Diabetic neuropathy is a nerve disorder caused by diabetes. Symptoms of neuropathy include numbness and sometimes pain in the hands, feet, or legs. Nerve damage caused by diabetes can also lead to problems with internal organs such as the digestive tract, heart, and sexual organs, causing indigestion, diarrhea or constipation, dizziness, bladder infections, and impotence. In some cases, neuropathy can flare up suddenly, causing weakness and weight loss. Depression may follow. While some treatments are available, a great deal of research is still needed to understand how diabetes affects the nerves and to find more effective treatments for this complication. People with diabetes can develop nerve problems at any time. Significant clinical neuropathy can develop within the first 10 years after diagnosis of diabetes and the risk of developing neuropathy increases the longer a person has diabetes. Some recent studies have reported that:

60 percent of patients with diabetes have some forms of neuropathy, but in most cases (30 to 40 percent), there are no symptoms.

30 to 40 percent of patients with diabetes have symptoms suggesting neuropathy, compared with 10 percent of people without diabetes.

Diabetic neuropathy appears to be more common in smokers, people over 40 years of age, and those who have had problems controlling their blood glucose levels.

People with diabetes need to take special care of their feet. Neuropathy and blood vessel disease both increase the risk of foot ulcers. The nerves to the feet are the longest in the body, and are most often affected by neuropathy. Because of the loss of sensation caused by neuropathy, sores or injuries to the feet may not be noticed and may become ulcerated.

At least 15 percent of all people with diabetes eventually have a foot ulcer, and 6 out of every 1,000 people with diabetes have an amputation. However, doctors estimate that nearly three quarters of all amputations caused by neuropathy and poor circulation could be prevented with careful foot care.

To prevent foot problems from developing, people with diabetes should follow these rules for foot care:

Check your feet and toes daily for any cuts, sores, bruises, bumps, or infections--using a mirror if necessary.

Wash your feet daily, using warm (not hot) water and a mild soap. If you have neuropathy, you should test the water temperature with your wrist before putting your feet in the water. Doctors do not advise soaking your feet for long periods, since you may lose protective calluses. Dry your feet carefully with a soft towel, especially between the toes.

Cover your feet (except for the skin between the toes) with petroleum jelly, a lotion containing lanolin, or cold cream before putting on shoes and socks. In people with diabetes, the feet tend to sweat less than normal. Using a moisturizer helps prevent dry, cracked skin.

Wear thick, soft socks and avoid wearing slippery stockings, mended stockings, or stockings with seams.

Wear shoes that fit your feet well and allow your toes to move. Break in new shoes gradually, wearing them for only an hour at a time at first. After years of neuropathy, as reflexes are lost, the feet are likely to become wider and flatter. If you have difficulty finding shoes that fit, ask your doctor to refer you to a specialist, called a pedorthist, who can provide you with corrective shoes or inserts.

Examine your shoes before putting them on to make sure they have no tears, sharp edges, or objects in them that might injure your feet.

Never go barefoot, especially on the beach, hot sand, or rocks.

Cut your toenails straight across, but be careful not to leave any sharp corners that could cut the next toe.

Use an emery board or pumice stone to file away dead skin, but do not remove calluses, which act as protective padding. Do not try to cut off any growths yourself, and avoid using harsh chemicals such as wart remover on your feet.

Test the water temperature with your elbow before stepping in a bath.

If your feet are cold at night wear socks. (Do not use heating pads or hot water bottles.)

Avoid sitting with your legs crossed. Crossing your legs can reduce the flow of blood to the feet.

Ask your doctor to check your feet at every visit, and call your doctor if you notice that a sore is not healing well.

If you are not able to take care of your own feet, ask your doctor to recommend a podiatrist (specialist in the care and treatment of feet) who can help.