macular edema usually develops in people who already have other signs of diabetic retinopathy.

Glaucoma

Glaucoma is a group of eye diseases that can damage the optic nerve—the bundle of nerves that connects the eye to the brain. Diabetes doubles the chances of having glaucoma, which can lead to vision loss and blindness if not treated early.

Symptoms depend on which type of glaucoma you have. Learn more about glaucoma.

This photo shows how glaucoma affects vision. Shadows darken all sides of a view of two boys. Only the center is bright enough to see clearly.
Photo courtesy of the National Eye Institute, NIH.
People with glaucoma slowly lose side vision.

Cataracts

The lenses within our eyes are clear structures that help provide sharp vision—but they tend to become cloudy as we age. People with diabetes are more likely to develop cloudy lenses, called cataracts. People with diabetes can develop cataracts at an earlier age than people without diabetes. Researchers think that high glucose levels cause deposits to build up in the lenses of your eyes.

A blurry photo shows two boys with rubber balls. The photo shows how cloudy lenses in the eye, called cataracts, affect vision.
Photo courtesy of the National Eye Institute, NIH.
Cloudy vision and faded colors are symptoms of cataracts.

How common is diabetic eye disease?

Diabetic retinopathy

About one in three people with diabetes who are older than age 40 already have some signs of diabetic retinopathy.1 Diabetic retinopathy is the most common cause of vision loss in people with diabetes. Each person’s outlook for the future, however, depends in large part on regular care. Finding and treating diabetic retinopathy early can reduce the risk of blindness by 95 percent.

Glaucoma and cataracts

Your chances of developing glaucoma or cataracts are about twice that of someone without diabetes.

Who is more likely to develop diabetic eye disease?

Anyone with diabetes can develop diabetic eye disease. Your risk is greater with

  • high blood glucose that is not treated
  • high blood pressure that is not treated

High blood cholesterol and smoking may also raise your risk for diabetic eye disease.

Some groups are affected more than others. African Americans, American Indians and Alaska Natives, Hispanics/Latinos, Pacific Islanders, and older adults are at greater risk of losing vision or going blind from diabetes.

If you have diabetes and become pregnant, you can develop eye problems very quickly during your pregnancy. If you already have some diabetic retinopathy, it can get worse during pregnancy. Changes that help your body support a growing baby may put stress on the blood vessels in your eyes. Your health care team will suggest regular eye exams during pregnancy to catch and treat problems early and protect your vision.

Diabetes that occurs only during pregnancy, called gestational diabetes, does not usually cause eye problems. Researchers aren't sure why this is the case.

Your chances of developing diabetic eye disease increase the longer you have diabetes.

What are the symptoms of diabetic eye disease?

Often there are no early symptoms of diabetic eye disease. You may have no pain and no change in your vision as damage begins to grow inside your eyes, particularly with diabetic retinopathy.

When symptoms do occur, they may include

  • blurry or wavy vision
  • frequently changing vision—sometimes from day to day
  • dark areas or vision loss
  • poor color vision
  • spots or dark strings (also called floaters)
  • flashes of light

Talk with your eye doctor if you have any of these symptoms.

When should I see a doctor right away?

Call a doctor right away if you notice sudden changes to your vision, including flashes of light or many more spots (floaters) than usual. You also should see a doctor right away if it looks like a curtain is pulled over your eyes. These changes in your sight can be symptoms of a detached retina, which is a medical emergency.

How do doctors diagnose eye problems from diabetes?

Having a full, dilated eye exam is the best way to check for eye problems from diabetes. Your doctor will place drops in your eyes to widen your pupils. This allows the doctor to examine a larger area at the back of each eye, using a special magnifying lens. Your vision will be blurry for a few hours after a dilated exam.

Your doctor will also

  • test your vision
  • measure the pressure in your eyes

Your doctor may suggest other tests, too, depending on your health history.

Most people with diabetes should see an eye care professional once a year for a complete eye exam. Your own health care team may suggest a different plan, based on your type of diabetes and the time since you were first diagnosed.

How do doctors treat diabetic eye disease?

Your doctor may recommend having eye exams more often than once a year, along with management of your diabetes. This means managing your diabetes ABCs, which include your A1c, blood pressure, and cholesterol; and quitting smoking. Ask your health care team what you can do to reach your goals.

A woman holds a blood glucose testing meter next to a drop of blood on her finger.
Management of blood glucose can help prevent diabetic eye disease and keep it from getting worse.

Doctors may treat advanced eye problems with medicine, laser treatments, surgery, or a combination of these options.

Medicine

Your doctor may treat your eyes with anti-VEGF medicine, such as aflibercept, bevacizumab, or ranibizumab. These medicines block the growth of abnormal blood vessels in the eye. Anti-VEGF medicines can also stop fluid leaks, which can help treat diabetic macular edema.

The doctor will inject an anti-VEGF medicine into your eyes during office visits. You'll have several treatments during the first few months, then fewer treatments after you finish the first round of therapy. Your doctor will use medicine to numb your eyes so you don’t feel pain. The needle is about the thickness of a human hair.

Anti-VEGF treatments can stop further vision loss and may improve vision in some people.

Laser Treatment

Laser treatment, also called photocoagulation, creates tiny burns inside the eye with a beam of light. This method treats leaky blood vessels and extra fluid, called edema. Your doctor usually provides this treatment during several office visits, using medicine to numb your eyes. Laser treatment can keep eye disease from getting worse, which is important to prevent vision loss or blindness. But laser treatment is less likely to bring back vision you’ve already lost compared with anti-VEGF medicines.

There are two types of laser treatment:

  • Focal/grid laser treatment works on a small area of the retina to treat diabetic macular edema.
  • Scatter laser treatment, also called panretinal photocoagulation (PRP), covers a larger area of the retina. This method treats the growth of abnormal blood vessels, called proliferative diabetic retinopathy.

Vitrectomy

Vitrectomy is a surgery to remove the clear gel that fills the center of the eye, called the vitreous gel. The procedure treats problems with severe bleeding or scar tissue caused by proliferative diabetic retinopathy. Scar tissue can force the retina to peel away from the tissue beneath it, like wallpaper peeling away from a wall. A retina that comes completely loose, or detaches, can cause blindness.

During vitrectomy, a clear salt solution is gently pumped into the eye to maintain eye pressure during surgery and to replace the removed vitreous. Vitrectomy is done in a surgery center or hospital with pain medicine.

Cataract Lens Surgery

In a surgery center or hospital visit, your doctor can remove the cloudy lens in your eye, where the cataract has grown, and replace it with an artificial lens. People who have cataract surgery generally have better vision afterward. After your eye heals, you may need a new prescription for your glasses. Your vision following cataract surgery may also depend on treating any damage from diabetic retinopathy or macular edema.

What can I do to protect my eyes?

To prevent diabetic eye disease, or to keep it from getting worse, manage your diabetes ABCs: your A1c, blood pressure, and cholesterol; and quit smoking if you smoke. Read more information on how to manage diabetes.

Also, have a dilated eye exam at least once a year—or more often if recommended by your eye care professional. These actions are powerful ways to protect the health of your eyes—and can prevent blindness.

The sooner you work to manage your diabetes and other health conditions, the better. And, even if you’ve struggled in the past to manage your health, taking better care of yourself now can protect your eyes for the future. It’s never too late to begin.

What if I already have some vision loss from diabetes?

Ask your eye care professional to help you find a low vision and rehabilitation clinic. Special eye care professionals can help you manage vision loss that cannot be corrected with glasses, contact lenses, medicine, or surgery. Special devices and training may help you make the most of your remaining vision so that you can continue to be active, enjoy hobbies, visit friends and family members, and live without help from others.

References

Diabetes, Gum Disease, & Other Dental Problems

How can diabetes affect my mouth?

Too much glucose, also called sugar, in your blood from diabetes can cause pain, infection, and other problems in your mouth. Your mouth includes

  • your teeth
  • your gums
  • your jaw
  • tissues such as your tongue, the roof and bottom of your mouth, and the inside of your cheeks
Drawing of a woman’s facial profile with the jaw labeled. Inset shows teeth, gums, roof of the mouth, bottom of the mouth, tongue, and inside of cheek.

Glucose is present in your saliva—the fluid in your mouth that makes it wet. When diabetes is not controlled, high glucose levels in your saliva help harmful bacteria grow. These bacteria combine with food to form a soft, sticky film called plaque. Plaque also comes from eating foods that contain sugars or starches. Some types of plaque cause tooth decay or cavities. Other types of plaque cause gum disease and bad breath.

Image stating that high glucose levels equal an increase in plaque.  

Gum disease can be more severe and take longer to heal if you have diabetes. In turn, having gum disease can make your blood glucose hard to control.

What happens if I have plaque?

Plaque that is not removed hardens over time into tartar and collects above your gum line. Tartar makes it more difficult to brush and clean between your teeth. Your gums become red and swollen, and bleed easily—signs of unhealthy or inflamed gums, called gingivitis.

When gingivitis is not treated, it can advance to gum disease called periodontitis. In periodontitis, the gums pull away from the teeth and form spaces, called pockets, which slowly become infected. This infection can last a long time. Your body fights the bacteria as the plaque spreads and grows below the gum line. Both the bacteria and your body’s response to this infection start to break down the bone and the tissue that hold the teeth in place. If periodontitis is not treated, the gums, bones, and tissue that support the teeth are destroyed. Teeth may become loose and might need to be removed. If you have periodontitis, your dentist may send you to a periodontist, an expert in treating gum disease.

Drawing of a close-up view of teeth and healthy gums, and a drawing of a close-up view of teeth and gums with periodontitis.
Healthy gums                       Periodontitis

What are the most common mouth problems from diabetes?

The following chart shows the most common mouth problems from diabetes.

Problem What It Is Symptoms Treatment

gingivitis
  • unhealthy or inflamed gums
  • red, swollen, and bleeding gums
  • daily brushing and flossing
  • regular cleanings at the dentist

periodontitis
  • gum disease, which can change from mild to severe
  • red, swollen, and bleeding gums
  • gums that have pulled away from the teeth
  • long-lasting infection between the teeth and gums
  • bad breath that won’t go away
  • permanent teeth that are loose or moving away from one another
  • changes in the way your teeth fit together when you bite
  • sometimes pus between the teeth and gums
  • changes in the fit of dentures, which are teeth you can remove
  • deep cleaning at your dentist
  • medicine that your dentist prescribes
  • gum surgery in severe cases

thrush, called
candidiasis
  • the growth of a naturally occurring fungus that the body is unable to control
  • sore, white—or sometimes red—patches on your gums, tongue, cheeks, or the roof of your mouth
  • patches that have turned into open sores
  • medicine that your doctor or dentist prescribes to kill the fungus
  • cleaning dentures
  • removing dentures for part of the day or night, and soaking them in medicine that your doctor or dentist prescribes

dry mouth, called
xerostomia
  • a lack of saliva in your mouth, which raises your risk for tooth decay and gum disease
  • dry feeling in your mouth, often or all of the time
  • dry, rough tongue
  • pain in the mouth
  • cracked lips
  • mouth sores or infection
  • problems chewing, eating, swallowing, or talking
  • taking medicine to keep your mouth wet that your doctor or dentist prescribes
  • rinsing with a fluoride mouth rinse to prevent cavities
  • using sugarless gum or mints to increase saliva flow
  • taking frequent sips of water
  • avoiding tobacco, caffeine, and alcoholic beverages
  • using a humidifier, a device that raises the level of moisture in your home, at night
  • avoiding spicy or salty foods that may cause pain in a dry mouth

oral burning
  • a burning sensation inside the mouth caused by uncontrolled blood glucose levels
  • burning feeling in the mouth
  • dry mouth
  • bitter taste
  • symptoms may worsen throughout the day
  • seeing your doctor, who may change your diabetes medicine
  • once your blood glucose is under control, the oral burning will go away

More symptoms of a problem in your mouth are

  • a sore, or an ulcer, that does not heal
  • dark spots or holes in your teeth
  • pain in your mouth, face, or jaw that doesn’t go away
  • loose teeth
  • pain when chewing
  • a changed sense of taste or a bad taste in your mouth
  • bad breath that doesn’t go away when you brush your teeth

How will I know if I have mouth problems from diabetes?

Check your mouth for signs of problems from diabetes. If you notice any problems, see your dentist right away. Some of the first signs of gum disease are swollen, tender, or bleeding gums. Sometimes you won’t have any signs of gum disease. You may not know you have it until you have serious damage. Your best defense is to see your dentist twice a year for a cleaning and checkup.

Drawing of a man checking the inside of his mouth in the bathroom mirror for signs of problems from diabetes.
Check your mouth for signs of problems from diabetes.

How can I prepare for a visit to my dentist?

Plan ahead. Talk with your doctor and dentist before the visit about the best way to take care of your blood glucose during dental work.

You may be taking a diabetes medicine that can cause low blood glucose, also called hypoglycemia. If you take insulin or other diabetes medicines, take them and eat as usual before visiting the dentist. You may need to bring your diabetes medicines and your snacks or meal with you to the dentist’s office.

You may need to postpone any nonemergency dental work if your blood glucose is not under control.

If you feel nervous about visiting the dentist, tell your dentist and the staff about your feelings. Your dentist can adapt the treatment to your needs. Don’t let your nerves stop you from having regular checkups. Waiting too long to take care of your mouth may make things worse.

Drawing of a male patient seated in a dental chair and talking with his male dentist.
If you feel nervous about visiting the dentist, tell your dentist and the staff about your feelings.

If you feel nervous about visiting the dentist, tell your dentist and the staff about your feelings.

What if my mouth is sore after my dental work?

A sore mouth is common after dental work. If this happens, you might not be able to eat or chew the foods you normally eat for several hours or days. For guidance on how to adjust your usual routine while your mouth is healing, ask your doctor

  • what foods and drinks you should have
  • if you should change the time when you take your diabetes medicines
  • if you should change the dose of your diabetes medicines
  • how often you should check your blood glucose

How does smoking affect my mouth?

Smoking makes problems with your mouth worse. Smoking raises your chances of getting gum disease, oral and throat cancers, and oral fungal infections. Smoking also discolors your teeth and makes your breath smell bad.

Smoking and diabetes are a dangerous mix. Smoking raises your risk for many diabetes problems. If you quit smoking,

  • you will lower your risk for heart attack, stroke, nerve disease, kidney disease, and amputation
  • your cholesterol and blood pressure levels might improve
  • your blood circulation will improve

If you smoke, stop smoking. Ask for help so that you don’t have to do it alone. You can start by calling 1–800–QUITNOW or 1–800–784–8669.

No-smoking symbol. A lit cigarette inside a circle is crossed out by a heavy line.

How can I keep my mouth healthy?

You can keep your mouth healthy by taking these steps:

  • Keep your blood glucose numbers as close to your target as possible. Your doctor will help you set your target blood glucose numbers and teach you what to do if your numbers are too high or too low.
  • Eat healthy meals and follow the meal plan that you and your doctor or dietitian have worked out.
  • Brush your teeth at least twice a day with fluoride toothpaste. Fluoride protects against tooth decay.
    • Aim for brushing first thing in the morning, before going to bed, and after each meal and sugary or starchy snack.
    • Use a soft toothbrush.
    • Gently brush your teeth with the toothbrush angled towards the gum line.
    • Use small, circular motions.
    • Brush the front, back, and top of each tooth. Brush your tongue, too.
    • Change your toothbrush every 3 months or sooner if the toothbrush looks worn or the bristles spread out. A new toothbrush removes more plaque.
    Drawing of a toothbrush, toothpaste, and dental floss.
  • Drink water that contains added fluoride or ask your dentist about using a fluoride mouth rinse to prevent tooth decay.
  • Ask your dentist about using an anti-plaque or anti-gingivitis mouth rinse to control plaque or prevent gum disease.
  • Use dental floss to clean between your teeth at least once a day. Flossing helps prevent plaque from building up on your teeth. When flossing,
    • slide the floss up and down and then curve it around the base of each tooth under the gums
    • use clean sections of floss as you move from tooth to tooth
    Drawing of a woman flossing her lower teeth.
  • Another way of removing plaque between teeth is to use a dental pick or brush—thin tools designed to clean between the teeth. You can buy these picks at drug stores or grocery stores.
  • If you wear dentures, keep them clean and take them out at night. Have them adjusted if they become loose or uncomfortable.
  • Call your dentist right away if you have any symptoms of mouth problems.
  • See your dentist twice a year for a cleaning and checkup. Your dentist may suggest more visits if you need them.
    Drawing of a female dentist examining a male patient’s teeth.
    See your dentist twice a year for a cleaning and checkup.
  • Follow your dentist’s advice.
    • If your dentist tells you about a problem, take care of it right away.
    • Follow any steps or treatments from your dentist to keep your mouth healthy.
  • Tell your dentist that you have diabetes.
    • Tell your dentist about any changes in your health or medicines.
    • Share the results of some of your diabetes blood tests, such as the A1C test or the fasting blood glucose test.
    • Ask if you need antibiotics before and after dental treatment if your diabetes is uncontrolled.
  • If you smoke, stop smoking.
This information may contain content about medications and, when taken as prescribed, the conditions they treat. When prepared, this content 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.

Diabetes & Sexual & Urologic Problems

Troublesome bladder symptoms and changes in sexual function are common health problems as people age. Having diabetes can mean early onset and increased severity of these problems. Sexual and urologic complications of diabetes occur because of the damage diabetes can cause to blood vessels and nerves. Men may have difficulty with erections or ejaculation. Women may have problems with sexual response and vaginal lubrication. Urinary tract infections and bladder problems occur more often in people with diabetes. People who keep their diabetes under control can lower their risk of the early onset of these sexual and urologic problems.

Diabetes and Sexual Problems

Both men and women with diabetes can develop sexual problems because of damage to nerves and small blood vessels. When a person wants to lift an arm or take a step, the brain sends nerve signals to the appropriate muscles. Nerve signals also control internal organs like the heart and bladder, but people do not have the same kind of conscious control over them as they do over their arms and legs. The nerves that control internal organs are called autonomic nerves, which signal the body to digest food and circulate blood without a person having to think about it. The body's response to sexual stimuli is also involuntary, governed by autonomic nerve signals that increase blood flow to the genitals and cause smooth muscle tissue to relax. Damage to these autonomic nerves can hinder normal function. Reduced blood flow resulting from damage to blood vessels can also contribute to sexual dysfunction.

What sexual problems can occur in men with diabetes?

Erectile Dysfunction

Erectile dysfunction is a consistent inability to have an erection firm enough for sexual intercourse. The condition includes the total inability to have an erection and the inability to sustain an erection.

Estimates of the prevalence of erectile dysfunction in men with diabetes vary widely, ranging from 20 to 75 percent. Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes. Among men with erectile dysfunction, those with diabetes may experience the problem as much as 10 to 15 years earlier than men without diabetes. Research suggests that erectile dysfunction may be an early marker of diabetes, particularly in men ages 45 and younger.

In addition to diabetes, other major causes of erectile dysfunction include high blood pressure, kidney disease, alcohol abuse, and blood vessel disease. Erectile dysfunction may also occur because of the side effects of medications, psychological factors, smoking, and hormonal deficiencies.

Men who experience erectile dysfunction should consider talking with a health care provider. The health care provider may ask about the patient's medical history, the type and frequency of sexual problems, medications, smoking and drinking habits, and other health conditions. A physical exam and laboratory tests may help pinpoint causes of sexual problems. The health care provider will check blood glucose control and hormone levels and may ask the patient to do a test at home that checks for erections that occur during sleep. The health care provider may also ask whether the patient is depressed or has recently experienced upsetting changes in his life.

Treatments for erectile dysfunction caused by nerve damage, also called neuropathy, vary widely and range from oral pills, a vacuum pump, pellets placed in the urethra, and shots directly into the penis, to surgery. All of these methods have advantages and disadvantages. Psychological counseling to reduce anxiety or address other issues may be necessary. Surgery to implant a device to aid in erection or to repair arteries is usually used as a treatment after all others fail.

Retrograde Ejaculation

Retrograde ejaculation is a condition in which part or all of a man's semen goes into the bladder instead of out the tip of the penis during ejaculation. Retrograde ejaculation occurs when internal muscles, called sphincters, do not function normally. A sphincter automatically opens or closes a passage in the body. With retrograde ejaculation, semen enters the bladder, mixes with urine, and leaves the body during urination without harming the bladder. A man experiencing retrograde ejaculation may notice that little semen is discharged during ejaculation or may become aware of the condition if fertility problems arise. Analysis of a urine sample after ejaculation will reveal the presence of semen.

Poor blood glucose control and the resulting nerve damage can cause retrograde ejaculation. Other causes include prostate surgery and some medications.

Retrograde ejaculation caused by diabetes or surgery may be helped with a medication that strengthens the muscle tone of the sphincter in the bladder. A urologist experienced in infertility treatments may assist with techniques to promote fertility, such as collecting sperm from the urine and then using the sperm for artificial insemination.

More information about erectile dysfunction is provided in the NIDDK health topic Erectile Dysfunction.

What sexual problems can occur in women with diabetes?

Many women with diabetes experience sexual problems. Although research about sexual problems in women with diabetes is limited, one study found 27 percent of women with type 1 diabetes experienced sexual dysfunction. Another study found 18 percent of women with type 1 diabetes and 42 percent of women with type 2 diabetes experienced sexual dysfunction.

Sexual problems may include

  • decreased vaginal lubrication, resulting in vaginal dryness
  • uncomfortable or painful sexual intercourse
  • decreased or no desire for sexual activity
  • decreased or absent sexual response

Decreased or absent sexual response can include the inability to become or remain aroused, reduced or no sensation in the genital area, and the constant or occasional inability to reach orgasm.

Causes of sexual problems in women with diabetes include nerve damage, reduced blood flow to genital and vaginal tissues, and hormonal changes. Other possible causes include some medications, alcohol abuse, smoking, psychological problems such as anxiety or depression, gynecologic infections, other diseases, and conditions relating to pregnancy or menopause.

Women who experience sexual problems or notice a change in sexual response should consider talking with a health care provider. The health care provider will ask about the patient's medical history, any gynecologic conditions or infections, the type and frequency of sexual problems, medications, smoking and drinking habits, and other health conditions. The health care provider may ask whether the patient might be pregnant or has reached menopause and whether she is depressed or has recently experienced upsetting changes in her life. A physical exam and laboratory tests may also help pinpoint causes of sexual problems. The health care provider will also talk with the patient about blood glucose control.

Prescription or over-the-counter vaginal lubricants may be useful for women experiencing vaginal dryness. Techniques to treat decreased sexual response include changes in position and stimulation during sexual relations. Psychological counseling may be helpful. Kegel exercises that help strengthen the pelvic muscles may improve sexual response. Studies of drug treatments are under way.

Diabetes and Urologic Problems

Urologic problems that affect men and women with diabetes include bladder problems and urinary tract infections.

Drawing of the urinary tract with kidneys, ureters, bladder, and urethra labeled.
The urinary tract.

Bladder Problems

Many events or conditions can damage nerves that control bladder function, including diabetes and other diseases, injuries, and infections. More than half of men and women with diabetes have bladder dysfunction because of damage to nerves that control bladder function. Bladder dysfunction can have a profound effect on a person's quality of life. Common bladder problems in men and women with diabetes include the following:

  • Overactive bladder. Damaged nerves may send signals to the bladder at the wrong time, causing its muscles to squeeze without warning. The symptoms of overactive bladder include
    • urinary frequency-urination eight or more times a day or two or more times a night
    • urinary urgency-the sudden, strong need to urinate immediately
    • urge incontinence-leakage of urine that follows a sudden, strong urge to urinate
  • Poor control of sphincter muscles. Sphincter muscles surround the urethra-the tube that carries urine from the bladder to the outside of the body-and keep it closed to hold urine in the bladder. If the nerves to the sphincter muscles are damaged, the muscles may become loose and allow leakage or stay tight when a person is trying to release urine.
  • Urine retention. For some people, nerve damage keeps their bladder muscles from getting the message that it is time to urinate or makes the muscles too weak to completely empty the bladder. If the bladder becomes too full, urine may back up and the increasing pressure may damage the kidneys. If urine remains in the body too long, an infection can develop in the kidneys or bladder. Urine retention may also lead to overflow incontinence-leakage of urine when the bladder is full and does not empty properly.

Diagnosis of bladder problems may involve checking both bladder function and the appearance of the bladder's interior. Tests may include x-rays, urodynamic testing to evaluate bladder function, and cystoscopy, a test that uses a device called a cystoscope to view the inside of the bladder.

Treatment of bladder problems due to nerve damage depends on the specific problem. If the main problem is urine retention, treatment may involve medication to promote better bladder emptying and a practice called timed voiding-urinating on a schedule-to promote more efficient urination. Sometimes people need to periodically insert a thin tube called a catheter through the urethra into the bladder to drain the urine. Learning how to tell when the bladder is full and how to massage the lower abdomen to fully empty the bladder can help as well. If urinary leakage is the main problem, medications, strengthening muscles with Kegel exercises, or surgery can help. Treatment for the urinary urgency and frequency of overactive bladder may involve medications, timed voiding, Kegel exercises, and surgery in some cases.

Urinary Tract Infections

Infections can occur when bacteria, usually from the digestive system, reach the urinary tract. If bacteria are growing in the urethra, the infection is called urethritis. The bacteria may travel up the urinary tract and cause a bladder infection, called cystitis. An untreated infection may go farther into the body and cause pyelonephritis, a kidney infection. Some people have chronic or recurrent urinary tract infections. Symptoms of urinary tract infections can include

  • a frequent urge to urinate
  • pain or burning in the bladder or urethra during urination
  • cloudy or reddish urine
  • in women, pressure above the pubic bone
  • in men, a feeling of fullness in the rectum

If the infection is in the kidneys, a person may have nausea, feel pain in the back or side, and have a fever. Frequent urination can be a sign of high blood glucose, so results from recent blood glucose monitoring should be evaluated.

The health care provider will ask for a urine sample, which will be analyzed for bacteria and pus. Additional tests may be done if the patient has frequent urinary tract infections. An ultrasound exam provides images from the echo patterns of sound waves bounced back from internal organs. An intravenous pyelogram uses a special dye to enhance x-ray images of the urinary tract. Cystoscopy might be performed.

Early diagnosis and treatment are important to prevent more serious infections. To clear up a urinary tract infection, the health care provider will probably prescribe antibiotic treatment based on the type of bacteria in the urine. Kidney infections are more serious and may require several weeks of antibiotic treatment. Drinking plenty of fluids will help prevent another infection.

Who is at risk for developing sexual and urologic problems of diabetes?

Risk factors are conditions that increase the chances of getting a particular disease. The more risk factors people have, the greater their chances of developing that disease or condition. Diabetic neuropathy and related sexual and urologic problems appear to be more common in people who

  • have poor blood glucose control
  • have high levels of blood cholesterol
  • have high blood pressure
  • are overweight
  • are older than 40
  • smoke
  • are physically inactive

Can diabetes-related sexual and urologic problems be prevented?

People with diabetes can lower their risk of sexual and urologic problems by keeping their blood glucose, blood pressure, and cholesterol levels close to the target numbers their health care provider recommends. Being physically active and maintaining a healthy weight can also help prevent the long-term complications of diabetes. For those who smoke, quitting will lower the risk of developing sexual and urologic problems due to nerve damage and also lower the risk for other health problems related to diabetes, including heart attack, stroke, and kidney disease.

More information about preventing diabetes complications is provided in the NIDDK health topic, Preventing Diabetes Problems.

Points to Remember

The nerve damage of diabetes may cause sexual or urologic problems.

  • Sexual problems in men with diabetes include
    • erectile dysfunction
    • retrograde ejaculation
  • Sexual problems in women with diabetes include
    • decreased vaginal lubrication and uncomfortable or painful intercourse
    • decreased or no sexual desire
    • decreased or absent sexual response
  • Urologic problems in men and women with diabetes include
    • bladder problems related to nerve damage, such as overactive bladder, poor control of sphincter muscles, and urine retention
    • urinary tract infections
  • Controlling diabetes through diet, physical activity, and medications as needed can help prevent sexual and urologic problems.
  • Treatment is available for sexual and urologic problems.

Clinical Trials

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and other components of the National Institutes of Health (NIH) conduct and support research into many diseases and conditions.

What are clinical trials, and are they right for you?
Clinical trials are part of clinical research and at the heart of all medical advances. Clinical trials look at new ways to prevent, detect, or treat disease. Researchers also use clinical trials to look at other aspects of care, such as improving the quality of life for people with chronic illnesses. Find out if clinical trials are right for you.

What clinical trials are open?
Clinical trials that are currently open and are recruiting can be viewed at www.ClinicalTrials.gov.

December 2016
Share

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings through its clearinghouses and education programs to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.