Dr. Einhorn shares what diabetic neuropathy is.
Diabetic neuropathy is a difficult condition where the peripheral nerves, typically in the toes and the feet, are affected by glucose in a way that they stop functioning either to not feel or to feel too much and to have pain. You can think of the nerve a little bit like a wire whose cover has been partially eroded and there’s still current going down that wire, and so early on you get sparking between the different parts of the wire, whether or not covered by insulation properly.
And that will cause tingling in your toes, and that’s the most typical beginning of neuropathy. When you know it’s diabetic, it typically will begin in the largest toes or usually the big toe; it will be symmetrical in both feet. It will start to involve the other toes. It will slowly work its way up to the foot as it progresses as sometimes you see it up the knee or even higher.
And so the painful neuropathies are one class. The numbness neuropathies are a different class where you just don’t feel normal stimuli, and these are especially dangerous because if you get a splinter or an injury you may not know it, and unless you’re looking all the time, you can get a lot of damage to that area.
A typical thing if you have numb diabetic feet is you must try to never go barefoot because if you step on a hot pool deck or you step on something that might injure the skin, you just won’t know it and it could sit and fester for a long time. Shoes become very dangerous in this type of neuropathy because, again, you don’t feel the discomfort of the poorly fitting shoe and your architecture of the foot is often also not normal, so normal shoes are even worse for you.
So the diabetic neuropathies are the way that amputations happen and really very difficult issue to treat. Typically, again, it happens in poorly controlled diabetes over a long period of time. If you’re a smoker or if you drink alcohol, you’re much more likely to get these neuropathies.
About Dr. Einhorn:
Dr. Daniel Einhorn received his undergraduate degree from Yale University, his medical degree from Tufts University School of Medicine, and his internship, residency and fellowship at Harvard Medical School. He served on the faculty of Harvard until coming to San Diego in 1984, and has since been a clinical endocrinologist with Diabetes and Endocrine Associates, Associate Clinical Professor of Medicine (Voluntary) at University of California, San Diego, and, until 2000, the Medical Director of the Diabetes Treatment and Research Center at Sharp Healthcare. He is the Medical Director of the Scripps Whittier Institute Diabetes Program. Dr. Einhorn has held many leadership positions with the Board of the American Association of Clinical Endocrinologists, the American Medical Association's Diabetes Advisory Council and The Endocrine Society. He Chaired the American College of Endocrinology Task Force on the Insulin Resistance Syndrome and the Conference on the Insulin Resistance Syndrome. He has served on the American Diabetes Association (ADA) Managed Care Initiative and on the regional ADA and Juvenile Diabetes Foundation, and as Chair of the Diabetes and Pregnancy Program of San Diego and Imperial Counties. He is a fellow of the American College of Physicians and the American College of Endocrinology. His research and publications cover diabetes prevention and reversal, recognition and treatment of diabetic complications, new technologies, new pharmaceuticals, combination therapies, and clinical decision-making.
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