Brief Answer:
Diabetic Neuropathy, Podiatrists and Neurologists

Detailed Answer:
Hi there, thanks for coming to HealthCareMagic. I'm sorry to hear that you have developed symptoms of diabetic neuropathy.

I'd like to make sure you understand what happens in Diabetic Neuropathy. That way you will be equipped to make better decisions in the future. After that I will make specific recommendations.

So, neuropathy is just a fancy pants term for nerve injury. In Diabetic Neuropathy the nerves are being damaged by the underlying diabetes. The way this happens is like this. When you are diabetic, the body has a lot of trouble maintaining a constant level of sugar in the blood stream. In uncontrolled or poorly controlled Diabetes, you tend to see swings in the blood sugar level through the day. Now, when the sugars are high.. bad things happen. Sugar molecules can be pretty nasty when they stick to the inner surfaces of blood vessels. They cause swelling and inflammation and can actually shrink the blood vessel over time.

Well Nerves, especially the nerves in your legs and feet have tons of TINY blood vessels supplying the neurons in the nerve with food and minerals. In a diabetic patient.. these TINY blood vessels start getting very badly damaged due to periods of high blood sugar levels.

So what you end up seeing is a situation where the nerves in your legs start losing their blood supply as the tiny vessels shrink to nothing. The nerves of course don't like this very much and send signals of burning pain to the brain to tell you that something is wrong.

Unfortunately, the process is not reversible... we don't know how to restore these tiny blood vessels (as a surgeon.. i can stitch a large blood vessel back together so that blood flow is restored.. but i can't do that to blood vessels which are SO TINY.. that they are much much thinner than a strand of hair).

So what we do to control the symptoms of Neuropathy is we give medications that basically try and make the BRAIN, ignore the signals coming from those dying and crying nerves. There are two very commonly given medications that achieve this

1) Gabapentin (Brand name Neurontin)
2) Pregabalin (Brand name Lyrica)

So when dealing with diabetic neuropathy, management has to happen on 2 fronts. the first is to CONTROL THE BLOOD SUGARS, so that further damage is slowed or stopped. The best kind of doctor that can handle an issue like this is a Diabetologist. These are specialists who concentrate their practices purely on the management of diabetes. they normally have a background in Internal Medicine or Endocrinology (studying glands and hormones).

The second front is to give the nerve meds like Neurontin. Lots of people in the medical community are familiar with these meds and prescribe them regularly. Among them are Diabetologists (of course), Neurologists and Podiatrists.

So, to deal with this issue for you, i suggest the following steps:

1) Get all your medications and recent lab reports together
2) Make an appointment with a diabetologist and make sure that your diabetes is under control. If it's not, then your meds will need tweaking and you will need to keep a close track of your blood sugars with a glucometer.

3) Discuss the use of Neurontin or Lyrica with your diabetologist and get a prescription for them for the same.

Going to podiatrist would be helpful. They would be able to help you with the neuropathy.. but they really wouldn't be able to address the root issue of diabetes management in the best way. Costmetic specialists really don't work on issues like this, so I don't think that would be very helpful here.

Did all that make sense? I hope i have managed to clarify whats going on and help you with a plan of action. Feel free to ask for more clarification or for more information. I will be happy to help.

Vinay

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Brief Answer:
It's all personal taste and practice

Detailed Answer:
Hey there, thanks for coming back. I'm glad you are in the process of getting your sugars under control. Make sure that you find a doctor that you are COMFORTABLE with more than anything. As far as Endocrinologists vs Internal Medicine in the management of Diabetes.. well me personally I would go with the Endocrinologist on the face of it. The confounding factor here is experience.. how many diabetic patients they manage and how much experience they have. It is very possible that some Internal medicine specialists have seen more patients with diabetes than an endocrinologist. The opposite could be true too.

So knowing your doctors practice and what they deal with, as well as their clinical experience is the best way to figure this out.

Hope that helped,

Vin

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Brief Answer:
Take Care

Detailed Answer:
Always Happy to help.

Vinay

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